Outcomes of a quality improvement project integrating mental health into primary care

Watts, Bradley V.; Shiner, Brian; Pomerantz, Andrew S.; Stender, Patricia; Weeks, William B.

doi:10.1136/qshc.2007.022418

Cited by 41 publications

(42 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As originally envisioned by VA policymakers in 2006, collocated care was to be collocated collaborative care, based on the White River Junction VA literature. [54][55][56][57] This model offers open access to MH and has demonstrated improvement in depression care. Operational definitions of collocated collaborative care in the field, however, required only collocating one or more MHS (i.e., psychiatrists, psychologists, social workers or advanced practice nurses) in PC.…”

Section: Discussionmentioning

confidence: 99%

Determinants of Readiness for Primary Care-Mental Health Integration (PC-MHI) in the VA Health Care System

et al. 2012

View full text Add to dashboard Cite

BACKGROUND: Depression management can be challenging for primary care (PC) settings. While several evidence-based models exist for depression care, little is known about the relationships between PC practice characteristics, model characteristics, and the practice's choices regarding model adoption. OBJECTIVE: We examined three Veterans Affairs (VA)-endorsed depression care models and tested the relationships between theoretically-anchored measures of organizational readiness and implementation of the models in VA PC clinics. DESIGN: 1) Qualitative assessment of the three VAendorsed depression care models, 2) Cross-sectional survey of leaders from 225 VA medium-to-large PC practices, both in 2007. MAIN MEASURES:We assessed PC readiness factors related to resource adequacy, motivation for change, staff attributes, and organizational climate. As outcomes, we measured implementation of one of the VA-endorsed models: collocation, Translating Initiatives in Depression into Effective Solutions (TIDES), and Behavioral Health Lab (BHL). We performed bivariate and, when possible, multivariate analyses of readiness factors for each model. KEY RESULTS: Collocation is a relatively simple arrangement with a mental health specialist physically located in PC. TIDES and BHL are more complex; they use standardized assessments and care management based on evidence-based collaborative care principles, but with different organizational requirements. By 2007, 107 (47.5 %) clinics had implemented collocation, 39 (17.3 %) TIDES, and 17 (7.6 %) BHL. Having established quality improvement processes (OR 2.30, [1.36,3.87], p=0.002) or a depression clinician champion (OR 2.36, [1.14, 4.88], p=0.02) was associated with collocation. Being located in a VA regional network that endorsed TIDES (OR 8.42, [3.69,19.26], p<0.001) was associated with TIDES implementation. The presence of psychologists or psychiatrists on PC staff, greater financial sufficiency, or greater spatial sufficiency was associated with BHL implementation. CONCLUSIONS: Both readiness factors and characteristics of depression care models influence model adoption. Greater model simplicity may make collocation attractive within local quality improvement efforts. Dissemination through regional networks may be effective for more complex models such as TIDES.

show abstract

Section: Discussionmentioning

confidence: 99%

Determinants of Readiness for Primary Care-Mental Health Integration (PC-MHI) in the VA Health Care System

et al. 2012

View full text Add to dashboard Cite

show abstract

“…The evidence was strongest for the implementation of PCMH, which consistently resulted in shorter wait times for both primary care and mental health appointments. 14,15,[17][18][19] A finding of particular interest in the PCMH literature was that integration at varying levels (e.g., colocation versus walk in access 1 day per week) resulted in improved access, suggesting that a range of models may yield positive effects. 14 The opening of CBOCs and the use telemedicine each had four studies showing that they resulted in improved access for veterans.…”

Section: Discussionmentioning

confidence: 99%

“…In regard to process outcomes, Watts et al found that more veterans at the VAMC received "optimal depression treatment" following integration. 15 Similarly, Shiner et al found that more veterans at the VAMC received care for depression, fewer veterans received no depression treatment, more veterans received care in mental health clinics, and more veterans received optimal care. 14 When implementing primary care into mental health clinics, Druss et al found that veterans in the PCMH condition had more primary care visits, fewer ER visits, received more preventative services, and reported greater satisfaction with care across a number of domains.…”

Section: 19mentioning

confidence: 99%

“…Watts et al examined a primary care clinic before and after PCMH integration at a VAMC and associated CBOCs. 15 After PCMH integration wait times for appointments in the mental health clinic decreased substantially. None of these differences were significant at the CBOCs.…”

Section: 1819mentioning

confidence: 99%

“…[14][15][16][17][18][19] One study was rated as good, 17 two as fair, 15,16 and two as of low methodological quality.…”

Section: Primary Care Mental Health Integrationmentioning

confidence: 99%

See 2 more Smart Citations

Interventions to Improve Veterans’ Access to Care: A Systematic Review of the Literature

et al. 2011

View full text Add to dashboard Cite

Women’s Health: Obstetrics and Gynecology

Geller

Nelson²,

Kornfield³

et al. 2014

Handbook of Clinical Psychology in Medical Settings

View full text Add to dashboard Cite

Outcomes of a quality improvement project integrating mental health into primary care

Cited by 41 publications

References 16 publications

Determinants of Readiness for Primary Care-Mental Health Integration (PC-MHI) in the VA Health Care System

Determinants of Readiness for Primary Care-Mental Health Integration (PC-MHI) in the VA Health Care System

Interventions to Improve Veterans’ Access to Care: A Systematic Review of the Literature

Women’s Health: Obstetrics and Gynecology

Contact Info

Product

Resources

About