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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
6761
Outcomes of a partnered facilitation strategy to implement primary care-mental health
Type: Journal Article
Year: 2014
Publication Place: United States
Abstract: BACKGROUND: Implementing new programs and practices is challenging, even when they are mandated. Implementation Facilitation (IF) strategies that focus on partnering with sites show promise for addressing these challenges. OBJECTIVE: Our aim was to evaluate the effectiveness of an external/internal IF strategy within the context of a Department of Veterans Affairs (VA) mandate of Primary Care-Mental Health Integration (PC-MHI). DESIGN: This was a quasi-experimental, Hybrid Type III study. Generalized estimating equations assessed differences across sites. PARTICIPANTS: Patients and providers at seven VA primary care clinics receiving the IF intervention and national support and seven matched comparison clinics receiving national support only participated in the study. INTERVENTION: We used a highly partnered IF strategy incorporating evidence-based implementation interventions. MAIN MEASURES: We evaluated the IF strategy using VA administrative data and RE-AIM framework measures for two 6-month periods. KEY RESULTS: Evaluation of RE-AIM measures from the first 6-month period indicated that PC patients at IF clinics had nine times the odds (OR=8.93, p<0.001) of also being seen in PC-MHI (Reach) compared to patients at non-IF clinics. PC providers at IF clinics had seven times the odds (OR=7.12, p=0.029) of referring patients to PC-MHI (Adoption) than providers at non-IF clinics, and a greater proportion of providers' patients at IF clinics were referred to PC-MHI (Adoption) compared to non-IF clinics (beta=0.027, p<0.001). Compared to PC patients at non-IF sites, patients at IF clinics did not have lower odds (OR=1.34, p=0.232) of being referred for first-time mental health specialty clinic visits (Effectiveness), or higher odds (OR=1.90, p=0.350) of receiving same-day access (Implementation). Assessment of program sustainability (Maintenance) was conducted by repeating this analysis for a second 6-month time period. Maintenance analyses results were similar to the earlier period. CONCLUSION: The addition of a highly partnered IF strategy to national level support resulted in greater Reach and Adoption of the mandated PC-MHI initiative, thereby increasing patient access to VA mental health care.
Topic(s):
General Literature
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Reference Links: 
View the DOI record for Outcomes of a partnered facilitation strategy to implement primary care-mental health
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View the PubMed citation for Outcomes of a partnered facilitation strategy to implement primary care-mental health6762
Outcomes of a primary care mental health implementation program in rural Rwanda: A quasi-experimental implementation-effectiveness study
Type: Journal Article
Year: 2020
Publication Place: United States
Abstract: INTRODUCTION: To address the know-do gap in the integration of mental health care into primary care in resource-limited settings, a multi-faceted implementation program initially designed to integrate HIV/AIDS care into primary care was adapted for severe mental disorders and epilepsy in Burera District, Rwanda. The Mentoring and Enhanced Supervision at Health Centers (MESH MH) program supported primary care-delivered mental health service delivery scale-up from 6 to 19 government-run health centers over two years. This quasi-experimental study assessed implementation reach, fidelity, and clinical outcomes at health centers supported by MESH MH during the scale up period. METHODS: MESH MH consisted of four strategies to ensure the delivery of the priority care packages at health centers: training; supervision and mentorship; audit and feedback; and systems-based quality improvement (QI). Implementation reach (service use) across the 19 health centers supported by MESH MH during the two year scale-up period was described using routine service data. Implementation fidelity was measured at four select health centers by comparing total clinical supervisory visits and checklists to target goals, and by tracking clinical observation checklist item completion rates over a nine month period. A prospective before and after evaluation measured clinical outcomes in consecutive adults presenting to four select health centers over a nine month period. Primary outcome assessments at baseline, 2 and 6 months included symptoms and functioning, measured by the General Health Questionnaire (GHQ-12) and the World Health Organization Disability Assessment Scale (WHO-DAS Brief), respectively. Secondary outcome assessments included engagement in income generating work and caregiver burden using a quantitative scale adapted to context. RESULTS: A total of 2239 mental health service users completed 15,744 visits during the scale up period. MESH MH facilitated 70% and 76% of supervisory visit and clinical checklist utilization target goals, respectively. Checklist item completion rates significantly improved overall, and for three of five checklist item subgroups examined. 121 of 146 consecutive service users completed outcome measurements six months after entry into care. Scores improved significantly over six months on both the GHQ-12, with median score improving from 26 to 10 (mean within-person change 12.5 [95% CI: 10.9-14.0] p< 0.0001), and the WHO-DAS Brief, with median score improving from 26.5 to 7 (mean within-person change 16.9 [95% CI: 14.9-18.8] p< 0.0001). Over the same period, the percentage of surveyed service users reporting an inability to work decreased significantly (51% to 6% (p < 0.001)), and the proportion of households reporting that a caregiver had left income-generating work decreased significantly (41% to 4% (p < 0.001)). CONCLUSION: MESH MH was associated with high service use, improvements in mental health care delivery by primary care nurses, and significant improvements in clinical symptoms and functional disability of service users receiving care at health centers supported by the program. Multifaceted implementation programs such as MESH MH can reduce the evidence to practice gap for mental health care delivery by nonspecialists in resource-limited settings. The primary limitation of this study is the lack of a control condition, consistent with the implementation science approach of the study. STUDY REGISTRATION: ISRCTN #37231.
