Literature Collection

OBJECTIVES: To assess primary care contributions to behavioral health in addressing unmet mental healthcare needs due to the COVID-19 pandemic. METHODS: Secondary data analysis of 2016 to 2018 Medical Expenditure Panel Survey of non-institutionalized US adults. We performed bivariate analysis to estimate the number and percentage of office-based visits and prescription medications for depression and anxiety disorders, any mental illness (AMI), and severe mental illness (AMI) by physician specialty (primary care, psychiatry, and subspecialty) and medical complexity. We ran summary statistics to compare the differences in sociodemographic factors between patients with AMI by seeing a primary care physician versus those seeing a psychiatrist. Binary logistic regression models were estimated to examine the likelihood of having a primary care visit versus psychiatrist visit for a given mental illness. RESULTS: There were 394 023 office-based visits in the analysis sample. AMI patients seeing primary care physician were thrice as likely to report 1 or more chronic conditions compared to those seeing psychiatrist. Among patients with a diagnosis of depression or anxiety and AMI the proportion of primary care visits ([38% vs 32%, P < .001], [39% vs 34%, P < .001] respectively), and prescriptions ([50% vs 40%, P < .001], [47% vs 44%, P < .05] respectively) were higher compared to those for psychiatric care. Patients diagnosed with SMI had a more significant percentage of prescriptions and visits to a psychiatrist than primary care physicians. CONCLUSION: Primary care physicians provided most of the care for depression, anxiety, and AMI. Almost a third of the care for SMI and a quarter of the SMI prescriptions occurred in primary care settings. Our study underscores the importance of supporting access to primary care given primary care physicians' critical role in combating the COVID-19 related rise in mental health burden.

INTRODUCTION: Ontario, Canada, is shifting to a more integrated healthcare delivery system through the Ontario Health Team (OHT) initiative. The extent to which OHTs have the capabilities to engage in integrated care is unknown and important to designing implementation supports. This article describes the development and psychometric testing of the Ontario Integrated Care Leadership Survey (OICLS), in 30 OHTs. The OICLS was informed by the Context and Capabilities for Integrated Care framework (CCIC). METHODS: The 42-item survey was distributed electronically to 765 eligible leaders across 30 OHTs; 480 (63%) responded representing approximately 600 organizations. Item analyses and scale psychometric analyses were undertaken to reduce the number of items in the CCIC survey tool while maintaining validity and reliability. RESULTS: The OICLS survey is comprised of 10 domains covering 12 of 17 capabilities identified in the CCIC. In the total sample, Cronbach's alpha exceeded 0.7 for nine of the ten domains. Descriptive responses to each of the 39 OICLS closed-ended survey questions illustrate the areas of strength and weakness and where supports are warranted to advance the formation of integrated care delivery systems. CONCLUSION: The OICLS offers a brief and valid assessment of foundational aspects of multi-organizational integrated care initiatives.

Integration of behavioral health care into primary care can improve health and economic outcomes. This study adapted the Behavioral Health Integration in Medical Care (BHIMC) index to the Colombian context and assessed the baseline level of behavioral health integration in a sample of primary care organizations. The BHIMC was able to detect the capacity to provide integrated behavioral care in Colombian settings. Results indicate a minimal to partial integration level across all sites, and that it is possible to measure the degree of integrated care capacity and identify improvement areas for better behavioral health care provision.

Integration of behavioral health care into primary care can improve health and economic outcomes. This study adapted the Behavioral Health Integration in Medical Care (BHIMC) index to the Colombian context and assessed the baseline level of behavioral health integration in a sample of primary care organizations. The BHIMC was able to detect the capacity to provide integrated behavioral care in Colombian settings. Results indicate a minimal to partial integration level across all sites, and that it is possible to measure the degree of integrated care capacity and identify improvement areas for better behavioral health care provision.