Email UpdatesLiterature Collection
Collection Insights
10K+
References
9K+
Articles
1400+
Grey Literature
4500+
Opioids & SU
The Literature Collection contains over 10,000 references for published and grey literature on the integration of behavioral health and primary care. Learn More
Use the Search feature below to find references for your terms across the entire Literature Collection, or limit your searches by Authors, Keywords, or Titles and by Year, Type, or Topic. View your search results as displayed, or use the options to: Show more references per page; Sort references by Title or Date; and Refine your search criteria. Expand an individual reference to View Details. Full-text access to the literature may be available through a link to PubMed, a DOI, or a URL. References may also be exported for use in bibliographic software (e.g., EndNote, RefWorks, Zotero).
10858 Results
4002
Formative evaluation of practice changes for managing depression within a Shared Care model in primary care
Type: Journal Article
Year: 2017
Publication Place: England
Abstract: Aim To investigate the implementation and initial impact of the Physician Integrated Network (PIN) mental health indicators, which are specific to screening and managing follow-up for depression, in three primary care practices with Shared Mental Health Care in Manitoba. BACKGROUND: Manitoba Health undertook a primary care renewal initiative in 2006 called the PIN, which included the development of mental health indicators specific to screening and managing follow-up for depression. These indicators were implemented in three PIN group practice sites in Manitoba, which are also part of Shared Mental Health Care. METHODS: The design was a non-experimental longitudinal design. A formative evaluation investigated the implementation and initial impact of the mental health indicators using mixed methods (document review, survey, and interview). Quantitative data was explored using descriptive and comparative statistics and a content and theme analysis of the qualitative interviews was conducted. Survey responses were received from 32 out of 36 physicians from the three sites. Interviews were conducted with 15 providers. Findings This evaluation illustrated providers' perceived attitudes, knowledge, skills, and behaviours related to recognizing and treating depression and expanded our understanding of primary care processes related to managing depression related to the implementation of a new initiative. Depression is viewed as an important problem in primary care practice that is time consuming to diagnose, manage and treat and requires further investigation. Implementation of the PIN mental health indicators was variable across sites and providers. There was an increase in use of the indicators across time and a general sentiment that benefits of screening outweigh the costs; however, the benefit of screening for depression remains unclear. Consistent with current guidelines, a question the findings of this evaluation suggests is whether there are more effective ways of having an impact on depression within primary care than screening.
Topic(s):
Education & Workforce
See topic collection
Reference Links: View the PubMed citation for Formative evaluation of practice changes for managing depression within a Shared Care model in primary care
4004
Fostering evidence-based quality improvement for patient-centered medical homes: Initiating local quality councils to transform primary care
Type: Journal Article
Year: 2018
Publication Place: United States
Abstract: BACKGROUND: Although the patient-centered medical home endorses quality improvement principles, methods for supporting ongoing, systematic primary care quality improvement have not been evaluated. We introduced primary care quality councils at six Veterans Health Administration sites as an organizational intervention with three key design elements: (a) fostering interdisciplinary quality improvement leadership, (b) establishing a structured quality improvement process, and (c) facilitating organizationally aligned frontline quality improvement innovation. PURPOSE: Our evaluation objectives were to (a) assess design element implementation, (b) describe implementation barriers and facilitators, and (c) assess successful quality improvement project completion and spread. METHODOLOGY/APPROACH: We analyzed administrative records and conducted interviews with 85 organizational leaders. We developed and applied criteria for assessing design element implementation using hybrid deductive/inductive analytic techniques. RESULTS: All quality councils implemented interdisciplinary leadership and a structured quality improvement process, and all but one completed at least one quality improvement project and a toolkit for spreading improvements. Quality councils were perceived as most effective when service line leaders had well-functioning interdisciplinary communication. Matching positions within leadership hierarchies with appropriate supportive roles facilitated frontline quality improvement efforts. Two key resources were (a) a dedicated internal facilitator with project management, data collection, and presentation skills and (b) support for preparing customized data reports for identifying and addressing practice level quality issues. CONCLUSIONS: Overall, quality councils successfully cultivated interdisciplinary, multilevel primary care quality improvement leadership with accountability mechanisms and generated frontline innovations suitable for spread. Practice level performance data and quality improvement project management support were critical. PRACTICE IMPLICATIONS: In order to successfully facilitate systematic, sustainable primary care quality improvement, regional and executive health care system leaders should engage interdisciplinary practice level leadership in a priority-setting process that encourages frontline innovation and establish local structures such as quality councils to coordinate quality improvement initiatives, ensure accountability, and promote spread of best practices.
