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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
8322
Resource document on risk management and liability issues in integrated care models
Type: Journal Article
Year: 2014
Publication Place: United States
Abstract: In the wake of the implementation of the Affordable Care Act, more than 30 million previously uninsured Americans will gain access to health care. Some of these individuals may never have interfaced with the behavioral health system. In response to an increasing need for behavioral health services, improved outcomes, and cost containment, there is a growing shift from independent behavioral health and primary care practices to collaborative care practice models. These new models have psychiatrists working with primary care providers (PCPs) and behavioral health providers (BHPs, typically social workers or psychologists) using a systematic approach to concurrently treat behavioral health and physical health conditions. By following this approach it allows the extension of psychiatric expertise to more patients.From early studies in the 1990's to improve the detection and treatment of depression in elderly patients in primary care settings, to more recent work on outcomes in the management of depression in patients with multiple chronic conditions, a vast body of research has demonstrated the benefit of collaborative care models. However, as with any new treatment modality, psychiatrists may approach collaborative care models with a degree of uncertainty about liability risks. While there are several documents as well as case law addressing the potential malpractice risk of consultation in other medical specialties, a review of the literature revealed few publications offering guidelines for psychiatric consultations. Previous publications have been limited in scope by focusing on interactions between psychiatrists with non-physician treatment providers and have not addressed the potential liability exposure in the overlapping roles of the psychiatrist within an integrated care setting. However, these authors likely could not have anticipated the change in scope of practice of psychiatry in recent years. This resource document provides background information on medical malpractice cases, defines the doctor-patient relationship, and distinguishes the different forms of "split treatment" and how this applies to psychiatric consultation offered to PCPs and BHPs in primary care settings. In addition, it describes the duty of the psychiatrist across the spectrum of roles on an integrated care team and makes recommendations to reduce the risk of medical malpractice issues.Close proximity can foster a culture of cooperation and mutual education between PCPs and psychiatrists. This approach, often referred to as "co-location," has several benefits for patients. The PCP may or may not choose to communicate with the psychiatrist about the behavioral health of patients or make referrals, but the contiguity may increase the chances of successful referral. Limitations in this model have given rise to new treatment paradigms for improving care. In integrated care settings, behavioral health specialists are incorporated into the primary care practice with the psychiatrist providing consultation to the PCP and BHP for management of a patient's behavioral health conditions. These recommendations may be based upon an informal or "curbside" consultation request by the PCP or BHP, a review of the medical record or registry, and, less frequently, by formal evaluation of the patient in person or by televideo.There are a number of integrated care models including the Improving Mood Promoting Access to Collaborative Treatment (IMPACT) model and Massachusetts Child Psychiatry Access Project (MCPAP). In these models of care, the psychiatry consultant's role may include key aspects of both formal and informal consultation and varying aspects of "split treatment" (including what have traditionally been referred to as supervisory, consultative or collaborative roles for non-physicians).This resource document provides a framework for some of the issues to consider when working in practices offering integrated care, and provides practical points to consider in managing liability concerns. Keep in mind that issues regarding liability may not always be clear, particularly in specialty areas that are rapidly evolving. Where indicated, the psychiatrist should clarify the extent of their involvement clinically and the level of interaction with the patient and care team. Whether there is liability for malpractice depends upon specific circumstances surrounding each case and each state has different laws, regulations and caselaw. Finally, consulting an attorney or risk manager for guidance on specific issues is strongly encouraged.
