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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
1501
Behavioural health consultants in integrated primary care teams: a model for future care
Type: Journal Article
Year: 2016
Publication Place: England
Abstract: BACKGROUND: Significant challenges exist within primary care services in the United Kingdom (UK). These include meeting current demand, financial pressures, an aging population and an increase in multi-morbidity. Psychological services also struggle to meet waiting time targets and to ensure increased access to psychological therapies. Innovative ways of delivering effective primary care and psychological services are needed to improve health outcomes. In this article we argue that integrated care models that incorporate behavioural health care are part of the solution, which has seldom been argued in relation to UK primary care. Integrated care involves structural and systemic changes to the delivery of services, including the co-location of multi-disciplinary primary care teams. Evidence from models of integrated primary care in the United States of America (USA) and other higher-income countries suggest that embedding continuity of care and collaborative practice within integrated care teams can be effective in improving health outcomes. The Behavioural Health Consultant (BHC) role is integral to this, working psychologically to support the team to improve collaborative working, and supporting patients to make changes to improve their health across management of long-term conditions, prevention and mental wellbeing. Patients' needs for higher-intensity interventions to enable changes in behaviour and self-management are, therefore, more fully met within primary care. The role also increases accessibility of psychological services, delivers earlier interventions and reduces stigma, since psychological staff are seen as part of the core primary care service. Although the UK has trialled a range of approaches to integrated care, these fall short of the highest level of integration. A single short pilot of integrated care in the UK showed positive results. Larger pilots with robust evaluation, as well as research trials are required. There are clearly challenges in adopting such an approach, especially for staff who must adapt to working more collaboratively with each other and patients. Strong leadership is needed to assist in this, particularly to support organisations to adopt the shift in values and attitudes towards collaborative working. CONCLUSIONS: Integrated primary care services that embed behavioural health as part of a multi-disciplinary team may be part of the solution to significant modern day health challenges. However, developing this model is unlikely to be straight-forward given current primary care structures and ways of working. The discussion, developed in this article, adds to our understanding of what the BHC role might consist off and how integrated care may be supported by such behavioural health expertise. Further work is needed to develop this model in the UK, and to evaluate its impact on health outcomes and health care utilisation, and test robustly through research trials.
Topic(s):
Education & Workforce
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View the DOI record for Behavioural health consultants in integrated primary care teams: a model for future care
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View the PubMed citation for Behavioural health consultants in integrated primary care teams: a model for future care1502
Behavioural health interventions in the Johns Hopkins Community Health Partnership: Integrated care as a component of health systems transformation
Type: Journal Article
Year: 2014
Publication Place: England
Abstract: Health systems in the USA have received a mandate to improve quality while reining in costs. Several opportunities have been created to stimulate this transformation. This paper describes the design, early implementation and lessons learned for the behavioural components of the John Hopkins Community Health Partnership (J-CHiP) programme. J-CHiP is designed to improve health outcomes and reduce the total healthcare costs of a group of high healthcare use patients who are insured by the government-funded health insurance programmes, Medicaid and Medicare. These patients have a disproportionately high prevalence of depression, other psychiatric conditions, and unhealthy behaviours that could be addressed with behavioural interventions. The J-CHiP behavioural intervention is based on integrated care models, which include embedding mental health professionals into primary sites. A four-session behaviour-based protocol was developed to motivate self-efficacy through illness management skills. In addition to staff embedded in primary care, the programme design includes expedited access to specialist psychiatric services as well as a community outreach component that addresses stigma. The progress and challenges involved with developing this programme over a relatively short period of time are discussed.
Topic(s):
Healthcare Policy
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, Healthcare Disparities
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, Financing & Sustainability
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1506
Beliefs about the causes of health complaints: a study in primary care
Type: Journal Article
Year: 2009
Publication Place: United States
Abstract: In public and interpersonal health communication, a need exists to explore the nature of lay beliefs about health complaints to achieve effective communication. Beliefs of patients visiting their family physician/general practitioner (GP) may give insight into this matter. The aim of this study was to investigate the spectrum of causes attributed to different categories of health complaints presented at the GP office. Before visiting their GP, 2,253 individuals completed a questionnaire about their health complaint and the cause they attributed to this complaint. The spectrum of causes attributed to all health complaints was compared between distinct categories of health complaints. Sixty-two percent of the GP patients attributed at least 1 cause to health complaints they presented at the GP office. Thirty-eight percent of GP patients did not attribute a cause to the health complaint they presented at the GP office. Patient beliefs differed across distinct health problems. Lay beliefs seemed to differ from basic notions of illness because patients attributed different causes to different health complaints. These differences in beliefs, when patients choose to share them with their GP, may serve as a starting point for the communication between the patients and the GP to achieve an effective communication. A need seems to emerge to discriminate between lay beliefs regarding the nature of specific illnesses and those regarding basic notions. GPs are therefore advised to attend to, or at least ask for, their patients' views specifically.