Topic(s):
Financing & Sustainability
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, Healthcare Disparities
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6763
Outcomes of a primary care mental health implementation program in rural Rwanda: A quasi-experimental implementation-effectiveness study
Type: Journal Article
Year: 2020
Publication Place: United States
Abstract: INTRODUCTION: To address the know-do gap in the integration of mental health care into primary care in resource-limited settings, a multi-faceted implementation program initially designed to integrate HIV/AIDS care into primary care was adapted for severe mental disorders and epilepsy in Burera District, Rwanda. The Mentoring and Enhanced Supervision at Health Centers (MESH MH) program supported primary care-delivered mental health service delivery scale-up from 6 to 19 government-run health centers over two years. This quasi-experimental study assessed implementation reach, fidelity, and clinical outcomes at health centers supported by MESH MH during the scale up period. METHODS: MESH MH consisted of four strategies to ensure the delivery of the priority care packages at health centers: training; supervision and mentorship; audit and feedback; and systems-based quality improvement (QI). Implementation reach (service use) across the 19 health centers supported by MESH MH during the two year scale-up period was described using routine service data. Implementation fidelity was measured at four select health centers by comparing total clinical supervisory visits and checklists to target goals, and by tracking clinical observation checklist item completion rates over a nine month period. A prospective before and after evaluation measured clinical outcomes in consecutive adults presenting to four select health centers over a nine month period. Primary outcome assessments at baseline, 2 and 6 months included symptoms and functioning, measured by the General Health Questionnaire (GHQ-12) and the World Health Organization Disability Assessment Scale (WHO-DAS Brief), respectively. Secondary outcome assessments included engagement in income generating work and caregiver burden using a quantitative scale adapted to context. RESULTS: A total of 2239 mental health service users completed 15,744 visits during the scale up period. MESH MH facilitated 70% and 76% of supervisory visit and clinical checklist utilization target goals, respectively. Checklist item completion rates significantly improved overall, and for three of five checklist item subgroups examined. 121 of 146 consecutive service users completed outcome measurements six months after entry into care. Scores improved significantly over six months on both the GHQ-12, with median score improving from 26 to 10 (mean within-person change 12.5 [95% CI: 10.9-14.0] p< 0.0001), and the WHO-DAS Brief, with median score improving from 26.5 to 7 (mean within-person change 16.9 [95% CI: 14.9-18.8] p< 0.0001). Over the same period, the percentage of surveyed service users reporting an inability to work decreased significantly (51% to 6% (p < 0.001)), and the proportion of households reporting that a caregiver had left income-generating work decreased significantly (41% to 4% (p < 0.001)). CONCLUSION: MESH MH was associated with high service use, improvements in mental health care delivery by primary care nurses, and significant improvements in clinical symptoms and functional disability of service users receiving care at health centers supported by the program. Multifaceted implementation programs such as MESH MH can reduce the evidence to practice gap for mental health care delivery by nonspecialists in resource-limited settings. The primary limitation of this study is the lack of a control condition, consistent with the implementation science approach of the study. STUDY REGISTRATION: ISRCTN #37231.
Topic(s):
Financing & Sustainability
See topic collection
, Healthcare Disparities
See topic collection
6764
Outcomes of a Rapid Adolescent Telehealth Scale-Up During the COVID-19 Pandemic
Type: Journal Article
Year: 2020
Topic(s):
Education & Workforce
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, Healthcare Disparities
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, HIT & Telehealth
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Reference Links:
View the DOI record for Outcomes of a Rapid Adolescent Telehealth Scale-Up During the COVID-19 Pandemic
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View the PubMed citation for Outcomes of a Rapid Adolescent Telehealth Scale-Up During the COVID-19 Pandemic6766
Outcomes of DATA 2000 certification trainings for the provision of buprenorphine treatment in the Veterans Health Administration
Type: Journal Article
Year: 2008
Publication Place: England
Abstract: Despite the high numbers of veterans with opioid dependence, few receive pharmacologic treatment for this disorder. The adoption of buprenorphine treatment within the Veterans Health Administration (VHA) has been slow. To expand capacity for buprenorphine treatment, the VHA sponsored two eight-hour credentialing courses for the Drug Addiction Treatment Act of 2000. We sought to describe the outcomes of such training. Following the training sessions, 29 participants (18 physicians) were highly satisfied with course content and affirmed their intention to prescribe buprenorphine; after nine-month follow-up, two physicians were prescribing. We conclude that providing credentialing courses, while popular, did not markedly promote the prescription of buprenorphine.