Topic(s):
Education & Workforce
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, Financing & Sustainability
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View the DOI record for Resource document on risk management and liability issues in integrated care models
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View the PubMed citation for Resource document on risk management and liability issues in integrated care models8325
RESPECT-Mil: Feasibility of a systems-level collaborative care approach to depression and post-traumatic stress disorder in military primary care
Type: Journal Article
Year: 2008
Publication Place: United States
Abstract: BACKGROUND: U.S. military ground forces report high rates of war-related traumatic stressors, posttraumatic stress disorder (PTSD), and depression following deployment in support of recent armed conflicts in Iraq and Afghanistan. Affected service members do not receive needed mental health services in most cases, and they frequently report stigma and significant structural barriers to mental health services. Improvements in primary care may help address these issues, and evidence supports the effectiveness of a systems-level collaborative care approach. OBJECTIVE: To test the feasibility of systems-level collaborative care for PTSD and depression in military primary care. We named our collaborative care model "Re-Engineering Systems of Primary Care for PTSD and Depression in the Military" (RESPECT-Mil). METHODS: Key elements of RESPECT-Mil care include universal primary care screening for PTSD and depression, brief standardized primary care diagnostic assessment for those who screen positive, and use of a nurse "care facilitator" to ensure continuity of care for those with unmet depression and PTSD treatment needs. The care facilitator assists primary care providers with follow-up, symptom monitoring, and treatment adjustment and enhances the primary care interface with specialty mental health services. We report assessments of feasibility of RESPECT-Mil implementation in a busy primary care clinic supporting Army units undergoing frequent Iraq, Afghanistan, and other deployments. RESULTS: Thirty primary care providers (family physicians, physician assistants, and nurse practitioners) were trained in the model and in the care of depression and PTSD. The clinic screened 4,159 primary care active duty patient visits: 404 screens (9.7%) were positive for depression, PTSD, or both. Sixty-nine patients participated in collaborative care for 6 weeks or longer, and the majority of these patients experienced clinically important improvement in PTSD and depression. Even although RESPECT-Mil participation was voluntary for providers, only one refused participation. No serious adverse events were noted. CONCLUSIONS: Collaborative care is an evidence-based approach to improving the quality of primary care treatment of anxiety and depression. Our version of collaborative care for PTSD and depression, RESPECT-Mil, is feasible, safe, and acceptable to military primary care providers and patients, and participating patients frequently showed clinical improvements. Efforts to implement and evaluate collaborative care approaches for mental disorders in populations at high risk for psychiatric complications of military service are warranted.
Topic(s):
Education & Workforce
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8326
RESPECT-PTSD: re-engineering systems for the primary care treatment of PTSD, a randomized controlled trial
Type: Journal Article
Year: 2013
Publication Place: United States
Abstract: BACKGROUND: Although collaborative care is effective for treating depression and other mental disorders in primary care, there have been no randomized trials of collaborative care specifically for patients with Posttraumatic stress disorder (PTSD). OBJECTIVE: To compare a collaborative approach, the Three Component Model (3CM), with usual care for treating PTSD in primary care. DESIGN: The study was a two-arm, parallel randomized clinical trial. PTSD patients were recruited from five primary care clinics at four Veterans Affairs healthcare facilities and randomized to receive usual care or usual care plus 3CM. Blinded assessors collected data at baseline and 3-month and 6-month follow-up. PARTICIPANTS: Participants were 195 Veterans. Their average age was 45 years, 91% were male, 58% were white, 40% served in Iraq or Afghanistan, and 42% served in Vietnam. INTERVENTION: All participants received usual care. Participants assigned to 3CM also received telephone care management. Care managers received supervision from a psychiatrist. MAIN MEASURES: PTSD symptom severity was the primary outcome. Depression, functioning, perceived quality of care, utilization, and costs were secondary outcomes. KEY RESULTS: There were no differences between 3CM and usual care in symptoms or functioning. Participants assigned to 3CM were more likely to have a mental health visit, fill an antidepressant prescription, and have adequate antidepressant refills. 3CM participants also had more mental health visits and higher outpatient pharmacy costs. CONCLUSIONS: Results suggest the need for careful examination of the way that collaborative care models are implemented for treating PTSD, and for additional supports to encourage primary care providers to manage PTSD.
