Literature Collection

The field of neuropsychology is making inroads in primary care as the importance of cognition in physical health is increasingly acknowledged. With neuropsychology primary care integration, patients receive a range of cognitive assessments (e.g., screens, brief neuropsychological assessments, treatment recommendations through provider-to-neuropsychologist consultations) based on a stepped model of care which can more efficiently diagnose cognitive disorders/problems and assist with treatment. Two case studies are described to illuminate this process. Information is provided to illustrate how neuropsychology integration was introduced in two primary care clinics at a community-based hospital system.

BACKGROUND: Americans experiencing substance use disorder (SUD) carry a significant chronic disease burden, yet only half use primary care. Patients in treatment for SUD who are connected with primary care typically have better overall health outcomes. LOCAL PROBLEM: The identified intensive outpatient program (IOP) had no protocol in place to engage patients with primary care. METHODS: This project piloted the development and implementation of an original, evidence-based primary care integration program. It consisted of a psychoeducation group, a referral by case management, and establishment of an internal referral process to affiliated primary care providers (PCPs). INTERVENTIONS: Following the psychoeducation group, pre and posttests of patient-reported knowledge and attitudes regarding primary care were compared. Participants were contacted to collect further data after IOP discharge. An education and feedback session was held with affiliated PCPs, and an internal referral process was devised by leadership. RESULTS: Mean scores measuring patient knowledge and attitudes regarding primary care increased after participation in the structured psychoeducation group. By time of IOP discharge, 100% (n = 12) of participants had either a referral or scheduled appointment with a PCP in place. At time of follow-up, 90% (n = 9) reported that they had attended or planned to attend their scheduled PCP appointment. CONCLUSIONS: A comprehensive integration program in the IOP setting can improve patient engagement with primary care. Quality improvement implementation will require consideration of challenges faced during the pilot involving scheduling, staff buy-in, changes in patient acuity, the electronic medical record, and insurance.