Literature Collection

INTRODUCTION: Mental health and substance use disorders are common in the United States; however, only a portion of adults with these conditions receive treatment. Recent recommendations include using integrated behavioral health (IBH) models to increase patient access to care. Despite IBH's effectiveness, few psychiatry residents are trained in it. Considering the scarcity of evaluated curricula on IBH, we created a curriculum to teach different IBH models to psychiatry residents. METHODS: The curriculum was developed using the constructivism theoretical framework and aligned with the principles of competency-based medical education. The learning activities allowed learners to apply knowledge relevant to IBH models to critically appraise a clinical scenario while practicing different components of IBH, such as electronic consults. More specifically, the curriculum assignment prompted residents to examine a clinical practice, identify the model, make recommendations for changes, and discuss the advantages and barriers of the proposed changes. We employed Kirkpatrick model levels 1 and 2b to evaluate the curriculum. RESULTS: Thirty-three residents participated in this curriculum. Eleven residents completed the assignment, which was qualitatively coded to evaluate their learning. Results indicated that the participants were able to compare different IBH models and critically appraise clinical practice using knowledge of those models. Twenty-two additional residents completed an anonymous retrospective pre- and postrotation survey on their perceived level of proficiency. Survey results showed improved perceived level of proficiency at rotation completion. DISCUSSION: The developed curriculum was successful in teaching residents to acquire and apply knowledge relevant to IBH.

BACKGROUND: Integrated care interventions can improve patient outcomes and reduce the burden on acute health services, but need a strong evidence base to ensure their effectiveness. Understanding the meso and macro context in which care is delivered and determining whether patient needs are met are essential to successful implementation. Care coordination in New South Wales (NSW), Australia has evolved over time to meet the needs of an ageing population with chronic health conditions and multi-morbidity with the aim of reducing potentially preventable hospitalisations. OBJECTIVE: To examine how an integrated care coordination program was understood and implemented at state, district and clinician levels in NSW. The Integrated Care for People with Chronic Conditions (ICPCC) program was implemented statewide, however local implementation varied. Patients who were suitable for integrated care coordination were identified via a hospitalisation risk prediction algorithm and/or referrals from health professionals. METHODS: Understanding and implementation of ICPCC were assessed via interviews and a focus group with a range of health staff. Qualitative data were analysed using NVivo software and normalisation process theory. RESULTS: There was a strong sense of program coherence from management, clinicians and referrers. They viewed ICPCC as effective in coordinating care for patients at risk of hospitalisation and incorporating self-management at home. All health staff interviewed understood the program purpose and necessity, including the importance of achieving patient and systemic goals. Networking, linking services and program promotion were important, as was reporting on benefits. While the algorithm effectively identified previously hospitalised patients, it did not identify all suitable patients in the community with an increasing risk of requiring acute health care intervention. Referrals from health professionals familiar with patient needs and complexity were an important additional mechanism for patient selection. CONCLUSIONS: There was a shared sense of coherence and understanding of the ICPCC program among health staff at the three levels of implementation within NSW. The program played an important role in assisting patients with a range of chronic conditions to access and benefit from integrated care coordination, while increasing their capacity to self-manage at home. Program intake via hospitalisation risk prediction algorithm plus referrals from health professionals familiar with patient needs and complexity can effectively identify those who may benefit from integrated care coordination.