Topic(s):
Medical Home
See topic collection
4006
Fostering participation of general practitioners in integrated health services networks: Incentives, barriers, and guidelines
Type: Journal Article
Year: 2009
Publication Place: England
Abstract: BACKGROUND: While the active participation of general practitioners (GPs) in integrated health services networks (IHSNs) plays a critical role in their success, little is known about the incentives and barriers to their actual participation. METHODS: Data were gathered through semi-structured interviews and a mail survey with GPs enrolled in SIPA (system of integrated care for older persons) at 2 sites in Montreal. A total of 61 GPs completed the questionnaire, from which 22 were randomly selected for the qualitative study, with active and non-active participation in the IHSN. RESULTS: The key themes associated with GP participation were clinician characteristics, consequences perceived at the outset, the SIPA implementation process, relationships with the SIPA team and professional consequences. The incentive factors reported were collaborative practices, high rates of elderly and SIPA patients in their clienteles, concerns about SIPA, the selection of frail elderly patients, close relationships with the case manager, the perceived efficacy of SIPA, and improved professional practices. Barriers to GP participation included high expectations, GP recruitment, lack of information on SIPA, difficult relationships with SIPA geriatricians and deterioration of physician-patient relationships. Four profiles of participation were identified: 2 groups of participants active in SIPA and 2 groups of participants not active in SIPA. The active GPs were familiar with collaborative practices, had higher IHSN patient rates, expressed more concerns than expectations, reported satisfactory relationships with case managers and perceived the efficacy of SIPA. Both active and non-active GPs reported quality care in the IHSN and improved professional practice. CONCLUSION: Throughout the implementation process, the participation of GPs in an IHSN depends on numerous professional (clinician characteristics) and organizational factors (GP recruitment, relationships with case managers). Our study provides guiding principles for establishing future integrated models of care. It suggests practical guidelines to support the active participation of GPs in these networks such as physicians with collaborative practices, recruitment of significant number of patients per physicians, the information provided and the accompaniment by geriatricians.
Topic(s):
Education & Workforce
See topic collection
4007
Fostering sustainable, integrated medical and behavioral health services in medical settings
Type: Journal Article
Year: 2014
Publication Place: United States
Abstract: The integration of behavioral health (BH) and primary care services has been the subject of considerable attention for almost a decade. Such work has been motivated by the prevalence of chronic health problems in persons with BH conditions and correspondingly high rates of early death. Service integration efforts typically included cross-referral or bidirectional efforts to add some features of primary care to specialty BH settings or the reverse. This article proposes a third approach based on full service and financial integration and shows how it differs substantially from the other 2 models. This new model has the potential to bring much-needed BH services to persons served in primary care settings who have these conditions, while fostering integrated services in specialty settings for those with the most severe mental or substance use conditions. The Patient Protection and Affordable Care Act could provide a valuable opportunity to implement this third model.