Topic(s):
Opioids & Substance Use
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, Education & Workforce
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6767
Outcomes of Integrated Behavioral Health with Primary Care
Type: Journal Article
Year: 2017
Publication Place: United States
Topic(s):
Education & Workforce
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Reference Links: View the PubMed citation for Outcomes of Integrated Behavioral Health with Primary Care
6768
Outcomes of interprofessional education for community mental health services in England: the longitudinal evaluation of a postgraduate programme
Type: Journal Article
Year: 2006
Publication Place: England
Abstract: We report a comprehensive, longitudinal evaluation of a two-year, part-time postgraduate programme designed to enable health and social care professionals in England to work together to deliver new community mental health services, including psychosocial interventions (PSIs). The study tracked three successive cohorts of students (N = 111) through their learning. Outcomes were assessed according to the Kirkpatrick/Barr et al. framework using a mixed methodology, which employed both quantitative measures and interviews. The students evaluated the programme positively and appreciated its focus on interprofessional learning and partnership with services users, but mean levels of stress increased and almost one quarter dropped out. There was considerable evidence of professional stereotyping but little evidence of change in these during the programme. Students reported substantial increases in their knowledge and skills in multidisciplinary team working and use of PSIs (p < 0.001). Experiences in the implementation of learning varied; in general, students reported significantly greater role conflict (p = 0.01) compared to a sample of their team colleagues (N = 62), but there was strong evidence from self-report measures (p < 0.001) and work-place interviews that the students' use of PSIs had increased. Users with severe mental health problems (N = 72) randomly selected from caseloads of two cohorts of students improved over six months in terms of their social functioning (p = 0.047) and life satisfaction (p = 0.014). Having controlled statistically for differences in baseline score, those in the intervention (programme) group retained a significant advantage in terms of life skills (p < 0.001) compared to service users in two non-intervention comparison groups (N = 133). Responses on a user-defined measure indicated a high level of satisfaction with students' knowledge, skills and personal qualities. We conclude that that there is strong evidence that a well-designed programme of IPE can be effective in helping students to learn new knowledge and skills, and to implement their learning in the workplace. Further, we consider that there is some modest evidence of the benefits of such learning for service users.
Topic(s):
Education & Workforce
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6769
Outcomes of mental health pharmacist-managed electronic consults at a Veterans Affairs health care system
Type: Journal Article
Year: 2018
Publication Place: United States
Abstract: Introduction: The demand for mental health services has increased as more veterans have been diagnosed with-and sought care for-one or more mental health conditions. Within the South Texas Veterans Health Care System (STVHCS), providers may submit electronic consults (e-consults) to mental health clinical pharmacy specialists for medication review and recommendations. These consults aim to manage veterans with uncomplicated mental health conditions in primary care, making specialty mental health providers more available for those who need such services. Pharmacists have improved outcomes and access to care for conditions such as diabetes and hypertension, but currently, there is limited evidence demonstrating the impact of pharmacists in mental health. Methods: This quality improvement project assessed the effectiveness of the e-consult service. Information was collected through a retrospective chart review of STVHCS veterans with the corresponding consult note placed in their chart from May 2014 through December 2015. Numbers of recommendations implemented and veterans maintained in primary care were analyzed as markers of effectiveness. Time and cost savings were secondarily explored. Results: A total of 361 consults were submitted for 353 unique patients. Of the 322 patients included in analyses, a total of 301 unique patients (93.5%) were maintained in primary care for at least 3 months. Of the 21 not maintained in primary care, 15 recommendations were implemented; of those maintained in primary care, 271 recommendations were implemented. Discussion: This service improves mental health care-and patient access-by promoting successful management and maintenance of less complicated patients in primary care.
