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: Given the increasing recognition of the value of greater integration of physical and mental health services for children and young people, we aimed to evaluate preferences among parents for the characteristics associated with integrated health service provision for two conditions (eating disorders, functional symptom disorders). METHODS: Two discrete choice experiments (DCEs) were conducted, using electronic surveys. Participants were adult parents of children and young people. Choice scenarios were based on five attributes for the eating disorders study, and four attributes for the functional symptom disorders study. RESULTS: Two hundred parents participated in each DCE. For eating disorders, days missed from school in the last year was the attribute valued most highly, followed by days in hospital in the last year, costs to the NHS, functioning, and interaction with peers with eating disorders. Respondents were willing to trade £531 of costs to the NHS for one less day missed from school. For functional symptom disorders, time to diagnosis was valued most highly, followed by days missed from school while obtaining a diagnosis, reservations about seeing a mental health practitioner, and costs of diagnosis to the NHS. Respondents were willing to trade £4237 of costs to the NHS to wait one month less for a diagnosis. CONCLUSION: Respondents' preferences were largely consistent with the planned goals of integrating physical and mental health services. Our findings show the factors which ought to be considered when designing new integrated pathways and evaluating them.

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.

Introduction: Psychological distress can have a significant impact on cardiovascular disease (CVD) and efforts to treat psychological distress may improve CVD risk factors. Therefore, we conducted a retrospective feasibility of implementation study to assess the utilization of short-term psychotherapy in patients engaged in a cardiovascular prevention program. Methods: Participants included patients engaged in the Women's Health or Preventive Cardiology programs from January 2019 to June 2022. Patients were referred for psychology services if deemed likely to benefit from improvements in their psychological well-being to control their CVD risk factors. Biomarkers were obtained within 6 months pre- and post-therapy. Results: More than half (52.8%) of the 36 patients referred to the program attended ≥6 psychotherapy sessions. In patients with HTN, 50% were above goal (130/80 mmHg) pre-therapy and 20.8% post-therapy. 55.5% of patients with an LDL-C ≥100 mg/dL pre-therapy achieved an LDL-C <100 mg/dL post-therapy. Among patients with a hemoglobin A1c ≥5.7% pre-therapy, 12.5% lowered their hemoglobin A1c to <5.7%. Conclusion: Our study shows the potential benefit of psychological services when delivered concurrently with preventive cardiology visits. These findings raise the possibility that expanding access to psychology services in clinical cardiology care may be a model to reduce excess cardiovascular risk factor burdens.