Topic(s):
General Literature
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View the DOI record for RESPECT-PTSD: re-engineering systems for the primary care treatment of PTSD, a randomized controlled trial
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View the PubMed citation for RESPECT-PTSD: re-engineering systems for the primary care treatment of PTSD, a randomized controlled trial8327
Responding to COVID-19 through an integrated primary care/behavioral health program
Type: Journal Article
Year: 2021
Topic(s):
Education & Workforce
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Reference Links:
View the DOI record for Responding to COVID-19 through an integrated primary care/behavioral health program
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View the PubMed citation for Responding to COVID-19 through an integrated primary care/behavioral health program8328
Responding to global stimulant use: challenges and opportunities
Type: Journal Article
Year: 2019
Topic(s):
Opioids & Substance Use
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Reference Links:
View the DOI record for Responding to global stimulant use: challenges and opportunities
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View the PubMed citation for Responding to global stimulant use: challenges and opportunities8330
Responding to the opioid and overdose crisis with innovative services: The recovery community center office-based opioid treatment (RCC-OBOT) model
Type: Journal Article
Year: 2019
Topic(s):
Education & Workforce
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, Financing & Sustainability
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, Healthcare Policy
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, Opioids & Substance Use
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8331
Responding to the prescription opioid epidemic: Practical information for pediatricians
Type: Journal Article
Year: 2014
Publication Place: United States
Topic(s):
Opioids & Substance Use
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, Education & Workforce
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Reference Links: View the PubMed citation for Responding to the prescription opioid epidemic: Practical information for pediatricians
8333
Response to: Development of integrated mental health care: critical workforce competencies
Type: Journal Article
Year: 2014
Publication Place: United States
Topic(s):
Education & Workforce
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Reference Links:
View the DOI record for Response to: Development of integrated mental health care: critical workforce competencies
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View the PubMed citation for Response to: Development of integrated mental health care: critical workforce competencies8335
Responsible Opioid Prescribing for Chronic Pain: Interpreting the CDC Guideline, Understanding New Rhode Island Regulations
Type: Journal Article
Year: 2017
Publication Place: United States
Abstract: New Rhode Island regulations require physicians and other licensed practitioners to make significant adjustments to comply with new requirements for prescribing narcotics for chronic pain. Responding to the opioid epidemic, the new rules are intended to improve patient safety by changing physicians' prescribing patterns. However, the new rules may overlook the importance of treatment-access problems and the importance of buprenorphine products for treating pain and opioid dependence. Empirical data have demonstrated the safety and efficacy of buprenorphine in treating opioid-dependent patients with chronic pain, including those with and without substance abuse histories, but access to buprenorphine treatment remains limited throughout the state. The new regulations call upon physicians to make use of consultation services, which are also of limited availability. Although well intentioned, the new rules may contribute to treatment-access problems, and patients with chronic pain may resort to higher-risk "street" drugs when they are unable to access safe but effective medical treatment. [Full article available at http://rimed.org/rimedicaljournal-2017-10.asp].
Topic(s):
Opioids & Substance Use
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8336
Responsible Opioid Prescribing for Chronic Pain: Interpreting the CDC Guideline, Understanding New Rhode Island Regulations
Type: Journal Article
Year: 2017
Publication Place: United States
Abstract: New Rhode Island regulations require physicians and other licensed practitioners to make significant adjustments to comply with new requirements for prescribing narcotics for chronic pain. Responding to the opioid epidemic, the new rules are intended to improve patient safety by changing physicians' prescribing patterns. However, the new rules may overlook the importance of treatment-access problems and the importance of buprenorphine products for treating pain and opioid dependence. Empirical data have demonstrated the safety and efficacy of buprenorphine in treating opioid-dependent patients with chronic pain, including those with and without substance abuse histories, but access to buprenorphine treatment remains limited throughout the state. The new regulations call upon physicians to make use of consultation services, which are also of limited availability. Although well intentioned, the new rules may contribute to treatment-access problems, and patients with chronic pain may resort to higher-risk "street" drugs when they are unable to access safe but effective medical treatment. [Full article available at http://rimed.org/rimedicaljournal-2017-10.asp].
Topic(s):
Opioids & Substance Use
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8339
Retention and future job intentions of graduate primary care mental health workers: A newly developed role in England
Type: Journal Article
Year: 2007
Publication Place: England
Abstract: OBJECTIVES: Modernization of the English National Health Service (NHS) workforce has led to the introduction of a number of new roles. One such role is the graduate primary care mental health worker (PCMHW). Although generally successful in expanding primary mental health care, several challenges were raised by the initial implementation, including retention and development of effective career pathways for these workers. The aim of this study was to examine retention and future job intentions of graduate PCMHWs at the end of their one-year training. METHODS: Mail surveys of the first cohort of graduate PCMHWs recruited in 2004 were conducted at the beginning and end of their 12-month training. RESULTS: Satisfaction with training courses was generally low. Over half indicated they were likely to leave their graduate PCMHW post within the next few months. However, most intended to stay within the NHS. CONCLUSIONS: After training, problems were highlighted in relation to the quality of the training programmes and lack of development of an effective career pathway. This has serious consequences for the viability of this initiative.
Topic(s):
Education & Workforce
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Reference Links:
View the DOI record for Retention and future job intentions of graduate primary care mental health workers: A newly developed role in England
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View the PubMed citation for Retention and future job intentions of graduate primary care mental health workers: A newly developed role in England