Topic(s):
Financing & Sustainability
See topic collection
, Key & Foundational
See topic collection
Reference Links:
View the DOI record for Fostering sustainable, integrated medical and behavioral health services in medical settings
View DOI Record
View the PubMed citation for Fostering sustainable, integrated medical and behavioral health services in medical settings4009
Four innovations: A robust integrated behavioral health program in pediatric primary care
Type: Journal Article
Year: 2020
Publication Place: United States
Topic(s):
Education & Workforce
See topic collection
, Healthcare Disparities
See topic collection
Reference Links:
View the DOI record for Four innovations: A robust integrated behavioral health program in pediatric primary care
View DOI Record
View the PubMed citation for Four innovations: A robust integrated behavioral health program in pediatric primary care4010
Four states with robust prescription drug monitoring programs reduced opioid dosages
Type: Journal Article
Year: 2018
Abstract: State prescription drug monitoring programs (PDMPs) aim to reduce risky controlled-substance prescribing, but early programs had limited impact. Several states implemented robust features in 2012-13, such as mandates that prescribers register with the program and regularly check its registry database. Some states allow prescribers to fulfill the latter requirement by designating delegates to check the registry. The effects of robust PDMP features have not been fully assessed. We used commercial claims data to examine the effects of implementing robust PDMPs in four states on overall and high-risk opioid prescribing, comparing those results to trends in similar states without robust PDMPs. By the end of 2014 the absolute mean morphine-equivalent dosages that providers dispensed declined in a range of 6-77 mg per person per quarter in the four states, relative to comparison states. Only in one of the four states, Kentucky, did the percentage of people who filled opioid prescriptions decline versus its comparator state, with an absolute reduction of 1.6 percent by the end of 2014. Robust PDMPs may be able to significantly reduce opioid dosages dispensed, percentages of patients receiving opioids, and high-risk prescribing.
Topic(s):
Healthcare Policy
See topic collection
, Opioids & Substance Use
See topic collection
Reference Links:
View the DOI record for Four states with robust prescription drug monitoring programs reduced opioid dosages
View DOI Record
View the PubMed citation for Four states with robust prescription drug monitoring programs reduced opioid dosages4015
Framing the process in the implementation of care for people with generalized anxiety disorder in primary care: a qualitative evidence synthesis
Type: Journal Article
Year: 2020
Abstract:
BACKGROUND: Generalized anxiety disorder (GAD) is one of the most common mental disorders in primary care (PC). GAD has low remission and high relapse rates over long follow-up periods. Qualitative evidence was synthesized to understand the implementation of care and treatment options for people with GAD in PC. METHODS: Research published from 2008 to September 2020 was searched in five databases (MEDLINE, EMBASE, CINAHL, WOS and PsycArticles). Studies that used qualitative methods for data collection and analysis to investigate the implementation of care and treatment options for people with GAD in PC and outpatient settings were included. Non-qualitative studies, mixed methods studies that did not separately report qualitative findings and studies in languages other than English or Spanish were excluded. We used the Confidence in the Evidence from Reviews of Qualitative Research (CERQual) framework to assess the overall confidence in the findings. RESULTS: The results with a moderate level of confidence showed that the trajectory of care for people with GAD in PC and outpatient settings is long and fluctuates over time, involving multiple difficulties in accessing and maintaining initial treatment or successive treatment options. In addition, there are wide variations in the preferences for and acceptability of different treatment options. The results with a high level of confidence indicated that more information on GAD and its treatment options is needed for PC practitioners, GAD patients and their carers. The results with a low level of confidence suggested that patients use antidepressants for longer than recommended and that the interruption of treatment is not usually planned. CONCLUSIONS: Initial resistance to new treatments among people with GAD can make access and adherence to treatment difficult. Improving care may require patients to be informed of possible trajectories in stepped care pathways before the initiation of treatment so they are aware that they may need to try a number of options until the most effective treatment for them is found. Increased awareness of and information materials on GAD may facilitate both appropriate diagnosis and long-term care.
