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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
7701
Primary Care-Mental Health Integration in the VA Health System: Associations Between Provider Staffing and Quality of Depression Care
Type: Journal Article
Year: 2017
Publication Place: United States
Abstract: OBJECTIVES: The study examined whether staffing of Primary Care-Mental Health Integration (PCMHI) services in the Department of Veterans Affairs (VA) health system is related to quality of depression care. METHODS: Site surveys and administrative data from 349 VA facilities for fiscal year 2013 were used to calculate PCMHI staffing (full-time equivalents) per 10,000 primary care patients and discipline-specific staffing proportions for PCMHI psychologists, social workers, nurses, and psychiatric medication prescribers. Multivariable regression analyses were conducted at the facility level and assessed associations between PCMHI staffing ratios and the following indicators of depression treatment in the three months following a new episode of depression: any antidepressant receipt, adequacy of antidepressant receipt, any psychotherapy receipt, and psychotherapy engagement (three or more visits). RESULTS: Higher facility PCMHI staffing ratios were associated with a greater percentage of patients who received any psychotherapy treatment (B=1.16, p<.01) and who engaged in psychotherapy (B=.39, p<.01). When analyses controlled for total PCMHI staffing, the proportion of social workers as part of PCMHI was positively correlated with the percentage of patients with adequate antidepressant treatment continuation (B=3.16, p=.03). The proportion of nurses in PCMHI was negatively associated with the percentage of patients with engagement in psychotherapy (B=-2.83, p=.02). CONCLUSIONS: PCMHI programs with greater overall staffing ratios demonstrated better performance on indicators of psychotherapy for depression but not on indicators of antidepressant treatment. Further investigation is needed to determine whether differences in discipline-specific staffing play a causal role in driving associated differences in receipt of treatment.
Topic(s):
Education & Workforce
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7702
Primary Care-Mental Health Integration in the Veterans Affairs Health System: Program Characteristics and Performance
Type: Journal Article
Year: 2018
Abstract: OBJECTIVES: The Veterans Health Administration (VHA) has achieved substantial national implementation of primary care-mental health integration (PC-MHI) services. However, little is known regarding program characteristics, variation in characteristics across settings, or associations between program fidelity and performance. This study identified core elements of PC-MHI services and evaluated their associations with program characteristics and performance. METHODS: A principal-components analysis (PCA) of reports from 349 sites identified factors associated with PC-MHI fidelity. Analyses assessed the correlation among factors and between each factor and facility type (medical center or community-based outpatient clinic), primary care population size, and performance indicators (receipt of PC-MHI services, same-day access to mental health and primary care services, and extended duration of services). RESULTS: PCA identified seven factors: core implementation, care management (CM) assessments and supervision, CM supervision receipt, colocated collaborative care (CCC) by prescribing providers, CCC by behavioral health providers, participation in patient aligned care teams (PACTs) for special populations, and treatment of complex mental health conditions. Sites serving larger populations had greater core implementation scores. Medical centers and sites serving larger populations had greater scores for CCC by prescribing providers, CM assessments and supervision, and participation in PACTs. Greater core implementation scores were associated with greater same-day access. Sites with greater scores for CM assessments and supervision had lower scores for treatment of complex conditions. CONCLUSIONS: Outpatient clinics and sites serving smaller populations experienced challenges in integrated care implementation. To enhance same-day access, VHA should continue to prioritize PC-MHI implementation. Providing brief, problem-focused care may enhance CM implementation.
Topic(s):
General Literature
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Reference Links: 
View the DOI record for Primary Care-Mental Health Integration in the Veterans Affairs Health System: Program Characteristics and Performance
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View the PubMed citation for Primary Care-Mental Health Integration in the Veterans Affairs Health System: Program Characteristics and Performance7703
Primary care-mental health integration programs in the veterans affairs health system serve a different patient population than specialty mental health clinics
Type: Journal Article
Year: 2012
Publication Place: United States
Abstract: Objective: To assess whether Primary Care-Mental Health Integration (PC-MHI) programs within the Veterans Affairs (VA) health system provide services to patient subgroups that may be underrepresented in specialty mental health care, including older patients and women, and to explore whether PC-MHI served individuals with less severe mental health disorders compared to specialty mental health clinics.Method: Data were obtained from the VA National Patient Care Database for a random sample of VA patients, and primary care patients with an ICD-9-CM mental health diagnosis (N = 243,806) in 2009 were identified. Demographic and clinical characteristics between patients who received mental health treatment exclusively in a specialty mental health clinic (n = 128,248) or exclusively in a PC-MHI setting (n = 8,485) were then compared. Characteristics of patients who used both types of services were also explored.Results: Compared to patients treated in specialty mental health clinics, PC-MHI service users were more likely to be aged 65 years or older (26.4% vs 17.9%, P < .001) and female (8.6% vs 7.7%, P = .003). PC-MHI patients were more likely than specialty mental health clinic patients to be diagnosed with a depressive disorder other than major depression, an unspecified anxiety disorder, or an adjustment disorder (P < .001) and less likely to be diagnosed with more severe disorders, including bipolar disorder, posttraumatic stress disorder, psychotic disorders, and alcohol or substance dependence (P < .001).Conclusions: Primary Care-Mental Health Integration within the VA health system reaches demographic subgroups that are traditionally less likely to use specialty mental health care. By treating patients with less severe mental health disorders, PC-MHI appears to expand upon, rather than duplicate, specialty care services.
