There is so much good research coming out in the field of integrated care. Trying to keep up with all the new developments can feel like drinking from a fire hydrant. So, to save you time and keep you from overhydrating, your friendly neighborhood blog editor is here to separate the wheat from the chaff.
The studies you see below represent some of the best research coming out. I organized them into categories for easier reading and hope you find one that can make an immediate impact on your work. The categories are Implementation (evidence- and practice-based guidelines), Interventions (patient treatments), Specific Populations (integrated care for discrete patient groups), Attitudes and Perceptions (what people think of integrated care), Workforce Development (preparing the next generation of providers), and Outcome Research (end results of care delivery research).
Each category includes an abstract from the article that seems most impactful and then links to other research articles. If you found a recent article that is not listed here and want to right that wrong, please contact me and I will make sure we highlight it in a future blog post.
Sustaining integrated behavioral health practice without sacrificing the continuum of care
Abstract: This article describes how an innovative model of practice transformation, used by 4 integrated pediatric primary care practices over a 2 year grant period, promoted the practice of integrated primary care (IPC) behavioral health services. Practice transformation was possible through the implementation of an alternative billing strategy to enhance sustainability, effective utilization of clinical productivity to provide meaningful patient services, and the identification of strategies to further the practice of IPC. Specifically, we provide: (a) a description of the diversity of billing strategies typically used by pediatric practices utilizing integrated care and how those strategies are impacted by state health care policies; (b) a description of the grant, including the service delivery model, implementation phase, and data collection procedures; (c) results of implementation and billing/reimbursement data that were collected across the 4 practices; (d) an analysis of how billing strategies are critical in defining implementation strategies within pediatric integrated care; and (e) lessons learned about how billing strategies must be flexible and amenable to change over time to stay current with ever-changing health care policies and reimbursement models. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
1. Cost-savings analysis of primary care behavioral health in a pediatric setting: Implications for provider agencies and training programs.
2. What are the effective elements in patient-centered and multimorbidity care? A scoping review
3. The Core Dimensions of Integrated Care: A Literature Review to Support the Development of a Comprehensive Framework for Implementing Integrated Care
Adapting empirically supported treatments in the era of integrated care: A roadmap for success
Abstract: The emerging era of integrated care represents a major opportunity for clinical psychology to migrate empirically supported treatments (ESTs) into the mainstream of public health. To succeed will require us to modify current ESTs to make them brief, cost‐effective, patient‐centered and acceptable to and easily learned by both the mental health and health‐care professionals that will deliver them. Changes to the recently modified standards for designating ESTs are proposed that will facilitate adoption of a population health model of treatment development and testing, designed to promote rapid dissemination of empirically supported interventions that are a “good fit” for integrated settings. Defining characteristics of the “new look” for ESTs are examined.
Behavioral medicine interventions for adult primary care settings: A review.
Family Functioning in Pediatric Primary Care Patients
Abstract: Introduction. The purpose of this study was to pilot a brief measure of family functioning (Family Assessment Device–General Functioning [FAD_GF]) with caregivers of children aged 2 to 18 years, seen for routine pediatric primary care visits. Methods. This study evaluated the psychometric properties of the FAD_GF in a pediatric primary care sample of 400 families. Confirmatory factor analysis was used to validate the FAD_GF using R, and WLSMV was used to estimate missing variables. Results. The FAD_GF was found to be reliable with this sample, α = .90. The model fit was χ2(54) = 56.44, P = .38, with root mean square error of approximation = .01 and comparative fit index = .99. The 12 items were significantly predicted by family functioning, and family functioning explained more than 20% of the variance in the items, R2 > .25. Overall, 12.6% (n = 46) of families were identified as having clinically impaired family functioning. Discussion. The FAD_GF provides clinicians the ability to make evidence-informed decisions regarding referrals to family therapists.
Acceptability, feasibility and outcome of a screening programme for complicated grief in integrated primary and behavioural health care clinics
Integrated perinatal mental health care: a national model of perinatal primary care in vulnerable populations
Integrated care models for ADHD in children and adolescents: A systematic review.
Primary care integration in rural areas: A community-focused approach.
