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The Literature Collection contains over 11,000 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).
13014 Results
9243
Primary care perspectives on generalized anxiety disorder
Type:
Journal Article
Year:
2004
Publication Place:
United States
Abstract:
Recently, there has been increased interest in the impact and treatment of anxiety disorders. However, one type of anxiety disorder, generalized anxiety disorder (GAD), has received less attention than other disorders, such as panic disorder, despite the prevalence and amenability of this disorder to treatment in the primary care setting. Rates of GAD have been found to be between 2.8% and 8.5%, with a median prevalence of 5.8%-at least twice the rate reported in the National Comorbidity Survey. Up to one third of patients presenting to primary care clinics with somatic complaints had a mood or anxiety disorder. Generalized anxiety disorder is linked to the overuse of medical services: emergency department visits, hospitalizations, diagnostic and laboratory tests, pharmacy costs, and so on. Recognition of anxiety and depression in primary care is poor, with only 23% of pure anxiety cases being recognized compared with 56% of depression cases. The various stakeholders (patients, family members, employers, and insurers) in a patient's outcome often complicate treatment of anxiety. Barriers to effective treatment include time constraints, acute disease orientation of most care systems, lack of planned follow-up and monitoring, and relative unavailability of specialist access. The collaborative care approach is designed to overcome these barriers. With this approach, the patient is provided with additional educational materials, physicians are supported by physician extenders (nurses, social workers, or expert consultants) who provide case-based feedback, follow-up, extra visits, and telephone calls to patients. Providing efficacious treatment to primary care for GAD will require improving knowledge of providers and increasing patient engagement.
Topic(s):
Medically Unexplained Symptoms
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Reference Links:
View the PubMed citation for Primary care perspectives on generalized anxiety disorder
9245
Primary Care Physician Perceptions on Caring for Complex Patients with Medical and Mental Illness
Type:
Journal Article
Year:
2012
Abstract:
BACKGROUND: Mental illness is common and associated with poor outcomes for co-occurring medical illness. Since primary care physicians manage the treatment of complex patients with both mental and medical illnesses, their perspectives on the care of these patients is vital to improving clinical outcomes. OBJECTIVE: To examine physician perceptions of patient, physician and system factors that affect the care of complex patients with mental and medical illness. DESIGN: Inductive, participatory, team-based qualitative analysis of transcripts of in-depth semi-structured interviews. PARTICIPANTS: Fifteen internal medicine physicians from two university primary care clinics and three community health clinics. RESULTS: Participant characteristics were balanced in terms of years in practice, practice site, and gender. Physicians identified contributing factors to the complexity of patient care within the domains of patient, physician and system factors. Physicians identified 1) type of mental illness, 2) acuity of mental illness, and 3) communication styles of individual patients as the principal patient characteristics that affected care. Physicians expressed concern regarding their own lack of medical knowledge, clinical experience, and communication skills in treating mental illness. Further, they discussed tensions between professionalism and emotional responses to patients. Participants expressed great frustration with the healthcare system centered on: 1) lack of mental health resources, 2) fragmentation of care, 3) clinic procedures, and 4) the national healthcare system. CONCLUSIONS: Physicians in this study made a compelling case for increased training in the treatment of mental illness and improvements in the delivery of mental health care. Participants expressed a strong desire for increased integration of care through collaboration between primary care providers and mental health specialists. This approach could improve both comfort in treating mental illness and the delivery of care for complex patients.
Topic(s):
Education & Workforce
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Reference Links:
View the DOI record for Primary Care Physician Perceptions on Caring for Complex Patients with Medical and Mental Illness
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View the PubMed citation for Primary Care Physician Perceptions on Caring for Complex Patients with Medical and Mental Illness
9250
Primary care physicians treat somatization
Type:
Journal Article
Year:
2009
Publication Place:
United States
Abstract:
BACKGROUND: We hypothesized that somatizing patients managed by primary care physicians (PCP) would improve with a relationship-based intervention. METHODS: We randomized 30 adults with medically unexplained symptoms to treatment or usual care. Four PCPs were trained to intervene with cognitive-behavioral, pharmacological, and patient-centered management and deployed the intervention with seven scheduled visits over 12 months. Outcomes obtained at baseline and 12 months were: Mental component summary (MCS), the primary endpoint, and measures of physical and psychological symptoms and of satisfaction with the PCP. RESULTS: Patients averaged 52.5 years; 83.3% were female; 79.6% were black. Using a difference of differences approach, we found that the intervention produced a large effect size (ES) (0.82; CI: 0.08 to 1.57) for the MCS in the predicted direction, similar to the ES for physical (-0.80; CI: -1.55 to -0.04) and psychological (-1.06; CI: -1.83 to -0.28) improvement and for increased satisfaction with the PCP (0.94; CI: 0.15 to 1.74). Using ANCOVA in a sensitivity analysis, we found that the ES fell slightly (0.59), while other measures were unchanged. CONCLUSIONS: Moderate-large effect sizes support the hypothesis that PCPs can effectively treat somatization. This points to the importance of performing a full RCT.