Topic(s):
Medically Unexplained Symptoms
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View the DOI record for Beliefs about the causes of health complaints: a study in primary care
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View the PubMed citation for Beliefs about the causes of health complaints: a study in primary care1507
Beliefs and attitudes about opioid prescribing and chronic pain management: Survey of primary care providers
Type: Journal Article
Year: 2014
Publication Place: United States
Abstract: OBJECTIVE: There is growing concern of medication misuse and noncompliance among patients with chronic pain prescribed opioids for pain. The aim of this survey was to obtain information from primary care providers (PCPs) about their perception of prescribing opioids for patients with chronic pain. METHODS: PCPs were invited to complete a packet of questionnaires about attitudes and concerns about opioids for chronic pain. These questionnaires included 1) General Health Questionnaire, 2) Test of Opioid Knowledge (TOK), 3) Opioid Therapy Provider Survey, and 4) Concerns About Analgesic Prescription Questionnaire. RESULTS: Fifty-six (N = 56) PCPs from eight centers participated in this study. In general, the PCPs showed adequate opioid knowledge on the KOT and their general health was unrelated to prescription attitudes. Most expressed concern about medication misuse (89 percent) and felt that managing patients with chronic pain was stressful (84 percent). Most were worried about addiction (82 percent) and less than half felt that they were sufficiently trained in prescribing opioids (46 percent). Younger providers felt more reluctant to prescribe opioids, experienced more stress in managing patients with pain, had less overall confidence in managing patients with pain, and worried more about opioid dependence than older providers (p < 0.05). Younger providers were also less knowledgeable about opioids, but opioid knowledge was not found to be related to concerns about analgesic prescriptions. CONCLUSION: This study indicates a general concern and reluctance of primary care physicians to manage the prescribing of opioids among their patients with chronic pain and younger providers expressed more concern about opioids than older providers.
Topic(s):
Education & Workforce
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, Opioids & Substance Use
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View the DOI record for Beliefs and attitudes about opioid prescribing and chronic pain management: Survey of primary care providers
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View the PubMed citation for Beliefs and attitudes about opioid prescribing and chronic pain management: Survey of primary care providers1509
Benchmarks for Reducing Emergency Department Visits and Hospitalizations Through Community Health Workers Integrated Into Primary Care: A Cost-Benefit Analysis
Type: Journal Article
Year: 2017
Publication Place: United States
Abstract: BACKGROUND: Uncertainty about the financial costs and benefits of community health worker (CHW) programs remains a barrier to their adoption. OBJECTIVES: To determine how much CHWs would need to reduce emergency department (ED) visits and associated hospitalizations among their assigned patients to be cost-neutral from a payer's perspective. RESEARCH DESIGN: Using a microsimulation of patient health care utilization, costs, and revenues, we estimated what portion of ED visits and hospitalizations for different conditions would need to be prevented by a CHW program to fully pay for the program's expenses. The model simulated CHW programs enrolling patients with a history of at least 1 ED visit for a chronic condition in the prior year, utilizing data on utilization and cost from national sources. RESULTS: CHWs assigned to patients with uncontrolled hypertension and congestive heart failure, as compared with other common conditions, achieve cost-neutrality with the lowest number of averted visits to the ED. To achieve cost-neutrality, 4-5 visits to the ED would need to be averted per year by a CHW assigned a panel of 70 patients with uncontrolled hypertension or congestive heart failure-approximately 3%-4% of typical ED visits among such patients, respectively. Most other chronic conditions would require between 7% and 12% of ED visits to be averted to achieve cost-savings. CONCLUSION: Offsetting costs of a CHW program is theoretically feasible for many common conditions. Yet the benchmark for reducing ED visits and associated hospitalizations varies substantially by a patient's primary diagnosis.