ATTITUDES AND PERCEPTIONS
Stigmatizing attitudes of primary care professionals towards people with mental disorders: A systematic review
To examine stigmatizing attitudes towards people with mental disorders among primary care professionals and to identify potential factors related to stigmatizing attitudes through a systematic review.
A systematic literature search was conducted in Medline, Lilacs, IBECS, Index Psicologia, CUMED, MedCarib, Sec. Est. Saúde SP, WHOLIS, Hanseníase, LIS-Localizador de Informação em Saúde, PAHO, CVSO-Regional, and Latindex, through the Virtual Health Library portal (http://www.bireme.br website) through to June 2017. The articles included in the review were summarized through a narrative synthesis.
After applying eligibility criteria, 11 articles, out of 19.109 references identified, were included in the review. Primary care physicians do present stigmatizing attitudes towards patients with mental disorders and show more negative attitudes towards patients with schizophrenia than towards those with depression. Older and more experience doctors have more stigmatizing attitudes towards people with mental illness compared with younger and less-experienced doctors. Health-care providers who endorse more stigmatizing attitudes towards mental illness were likely to be more pessimistic about the patient’s adherence to treatment.
Stigmatizing attitudes towards people with mental disorders are common among physicians in primary care settings, particularly among older and more experienced doctors. Stigmatizing attitudes can act as an important barrier for patients to receive the treatment they need. The primary care physicians feel they need better preparation, training, and information to deal with and to treat mental illness, such as a user friendly and pragmatic classification system that addresses the high prevalence of mental disorders in primary care and community settings.
Integrated primary care: patient perceptions and the role of mental health stigma
Providing Mental Health Services in the Primary Care Setting: the Experiences and Perceptions of General Practitioners at a New York City Clinic
Integrating Mental Health into Primary Care: Training Current and Future Providers
Abstract: In this chapter the authors will discuss an important aspect of the integration of behavioral health (specifically psychiatry) and primary care from a global perspective. The chapter examines this topic through the continuum of medical education, from medical student to psychiatry residency, and concludes with a discussion of post-residency continuing education opportunities. Current psychiatry residents share their experience in working in an integrated primary care clinic, highlighting the challenges and rewards. The need to fully integrate this concept into all aspects of medical training is the primary goal of the authors. This will require a change in culture from the existing specialty-driven approach to patient care. It will also help address the current crisis in limited access to mental health care around the world. There will never be an adequate number of psychiatrists given the current model of mental health-care delivery. This is not a new problem, but altering current training experiences has the potential to begin this necessary transition in mental health-care delivery. Achieving this goal will improve the overall quality of life for patients worldwide.
Integrated Behavioral Health and Social Work: a Global Perspective
Developing a Computer Application to Prepare Social Workers for Integrated Health Care: Integrated Healthcare (Version 1.0)
Online CBT training for mental health providers in primary care
Community Mental Health Center Integrated Care Outcomes
Abstract: Despite the compelling logic for integrating care for people with serious mental illness, there is also need for quantitative evidence of results. This retrospective analysis used 2013–2015 data from seven community mental health centers to measure clinical processes and health outcomes for patients receiving integrated primary care (n = 18,505), as well as hospital use for the 3943 patients with hospitalizations during the study period. Bivariate and regression analyses tested associations between integrated care and preventive screening rates, hemoglobin A1c levels, and hospital use. Screening rates for body-mass index, blood pressure, smoking, and hemoglobin A1c all increased very substantially during integrated care. More than half of patients with baseline hypertension had this controlled within 90 days of beginning integrated care. Among patients hospitalized at any point during the study period, the probability of hospitalization in the first year of integrated care decreased by 18 percentage points, after controlling for other factors such as patient severity, insurance status, and demographics (p < .001). The average length of stay was also 32% shorter compared to the year prior to integrated care (p < .001). Savings due to reduced hospitalization frequency alone exceeded $1000 per patient. Data limitations restricted this study to a pre−/post-study design. However, the magnitude and consistency of findings across different outcomes suggest that for people with serious mental illness, integrated care can make a significant difference in rates of preventive care, health, and cost-related outcomes.
How Do Innovative Primary Care Practices Achieve the Quadruple Aim?