A Model of Enhanced Primary Care for Patients with Severe Mental Illness

Perrin, Jacob; Reimann, Brie; Capobianco, Jeff; Wahrenberger, Jack Todd; Sheitman, Brian; Steiner, Beat

doi:10.18043/ncm.79.4.240

Cited by 16 publications

(13 citation statements)

References 16 publications

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“…The primary care services at WakeBrook tailored for individuals with SMI include the following: smaller patient panels, allowing providers to spend more time with each patient building trust; training for providers on working with people with SMI, to help providers understand the unique needs and challenges of this population and learn how to de-escalate crisis situations; and regular communication between PCPs and patients' behavioral health providers, enabling proactive planning to address patients' complex needs. 30 WakeBrook receives referrals of people with SMI who are receiving outpatient behavioral healthcare from community providers but are not in primary care. As such, WakeBrook is generally not responsible for delivering regular outpatient psychiatric care to its patients, though patients can receive crisis and inpatient care at the co-located behavioral health facility.…”

Section: Introductionmentioning

confidence: 99%

Effect of Enhanced Primary Care for People with Serious Mental Illness on Service Use and Screening

et al. 2021

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Section: Introductionmentioning

confidence: 99%

Effect of Enhanced Primary Care for People with Serious Mental Illness on Service Use and Screening

et al. 2021

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“…[2][3][4][5][6][7][8][9][10] Regardless of housing status, patients with SMI often struggle to navigate medical care 2,7 ; they may report dissatisfaction with access to primary care and the coordination of services received. 11 In light of perceived discrimination reported by PEH in primary care, 12,13 and the central role of primary care in addressing the mortality gap for persons with SMI, 14 there is a pressing need to identify clinic paradigms that optimize care experiences for PEH with SMI.…”

Section: Introductionmentioning

confidence: 99%

Enhancing Primary Care Experiences for Homeless Patients with Serious Mental Illness: Results from a National Survey

Gabrielian

Jones

Hoge

et al. 2021

J Prim Care Community Health

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Objectives: Patients experiencing homelessness (PEH) with serious mental illness (SMI) have poor satisfaction with primary care. We assessed if primary care teams tailored for homeless patients (Homeless-Patient Aligned Care Teams (H-PACTs)) provide this population with superior experiences than mainstream primary care and explored whether integrated behavioral health and social services were associated with favorable experiences. Methods: We surveyed VA PEH with SMI (n = 1095) to capture the valence of their primary care experiences in 4 domains (Access/Coordination, Patient-Clinician Relationships, Cooperation, and Homeless-Specific Needs). We surveyed clinicians (n = 52) from 29 H-PACTs to elucidate if their clinics had embedded mental health, addiction, social work, and/or housing services. We counted these services in each H-PACT (0-4) and classified H-PACTs as having high (3-4) versus low (0-2) service integration. We controlled for demographics, housing history, and needs in comparing H-PACT versus mainstream experiences; and experiences in high versus low integration H-PACTs. Results: Among respondents, 969 (91%) had complete data and 626 (62%) were in H-PACTs. After covariate adjustment, compared to mainstream respondents, H-PACT respondents were more likely ( P < .01) to report favorable experiences (AORs = 1.7-2.1) and less likely to report unfavorable experiences (AORs = 0.5-0.6) in all 4 domains. Of 29 H-PACTs, 27.6% had high integration. High integration H-PACT respondents were twice as likely as low integration H-PACT respondents to report favorable access/coordination experiences (AOR = 1.7). Conclusions: Homeless-tailored clinics with highly-integrated services were associated with better care experiences among PEH with SMI. These observational data suggest that tailored primary care with integrated services may improve care perceptions among complex patients.

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“…Patients diagnosed with a behavioral health condition frequently have chronic medical comorbidities [4,5,[12][13][14][15]. The association of mental illness with chronic disease contributes to the inefficient use of health care services (eg, increased inpatient hospital utilization) [5,[16][17][18]. Other factors such as infrequent use of primary care and preventive services, poor chronic disease management, and the use of antipsychotic medications [19][20][21][22][23] also contribute to the overutilization of hospital services.…”

Section: Introductionmentioning

confidence: 99%

“…Behavioral health patients require coordinated care but often fail to receive it [ 17 , 26 ]. This level of care requires better communication and information sharing between general medical and behavioral health care providers.…”

Section: Introductionmentioning

confidence: 99%

Intention to Use Behavioral Health Data From a Health Information Exchange: Mixed Methods Study

Cochran¹,

Feldman²,

Ivankova³

et al. 2021

JMIR Ment Health

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Background Patients with co-occurring behavioral health and chronic medical conditions frequently overuse inpatient hospital services. This pattern of overuse contributes to inefficient health care spending. These patients require coordinated care to achieve optimal health outcomes. However, the poor exchange of health-related information between various clinicians renders the delivery of coordinated care challenging. Health information exchanges (HIEs) facilitate health-related information sharing and have been shown to be effective in chronic disease management; however, their effectiveness in the delivery of integrated care is less clear. It is prudent to consider new approaches to sharing both general medical and behavioral health information. Objective This study aims to identify and describe factors influencing the intention to use behavioral health information that is shared through HIEs. Methods We used a mixed methods design consisting of two sequential phases. A validated survey instrument was emailed to clinical and nonclinical staff in Alabama and Oklahoma. The survey captured information about the impact of predictors on the intention to use behavioral health data in clinical decision making. Follow-up interviews were conducted with a subsample of participants to elaborate on the survey results. Partial least squares structural equation modeling was used to analyze survey data. Thematic analysis was used to identify themes from the interviews. Results A total of 62 participants completed the survey. In total, 63% (n=39) of the participants were clinicians. Performance expectancy (β=.382; P=.01) and trust (β=.539; P<.001) predicted intention to use behavioral health information shared via HIEs. The interviewees (n=5) expressed that behavioral health information could be useful in clinical decision making. However, privacy and confidentiality concerns discourage sharing this information, which is generally missing from patient records altogether. The interviewees also stated that training for HIE use was not mandatory; the training that was provided did not focus specifically on the exchange of behavioral health information. Conclusions Despite barriers, individuals are willing to use behavioral health information from HIEs if they believe that it will enhance job performance and if the information being transmitted is trustworthy. The findings contribute to our understanding of the role HIEs can play in delivering integrated care, particularly to vulnerable patients.

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A Model of Enhanced Primary Care for Patients with Severe Mental Illness

Cited by 16 publications

References 16 publications

Effect of Enhanced Primary Care for People with Serious Mental Illness on Service Use and Screening

Effect of Enhanced Primary Care for People with Serious Mental Illness on Service Use and Screening

Enhancing Primary Care Experiences for Homeless Patients with Serious Mental Illness: Results from a National Survey

Intention to Use Behavioral Health Data From a Health Information Exchange: Mixed Methods Study

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