Topic(s):
Medically Unexplained Symptoms
See topic collection
9251
Primary care physicians' and psychiatrists' approaches to treating mild depression
Type:
Journal Article
Year:
2012
Topic(s):
Education & Workforce
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Reference Links:
View the DOI record for Primary care physicians' and psychiatrists' approaches to treating mild depression
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View the PubMed citation for Primary care physicians' and psychiatrists' approaches to treating mild depression
9252
Primary care physicians' and psychiatrists' willingness to refer to religious mental health providers
Type:
Journal Article
Year:
2013
Abstract:
BACKGROUND: Recent decades have witnessed some integration of mental health care and religious resources. AIM: We measured primary care physicians' (PCPs) and psychiatrists' knowledge of religious mental health-care providers, and their willingness to refer there. METHODS: A national survey of PCPs and psychiatrists was conducted, using vignettes of depressed and anxious patients. Vignettes included Christian or Jewish patients, who regularly or rarely attended services. We asked whether physicians knew of local religious mental health providers, and whether they would refer patients there. RESULTS: In all, 896/1427 PCPs and 312/487 psychiatrists responded. Half of PCPs (34.1%-44.1%) and psychiatrists (51.4%-56.3%) knew Christian providers; fewer PCPs (8.5%-9.9%) and psychiatrists (15.8%-19.6%) knew Jewish providers. Predictors included the following: patients were Christian (odds ratio (OR) = 2.2-2.9 for PCPs, 2.3-2.4 for psychiatrists), respondents were Christian (OR = 2.1-9.3 for PCPs) and respondents frequently attend services (OR = 3.5-7.0 for PCPs). Two-thirds of PCPs (63.3%-64%) and psychiatrists (48.8%-52.6%) would refer to religious providers. Predictors included the following: patients regularly attend services OR = 1.2 for PCPs, 1.6 for Psychiatrists, depression vignette only), respondents were Christian (OR = 2.8-18.1 for PCPs, 2.3-9.2 for psychiatrists) and respondents frequently attend services (OR = 5.1-6.3 for PCPs). CONCLUSION: Many physicians would refer patients to religious mental health providers. However, less religious PCPs are less knowledgeable about local religious providers.
Topic(s):
Education & Workforce
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Reference Links:
View the DOI record for Primary care physicians' and psychiatrists' willingness to refer to religious mental health providers
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View the PubMed citation for Primary care physicians' and psychiatrists' willingness to refer to religious mental health providers
9254
Primary Care Physicians' Attitudes Toward Postpartum Depression: Is It Part of Their Job?
Type:
Journal Article
Year:
2016
Publication Place:
United States
Topic(s):
Education & Workforce
See topic collection
Reference Links:
View the DOI record for Primary Care Physicians' Attitudes Toward Postpartum Depression: Is It Part of Their Job?
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View the PubMed citation for Primary Care Physicians' Attitudes Toward Postpartum Depression: Is It Part of Their Job?
9255
Primary care physicians' detection of psychological distress among elderly patients
Type:
Journal Article
Year:
2005
Publication Place:
United States
Abstract:
OBJECTIVES: Elderly persons suffer from high rates of psychological distress that are sometimes unrecognized by healthcare providers. Authors compared rates of psychological distress and physician detection among elderly and non-elderly primary-care patients and examined, among elderly patients, variables associated with distress and physician detection. METHODS: This was a national survey of a sample of 2,325 Israeli primary healthcare recipients and 67 physicians. Patients completed the General Health Questionnaire (GHQ) and background questionnaires. Physicians completed forms indicating their diagnosis and treatment and their attitudes toward elderly patients. RESULTS: Of those age 60 and over, 58.7% had a GHQ score reflecting distress, as did 49% of those age 40-59 and 30.4% of those age 18-39. There was no age-group difference in physician concordance on GHQ. In elderly patients, variables associated with GHQ psychological distress were being female, having more self-reported chronic diseases, poorer self-reported health, and more frequent primary-care clinic visits. Physician agreement with GHQ distress for elderly patients was best for female patients and patients who visited a physician more often. Physicians treated 71% of the instances of distress they noted in older patients and 42% of the GHQ-detected cases. CONCLUSIONS: Physicians appear to detect distress no less accurately among older than younger patients. A majority of elderly primary-care patients are distressed, and many of them are neither diagnosed nor treated for distress. Increased attention by primary-care physicians to possible psychological distress among elderly patients who perceive their health status as poor and those patients who visit more frequently could improve detection of distress among these elderly patients.