Topic(s):
Education & Workforce
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, Healthcare Disparities
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7706
Primary care, behavioral health, and public health: partners in reducing mental health stigma
Type: Journal Article
Year: 2013
Publication Place: United States
Topic(s):
General Literature
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Reference Links:
View the DOI record for Primary care, behavioral health, and public health: partners in reducing mental health stigma
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View the PubMed citation for Primary care, behavioral health, and public health: partners in reducing mental health stigma7707
Primary care, behavioral health, provider colocation, and rurality
Type: Journal Article
Year: 2014
Publication Place: United States
Abstract: Purpose: The purpose of this study was to characterize the proximity of primary care and behavioral health service delivery sites in the United States and factors influencing their colocation. METHODS: We geocoded the practice addresses of primary care and behavioral health providers found in the Centers for Medicare & Medicaid Services' National Plan and Provider Enumeration System Downloadable File to report where colocation is occurring throughout the country. RESULTS: The extent to which primary care physicians are colocated with behavioral health providers is strongly associated with rurality. Specifically, 40.2% of primary care physicians in urban areas are colocated with behavioral health providers compared with 22.8% in isolated rural areas and 26.5% in frontier areas. However, when controlling for number of primary care physicians at a location, the odds of colocation actually are greater for physicians in a frontier area than those in urban areas (odds ratio, 1.289; P < .01). CONCLUSIONS: Our findings offer new insights into the overlap of the behavioral health and primary care workforce, where opportunities for integration may be limited because of practice size and the proximity of providers, and where new possibilities for integration exist.
Topic(s):
Education & Workforce
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, Healthcare Disparities
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Reference Links:
View the DOI record for Primary care, behavioral health, provider colocation, and rurality
View DOI Record
View the PubMed citation for Primary care, behavioral health, provider colocation, and rurality7708
Primary care, depression, and anxiety: exploring somatic and emotional predictors of mental health status in adolescents
Type: Journal Article
Year: 2012
Publication Place: United States
Abstract: Introduction: A growing body of research points to regular, comprehensive mental health screening in primary care practices as an effective tool, but a thorough and efficient approach is not yet widely used. The purpose of this report is to describe the pattern of mental health-related concerns, protective and social risk factors reported by adolescents during routine well-child visits in primary care settings, and their occurrence among teens that screen positive for either depression or anxiety with brief validated measures. METHODS: A personal digital assistant-based questionnaire was administered as part of clinical care to adolescents 11 to 18 years old (N = 2184) attending preventive well-child visits in 13 pediatric and family medicine primary care practices in a northern New England practice-based research network over 18 months (2008 to 2009). Depressive and anxiety-related symptoms were assessed using the 2-question versions of the Patient Health Questionnaire and Generalized Anxiety Disorder scale, respectively. Analyses determined the role that the protective and social risk factors played in determining who screens positive for depression and anxiety. RESULTS: In the fully adjusted model, risk factors that were significant (P < .05) predictors for a positive screen of depression included substance use (adjusted odds ratio [AOR], 2.05); stress (AOR, 3.59); anger (AOR, 1.94); and worries about family alcohol and drug use (AOR, 2.69). Among protective factors, that is, those that reduce the risk of depression, age (AOR, 0.87 for younger patients); having parents who listen (AOR, 0.34); and having more assets (AOR, 0.65) were significant. Significant predictors of screening positive for anxiety included substance use (AOR, 1.97); stress (AOR, 6.10); anger (AOR, 2.31); trouble sleeping (AOR, 1.75), and the sex of the adolescent (AOR, 1.87 for girls). Although having parents who listen was still a significant protective factor for anxiety (AOR, 2.26), other assets were not significant. CONCLUSIONS: Comprehensive primary care mental health screening that considers both anxiety and depression while including strength-based and psychosocial support questions is a helpful adjunct to clinical practices and has been done routinely by using an electronic tool at the point of care. Because certain common somatic and emotional concerns can precede depression and anxiety, routine screening for these issues along with depression and anxiety screening is suggested.
Topic(s):
Medically Unexplained Symptoms
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Reference Links:
View the DOI record for Primary care, depression, and anxiety: exploring somatic and emotional predictors of mental health status in adolescents
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View the PubMed citation for Primary care, depression, and anxiety: exploring somatic and emotional predictors of mental health status in adolescents7710
Primary care, public health, and mental health
Type: Journal Article
Year: 2010
Publication Place: United States
Topic(s):
General Literature
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7712
Primary care: Current problems and proposed solutions
Type: Journal Article
Year: 2010
Publication Place: United States
Abstract: In 2005, approximately 400,000 people provided primary medical care in the United States. About 300,000 were physicians, and another 100,000 were nurse practitioners and physician assistants. Yet primary care faces a growing crisis, in part because increasing numbers of U.S. medical graduates are avoiding careers in adult primary care. Sixty-five million Americans live in what are officially deemed primary care shortage areas, and adults throughout the United States face difficulty obtaining prompt access to primary care. A variety of strategies are being tried to improve primary care access, even without a large increase in the primary care workforce.