Topic(s):
Education & Workforce
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, Financing & Sustainability
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1511
Benefit-cost analysis of brief physician advice with problem drinkers in primary care settings
Type: Journal Article
Year: 2000
Publication Place: UNITED STATES
Abstract: BACKGROUND: Few studies have estimated the economic costs and benefits of brief physician advice in managed care settings. OBJECTIVE: To conduct a benefit-cost analysis of brief physician advice regarding problem drinking. DESIGN: Patient and health care costs associated with brief advice were compared with economic benefits associated with changes in health care utilization, legal events, and motor vehicle accidents using 6- and 12-month follow-up data from Project TrEAT (Trial for Early Alcohol Treatment), a randomized controlled clinical trial. SUBJECTS: 482 men and 292 women who reported drinking above a threshold limit were randomized into control (n = 382) or intervention (n = 392) groups. MEASURES: Outcomes included alcohol use, emergency department visits, hospital days, legal events, and motor vehicle accidents. RESULTS: No significant differences between control and intervention subjects were present for baseline alcohol use, age, socioeconomic status, smoking, depression or anxiety, conduct disorders, drug use, crimes, motor vehicle accidents, or health care utilization. The total economic benefit of the brief intervention was $423,519 (95% CI: $35,947, $884,848), composed of $195,448 (95% CI: $36,734, $389,160) in savings in emergency department and hospital use and $228,071 (95% CI: -$191,419, $757,303) in avoided costs of crime and motor vehicle accidents. The average (per subject) benefit was $1,151 (95% CI: $92, $2,257). The estimated total economic cost of the intervention was $80,210, or $205 per subject. The benefit-cost ratio was 5.6:1 (95% CI: 0.4, 11.0), or $56,263 in total benefit for every $10,000 invested. CONCLUSIONS: These results offer the first quantitative evidence that implementation of a brief intervention for problem drinkers can generate positive net benefit for patients, the health care system, and society.
Topic(s):
Financing & Sustainability
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Reference Links: View the PubMed citation for Benefit-cost analysis of brief physician advice with problem drinkers in primary care settings
1512
Benefits of a primary care clinic co-located and integrated in a mental health setting for veterans with serious mental illness
Type: Journal Article
Year: 2012
Publication Place: United States
Abstract: INTRODUCTION: Efficacy trials have shown that primary care co-located in the mental health setting improves the receipt of high-quality medical care among people with serious mental illness. We tested whether implementation of such a program affected health service use and cardiovascular risk factor control among veterans with serious mental illness who had previously demonstrated limited primary care engagement. METHODS: We performed a cohort study of veterans enrolled in a co-located, integrated primary care clinic in the mental health outpatient unit through targeted chart review. Two successive 6-month periods in the year before and in the year following enrollment in the co-located primary care clinic were examined for primary care and emergency department use and for goal attainment of blood pressure, fasting blood lipids, body mass index (BMI), and, among patients with diabetes, hemoglobin A1c (HbA1c). We used repeated-measures logistic regression to analyze goal attainment and repeated measures Poisson regression to analyze service use. RESULTS: Compared with the period before enrollment, the 97 veterans enrolled in the clinic had significantly more primary care visits during 6 months and significantly improved goal attainment for blood pressure, low-density lipoprotein cholesterol, triglycerides, and BMI. Changes with regard to goal attainment for high-density lipoprotein cholesterol and HbA1c were not significant. CONCLUSION: Enrollment in a co-located, integrated clinic was associated with increased primary care use and improved attainment of some cardiovascular risk goals among veterans with serious mental illness. Such a clinic can be implemented effectively in the mental health setting.
Topic(s):
Healthcare Policy
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1513
Benefits of integrated behavioral health services: The physician perspective
Type: Journal Article
Year: 2016
Publication Place: United States
Topic(s):
Education & Workforce
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Reference Links:
View the DOI record for Benefits of integrated behavioral health services: The physician perspective
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View the PubMed citation for Benefits of integrated behavioral health services: The physician perspective1516
Benefits of telephone care over primary care for smoking cessation: a randomized trial
Type: Journal Article
Year: 2006
Publication Place: United States
Abstract: BACKGROUND: Brief clinician intervention and telephone counseling are both effective aids for smoking cessation. However, the potential benefit of telephone care above and beyond routine clinician intervention has not been examined previously. The objective of this study is to determine if telephone care increases smoking cessation compared with brief clinician intervention as part of routine health care. METHODS: This 2-group, prospective, randomized controlled trial enrolled 837 daily smokers from 5 Veterans Affairs medical centers in the upper Midwest. The telephone care group (n = 417) received behavioral counseling with mailing of smoking cessation medications as clinically indicated. The standard care group (n = 420) received intervention as part of routine health care. The primary outcome was self-reported 6-month duration of abstinence 12 months after enrollment. Secondary outcomes were 7-day point prevalence abstinence at 3 and 12 months, participation in counseling programs, and use of smoking cessation medications. RESULTS: Using intention-to-treat procedures, we found that the rate of 6-month abstinence at the 12-month follow-up was 13.0% in the telephone care group and 4.1% in the standard care group (odds ratio [OR], 3.50; 95% confidence interval [CI], 1.99-6.15). The rate of 7-day point prevalence abstinence at 3 months was 39.6% in the telephone care group and 10.1% in the standard care group (OR, 5.84; 95% CI, 4.02-8.50). Telephone care compared with standard care increased the rates of participation in counseling programs (97.1% vs 24.0%; OR, 96.22; 95% CI, 52.57-176.11) and use of smoking cessation medications (89.6% vs 52.3%; OR, 7.85; 95% CI, 5.34-11.53). CONCLUSION: Telephone care increases the use of behavioral and pharmacologic assistance and leads to higher smoking cessation rates compared with routine health care provider intervention.