Topic(s):
Financing & Sustainability
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, HIT & Telehealth
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Reference Links:
View the DOI record for Outcomes of mental health pharmacist-managed electronic consults at a Veterans Affairs health care system
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View the PubMed citation for Outcomes of mental health pharmacist-managed electronic consults at a Veterans Affairs health care system6771
Outcomes of recognizing depressed Chinese American patients in primary care
Type: Journal Article
Year: 2005
Publication Place: United States
Abstract: PURPOSE: This study aims to examine the effect of identifying Chinese American patients as having major depressive disorder (MDD) to their primary care physicians (PCPs) on the latter's attention given to the treatment of depression. METHODOLOGY: Forty Chinese American patients from a primary care clinic were identified as having major depressive disorder (MDD), and their primary care physicians (PCPs) were notified of the diagnosis by letter. Three months later, medical records of subjects in the study were reviewed to see if their PCPs had intervened through referral and/or initiated treatment of depression. RESULTS: PCPs documented intervention in 19 patients (47%) regarding their depression. Two of these patients (11%) were started on an antidepressant. Four (21%) accepted and 13 (68%) declined referral to mental health services. No intervention was recorded for 21 (53%) patients. CONCLUSION: We conclude that recognition alone of MDD among Chinese Americans in the community primary care setting does not lead to adequate initiation of treatment for depression by PCPs.
Topic(s):
Healthcare Disparities
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Reference Links: View the PubMed citation for Outcomes of recognizing depressed Chinese American patients in primary care
6774
Outpatient costs in pharmaceutically treated diabetes patients with and without a diagnosis of depression in a Dutch primary care setting
Type: Journal Article
Year: 2012
Publication Place: England
Abstract: BACKGROUND: To assess differences in outpatient costs among pharmaceutically treated diabetes patients with and without a diagnosis of depression in a Dutch primary care setting. METHODS: A retrospective case control study over 3 years (2002-2004). Data on 7128 depressed patients and 23772 non-depressed matched controls were available from the electronic medical record system of 20 general practices organized in one large primary care organization in the Netherlands. A total of 393 depressed patients with diabetes and 494 non-depressed patients with diabetes were identified in these records. The data that were extracted from the medical record system concerned only outpatient costs, which included GP care, referrals, and medication. RESULTS: Mean total outpatient costs per year in depressed diabetes patients were euro1039 (SD 743) in the period 2002-2004, which was more than two times as high as in non-depressed diabetes patients (euro492, SD 434). After correction for age, sex, type of insurance, diabetes treatment, and comorbidity, the difference in total annual costs between depressed and non-depressed diabetes patients changed from euro408 (uncorrected) to euro463 (corrected) in multilevel analyses. Correction for comorbidity had the largest impact on the difference in costs between both groups. CONCLUSIONS: Outpatient costs in depressed patients with diabetes are substantially higher than in non-depressed patients with diabetes even after adjusting for confounders. Future research should investigate whether effective treatment of depression among diabetes patients can reduce health care costs in the long term.
Topic(s):
HIT & Telehealth
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6778
Outpatient Psychiatric Documentation Use by Primary Care Physicians Following De-Sensitization in the Electronic Medical Record
Type: Journal Article
Year: 2014
Abstract: OBJECTIVE: The authors assessed the ways in which primary care physicians (PCPs) utilize outpatient psychiatric documentation that has recently become accessible to non-psychiatric providers in the UC Davis Healthcare System electronic medical record (EMR). METHODS: The authors distributed a nine-question paper survey to 71 PCPs on the UC Davis Medical Center Campus in Sacramento, California. Questions addressed awareness of changes in accessibility of psychiatric documentation, which parts of the psychiatric note were most useful, and ways in which reviewing psychiatric notes changed providers' practice and perception of patients with mental illness. RESULTS: Survey return rate was 100 % due to in-person distribution and collection of survey. More than half (58 %) of respondents were unaware that they had access to psychiatric notes. Within the psychiatric note, providers focused most on plan, diagnosis, and assessment components. Those who were aware reported improved understanding (97 %) and comfort with discussing mental illness (79 %), increased consideration of side effects of psychiatric medications (79 %), and improved efficiency in encounters with psychiatric patients (97 %). Responses about likelihood to contact psychiatrists directly varied considerably. About 45 % of respondents were more likely to consider psychosomatic etiology for patients who were also seen by outpatient psychiatry. CONCLUSIONS: Overall, PCPs reported that accessibility of outpatient psychiatric notes significantly enhanced their experience of caring for patients with mental illness. Future goals include increasing awareness and education about availability of psychiatric notes as well as optimizing communication between psychiatrists and PCPs. The authors recommend future studies focused on changes in perceptions among providers as a result of continued use of psychiatric documentation.
Topic(s):
Education & Workforce
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, HIT & Telehealth
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6779
Outpatient transition to extended-release injectable naltrexone for patients with opioid use disorder: A phase 3 randomized trial
Type: Journal Article
Year: 2018
Publication Place: Ireland
Topic(s):
Opioids & Substance Use
See topic collection