Topic(s):
Healthcare Disparities
See topic collection
4016
Free child passenger restraints for patients in an urban pediatric medical home: Effects on caregiver behavior
Type: Journal Article
Year: 2009
Publication Place: United States
Abstract: CONTEXT: Motor vehicle crashes are a leading cause of death in children despite the availability of effective child passenger restraints that reduce morbidity and mortality. Inappropriate restraint is more common in minority and low-income populations. Removing barriers by distributing child passenger restraint systems (CPRS) and providing education has been 1 approach to improve child safety. The objective of this study was to evaluate the efficacy of providing no-cost CPRS in combination with targeted education to improve restraint use for low-income, minority, and urban children in a medical home. DESIGN: This prospective, non-randomized, community-based cohort study used a certified car seat technician to provide CPRS and training to the caregivers of 101 children when those caregivers reported not owning the appropriate type of restraint system during the index clinic visit. RESULTS: In the first 3 months of follow-up, caregivers were 2.4 times more likely to report appropriate use of CPRS: relative risk 2.4 (95% confidence interval [CI] 1.7 to 3.5). Reported improvement declined slightly between months 4 and 9. CONCLUSIONS: Appropriate restraint significantly improved, yet rates remained suboptimal. Multifactoral approaches are needed to understand why the set of patients studied and other at-risk populations may not use child restraints properly even when given access and information.
Topic(s):
Medical Home
See topic collection
Reference Links: View the PubMed citation for Free child passenger restraints for patients in an urban pediatric medical home: Effects on caregiver behavior
4017
Frequencies of emergency department use and hospitalization comparing patients with different types of substance or polysubstance-related disorders
Type: Journal Article
Year: 2021
Topic(s):
Education & Workforce
See topic collection
, Healthcare Disparities
See topic collection
, Opioids & Substance Use
See topic collection
4018
Frequency and correlates of sleep disturbance in methadone and buprenorphine-maintained patients
Type: Journal Article
Year: 2018
Publication Place: England
Topic(s):
Opioids & Substance Use
See topic collection
Reference Links:
View the DOI record for Frequency and correlates of sleep disturbance in methadone and buprenorphine-maintained patients
View DOI Record
View the PubMed citation for Frequency and correlates of sleep disturbance in methadone and buprenorphine-maintained patients4019
Frequency of generalized anxiety disorder in Chinese primary care
Type: Journal Article
Year: 2010
Publication Place: United States
Abstract: OBJECTIVE: This study aimed to assess the frequency of generalized anxiety disorder (GAD) among primary care patients in China. We also determined the rate of comorbid major depression (MD) in patients with GAD and explored the differences in sociodemographic and health-related characteristics between patients with and without GAD. METHOD: We invited consecutive outpatients who presented to 4 primary care facilities in Shanghai, China to fill out a survey composed of a screening questionnaire based on the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV) for GAD (GAD-7), the Zung Self-Rating Depression Scale (SDS), and various sociodemographic and health-related variables. The 4 primary care facilities covered urban and suburban areas of the city. Patients completed the survey in the reception area as they waited for their medical appointment. RESULTS: The frequency of GAD in Chinese primary care was 4.1% (3.9% for males and 4.3% for females). This estimate was based on 127 positive results among a total of 3073 surveys collected. Of the patients who screened positive for GAD, 72.4% also screened positive for MD. Patients with GAD were more likely to report chronic medical conditions and to attend a university-affiliated primary care clinic. CONCLUSION: Our results showed that the frequency of GAD was significantly high in Chinese primary care patients. Compared with the GAD prevalence in Chinese general population from previously published studies, our findings suggest a link between GAD and health-seeking behaviors. Generalized anxiety disorder was also strongly correlated with MD. Integration of a routine GAD screening regime merits serious consideration to screen, diagnose, and treat patients with GAD in the primary care setting.
Topic(s):
General Literature
See topic collection
Reference Links:
View the DOI record for Frequency of generalized anxiety disorder in Chinese primary care
View DOI Record
View the PubMed citation for Frequency of generalized anxiety disorder in Chinese primary care