Topic(s):
HIT & Telehealth
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View the DOI record for Benefits of telephone care over primary care for smoking cessation: a randomized trial
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View the PubMed citation for Benefits of telephone care over primary care for smoking cessation: a randomized trial1517
Benzodiazepine maintenance in opiate substitution treatment: Good or bad? A retrospective primary care case-note review
Type: Journal Article
Year: 2017
Publication Place: United States
Abstract:
BACKGROUND: Co-prescribing benzodiazepines to patients in opiate substitution treatment is controversial and often alleged to increase mortality. In an inner-London general practice, patients with problematic benzodiazepine co-dependence were allowed benzodiazepine maintenance treatment (BMT) since 1994, providing an opportunity for analysis. METHOD: 1) Case-note review of all 278 opiate substitution treatment patients, accruing 1289 patient treatment years; 46% had concurrent BMT. 2) National Health Service database search for patients who died after leaving accrued a further 883 years of information; only patients who left the UK were unaccounted for (4%). Three groups were studied: 1) never obtained benzodiazepine prescription (NOB): n=80); 2) briefly/occasionally prescribed benzodiazepines (BOP): n=71; 3) BMT: n=127. OUTCOMES MEASURED: Treatment retention (months); deaths/100 patient treatment years; deaths after leaving the service/100 years of information. RESULTS: Treatment retention: NOB: 34 months; BOP: 51 months; BMT: 72 months. In-treatment mortality: NOB: 1.79/100 patient treatment years; BOP: 0.33/100 patient treatment years; BMT: 1.31/100 patient treatment years. Deaths after leaving service: NOB: 2.24/100 years of information, BOP: 0.63/100 years of information. However, mortality for previously BMT-patients increased by 450% to 5.90/100 years of information. DISCUSSION: BMT patients had longer treatment retention than NOB or BOP and lower mortality than NOB patients. It is unlikely that patients had access to prescribed benzodiazepines on leaving the service because of restrictions in the national guidelines but co-dependent patients are a high-risk group who may stand to gain most benefit from opiate substitution treatment if combined with benzodiazepine-maintenance.
Topic(s):
Education & Workforce
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, Opioids & Substance Use
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Reference Links:
View the DOI record for Benzodiazepine maintenance in opiate substitution treatment: Good or bad? A retrospective primary care case-note review
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View the PubMed citation for Benzodiazepine maintenance in opiate substitution treatment: Good or bad? A retrospective primary care case-note review1518
Benzodiazepine-Involved Overdose Deaths in the USA: 2000-2019
Type: Journal Article
Year: 2022
Publication Place: United States
Topic(s):
Healthcare Disparities
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, Opioids & Substance Use
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Reference Links:
View the DOI record for Benzodiazepine-Involved Overdose Deaths in the USA: 2000-2019
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View the PubMed citation for Benzodiazepine-Involved Overdose Deaths in the USA: 2000-20191519
Best clinical practice: guidelines for managing major depression in primary medical care
Type: Journal Article
Year: 1999
Abstract: Abstract: Practice guidelines such as those of the United States Public Health Service Agency for Health Care Policy and Research have been instrumental in addressing the significant problem of how best to manage major depression in primary medical care settings. Since this set of guidelines was published in 1993, new findings from randomized clinical trials and extensive clinical experience permit us to reevaluate trends in treatment of major depression in primary medical care. This review suggests guidelines for achieving best clinical practice given current knowledge.
Topic(s):
Education & Workforce
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Reference Links: View the PubMed citation for Best clinical practice: guidelines for managing major depression in primary medical care