Topic(s):
Education & Workforce
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7714
Primary care: mental and behavioral health and persons with intellectual and developmental disabilities
Type: Journal Article
Year: 2014
Publication Place: Switzerland
Abstract: INTRODUCTION: There are multiple ways to address the mental and behavioral health needs of people with intellectual and developmental disabilities (IDD). METHOD: In this paper, we do not argue for a particular approach or set of approaches, but instead review the benefits of integrating mental and behavioral health supports with primary healthcare based primarily on our experience in and understanding of healthcare systems in the United States. It is estimated that between 35 and 40% of people with IDD also live with psychiatric disorders. NADD, an association for persons with developmental disabilities and mental health needs in the US holds that coexisting IDD and a psychiatric disorder interferes with a person's education and job readiness, and disrupts family and peer relationships. Historically, the presence of such disorders among people with IDD was not well understood or was discounted altogether. CONCLUSION: Over the past 15 years, however, greater attention is being paid to these comorbidities and their treatment, including the need to integrate mental and behavioral health treatments into primary care. Healthcare must account for multiple domains of quality of life, going beyond yearly physicals, and acute care visits, for example, to assess individuals' healthcare goals and support them in achieving those goals. While integrated healthcare delivery systems can be difficult to find and access for people with IDD, such approaches are more responsive to the comprehensive needs and desires of people with IDD.
Topic(s):
Healthcare Disparities
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Reference Links:
View the DOI record for Primary care: mental and behavioral health and persons with intellectual and developmental disabilities
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View the PubMed citation for Primary care: mental and behavioral health and persons with intellectual and developmental disabilities7716
Primary care/behavioral health integration efforts in North Carolina
Type: Journal Article
Year: 2012
Publication Place: United States
Topic(s):
Education & Workforce
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Reference Links: View the PubMed citation for Primary care/behavioral health integration efforts in North Carolina
7717
Primary health care and the social determinants of health: essential and complementary approaches for reducing inequities in health
Type: Journal Article
Year: 2011
Publication Place: England
Abstract: Increasing focus on health inequities has brought renewed attention to two related policy discourses - primary health care and the social determinants of health. Both prioritise health equity and also promote a broad view of health, multisectoral action and the participation of empowered communities. Differences arise in the lens each applies to the health sector, with resultant tensions around their mutual ability to reform health systems and address the social determinants. However, pitting them against each is unproductive. Health services that do not consciously address social determinants exacerbate health inequities. If a revitalised primary health care is to be the key approach to organise society to minimise health inequities, action on social determinants has to be a major constituent strategy. Success in reducing health inequities will require ensuring that the broad focus of primary health care and the social determinants is kept foremost in policy - instead of the common historical experience of efforts being limited to a part of the health sector.
Topic(s):
Healthcare Disparities
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, Healthcare Policy
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7718
Primary health care experiences of Hispanics with serious mental illness: a mixed-methods study
Type: Journal Article
Year: 2014
Publication Place: United States
Abstract: This mixed-methods study examines the primary health care experiences of Hispanic patients with serious mental illness. Forty patients were recruited from an outpatient mental health clinic. Participants reported a combination of perceived discrimination and stigmatization when receiving medical care. They rated the quality of chronic illness care as poor and reported low levels of self-efficacy and patient activation. These indicators were positively associated with how patients viewed their relationships with primary care providers. A grounded model was developed to describe the structural, social, and interpersonal processes that shaped participants' primary care experiences.
Topic(s):
Healthcare Disparities
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Reference Links:
View the DOI record for Primary health care experiences of Hispanics with serious mental illness: a mixed-methods study
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View the PubMed citation for Primary health care experiences of Hispanics with serious mental illness: a mixed-methods study7720
Primary health care in the mental health workplace: insights from the Australian experience
Type: Journal Article
Year: 2014
Publication Place: England
Abstract: In Australia, Primary Health Care and the mental health sector have always shared a philosophy. In 1978, Primary Health Care was first put forward as a strategy to improve "health for all." Recently, the Australian Government included mental health as a national health priority, identifying six strategies consistent with a Primary Health Care approach to address the mental health of all Australians. Throughout this time, Primary Health Care has been highlighted in all models of care. However, in reality, it appears that in mental health services, mental health nurses, despite good intentions, are not delivering care in a planned or systematised way and that much needs to be done to further improve the situation for individuals accessing the health care system. Services currently focus on those identified as seriously mentally unwell; in order to really make an impact it is argued that services should be broader, offered to the population at large and, further, that the emphasis on case work at an individual level should be changed to an approach that considers prevention, maintenance, and follow-up as well as crisis intervention. This article reflects the Australian experience and offers some insights from that experience.
Topic(s):
General Literature
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Reference Links:
View the DOI record for Primary health care in the mental health workplace: insights from the Australian experience
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View the PubMed citation for Primary health care in the mental health workplace: insights from the Australian experience