Topic(s):
Medically Unexplained Symptoms
See topic collection
Reference Links:
View the DOI record for Primary care physicians' detection of psychological distress among elderly patients
View DOI Record
View the PubMed citation for Primary care physicians' detection of psychological distress among elderly patients
9257
Primary Care Physicians' Knowledge and Attitudes Regarding Prescription Opioid Abuse and Diversion
Type:
Journal Article
Year:
2016
Publication Place:
United States
Abstract:
OBJECTIVES: Physicians are a key stakeholder in the epidemic of prescription opioid abuse. Therefore, we assessed their knowledge of opioid abuse and diversion, as well as their support for clinical and regulatory interventions to reduce opioid-related morbidity and mortality. MATERIALS AND METHODS: We conducted a nationally representative postal mail survey of 1000 practicing internists, family physicians, and general practitioners in the United States between February and May 2014. RESULTS: The adjusted response rate was 58%, and all physicians (100%) believed that prescription drug abuse was a problem in their communities. However, only two-thirds (66%) correctly reported that the most common route of abuse was swallowing pills whole, and nearly one-half (46%) erroneously reported that abuse-deterrent formulations were less addictive than their counterparts. In addition, a notable minority of physicians (25%) reported being "not at all" or "only slightly concerned" about the potential for opioid diversion from the licit to the illicit market when this practice is common at all levels of the pharmaceutical supply chain. Most physicians supported clinical and regulatory interventions to reduce prescription opioid abuse, including the use of patient contracts (98%), urine drug testing (90%), requiring prescribers to check a centralized database before prescribing opioids (88%), and instituting greater restrictions on the marketing and promotion of opioids (77% to 82%). Despite this, only one-third of physicians (33%) believed that interventions to reduce prescription opioid abuse had a moderate or large effect on preventing patients' clinically appropriate access to pain treatment. DISCUSSION: Although physicians are unaware of some facets of prescription opioid-related morbidity, most support a variety of clinical and regulatory interventions to improve the risk-benefit balance of these therapies.
Topic(s):
Opioids & Substance Use
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, Education & Workforce
See topic collection
Reference Links:
View the DOI record for Primary Care Physicians' Knowledge and Attitudes Regarding Prescription Opioid Abuse and Diversion
View DOI Record
View the PubMed citation for Primary Care Physicians' Knowledge and Attitudes Regarding Prescription Opioid Abuse and Diversion
9258
Primary care physicians' opioid-related prevention behaviors and intentions: A descriptive analysis
Type:
Journal Article
Year:
2022
Publication Place:
United States
Abstract:
OBJECTIVE: Primary care physicians (PCPs) are positioned to mitigate opioid morbidity and mortality, but their engagement in primary, secondary, and tertiary opioid-related prevention behaviors is unclear. The objective of this study was to evaluate Tennessee PCPs' engagement in and intention to engage in multiple opioid-related prevention behaviors. METHODS: A survey instrument was developed, pretested, and pilot tested with practicing PCPs. Thereafter, a census of eligible Tennessee PCPs was conducted using a modified, four-wave tailored design method approach. Three patient scenarios were employed to assess physician intention to engage in 10 primary, secondary, and tertiary prevention behaviors. Respondents were asked to report, given 10 similar scenarios, the number of times (0-10) they would engage in prevention behaviors. Descriptive statistics were calculated using SPSS version 25. RESULTS: A total of 296 usable responses were received. Physician intention to engage in prevention behaviors varied across the 10 behaviors studied. Physicians reported frequently communicating risks associated with prescription opioids to patients (8.9 ± 2.8 out of 10 patients), infrequently utilizing brief questionnaires to assess for risk of opioid misuse (1.7 ± 3.3 out of 10 patients), and screening for current opioid misuse (3.1 ± 4.3 out of 10 patients). Physicians reported seldomly co-prescribing naloxone for overdose reversal and frequently discharging from practice patients presenting with an opioid use disorder. CONCLUSIONS: This study noted strengths and opportunities to increase engagement in prevention behaviors. Understanding PCPs' engagement in opioid-related prevention behaviors is important to effectively target and implement morbidity and mortality reducing interventions.
Topic(s):
Education & Workforce
See topic collection
, Measures
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, Opioids & Substance Use
See topic collection
Reference Links:
View the DOI record for Primary care physicians' opioid-related prevention behaviors and intentions: A descriptive analysis
View DOI Record
View the PubMed citation for Primary care physicians' opioid-related prevention behaviors and intentions: A descriptive analysis