Literature Collection

Many people face problems about physical, mental, and social dimensions of health, and may have complex needs. They often experience a mismatch between their needs and the ability of the healthcare system to meet them, resulting in under- or overutilization of the healthcare system. On one hand, improving access to community-based primary healthcare for hard-to-reach populations should bring all healthcare and social services to one point of contact, near the community. On the other hand, better addressing the unmet needs of people who overuse healthcare services calls for integrated care among providers across all settings and sectors. In either case, intersectoral action between healthcare and social professionals and resources remains central to bringing care closer to the people and the community, enhancing equitable access, and improving health status. However, efforts to implement integrated care are unevenly weighted toward clinical and professional strategies (micro level), which could jeopardize our ability to implement and sustain integrated care. The development of appropriate policies and governance mechanisms (macro level) is essential to break down silos, promote a coherent intersectoral action, and improve health equity.

BACKGROUND: The integration of mental health services within primary care settings is a growing priority in Canada, driven by the need to improve access and ensure comprehensive patient-centred care. This year-long pilot quality improvement (QI) project was conducted to examine the feasibility and impact of introducing monthly telephone consultations between primary care physicians (PCPs) and psychiatrists working at a secondary care regional hospital in Ontario, Canada. METHODS: PCPs were connected with a team of psychiatrists via email on a voluntary basis. Once connected, PCPs were encouraged to contact psychiatrists by text or email to book monthly telephone consultation for patient care. RESULTS: A total of seven PCPs and five psychiatrists participated in this project. A total of 66 patients were discussed via telephone consultations between PCPs and psychiatrists and 11 of these patients were referred to psychiatry for further assessment. The number of referrals to psychiatry O-P service from the seven PCPs involved in this pilot decreased from 83 for the period of November 2021 to October 2022 to 53 for the period of this project, that is, November 2022 to October 2023.There were initial challenges in scheduling consultations due to busy practices. After the first few months of regular monthly contact, three psychiatrists reported fewer ongoing contacts with PCPs and that PCPs email them on an as needed basis. Two psychiatrists continued to have ongoing 4-6 weeks contact with their assigned PCP, discussing on average 3-4 patients, after 1 year.Psychiatrists found the telephone meetings productive and the PCPs were appreciative of the support provided and were willing to take over the primary care of some patients under the care of the psychiatrists, who had medical needs but no PCP. CONCLUSION: This pilot QI project confirms the feasibility and successful collaborations between PCPs and psychiatrists through monthly phone calls.

OBJECTIVES: Although cognitive behavioral therapy is an effective intervention for chronic pain, it is a lengthy treatment typically applied only in specialty care settings. The aim of this project was to collect preliminary effectiveness data for Brief Cognitive Behavioral Therapy for Chronic Pain (Brief CBT-CP), an abbreviated, modular form of treatment designed for use in primary care. METHODS: A clinical demonstration project was conducted in which Brief CBT-CP was delivered to primary care patients by 22 integrated care providers practicing in the Primary Care Behavioral Health model of Veterans Health Administration primary care clinics. Brief measures were used at each appointment to collect patient-reported clinical outcomes. RESULTS: One hundred eighteen patients provided sufficient data for analysis (male, 75%; mean age, 51.4 y). Multilevel modeling suggested that a composite measure of pain intensity and functional limitations showed statistically significant improvements by the third appointment (Cohen's d=0.65). Pain-related self-efficacy outcomes showed a similar pattern of results but of smaller effect size (Cohen's d=0.22). The exploratory analysis identified that Brief CBT-CP modules addressing psychoeducation and goal setting, pacing, and relaxation training were associated with the most significant gains in treatment outcomes. DISCUSSION: These findings provide early support for the effectiveness of Brief CBT-CP when delivered by providers in every day Primary Care Behavioral Health settings. Results are discussed in relation to the need for additional research regarding the potential value of employing safe, population-based, nonpharmacological approaches to pain management in primary care.