Outcomes of Integrated Behavioral Health with Primary Care

Balasubramanian, Bijal A.; Cohen, Deborah J.; Jetelina, Katelyn K.; Dickinson, L. Miriam; Davis, Melinda M.; Gunn, Rose; Gowen, L. Kris; deGruy, Frank V.; Miller, Benjamin F.; Green, Larry A.

doi:10.3122/jabfm.2017.02.160234

Cited by 77 publications

(65 citation statements)

References 32 publications

(42 reference statements)

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“…29–31 This momentum to change practice and policy is crucial because integrated care is specifically designed to identify and address patient medical and behavioral health care needs together and to improve quality, patient experience, and reduce costs. 4,6,32–35 …”

Section: Discussionmentioning

confidence: 99%

Evaluation of an Electronic Health Record (EHR) Tool for Integrated Behavioral Health in Primary Care

et al. 2018

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Background: Integrating behavioral health into primary care can improve care quality; however, most electronic health records are not designed to meet the needs of integrated teams. We worked with practices and behavioral health (BH) clinicians to design a suite of electronic health record tools to address these needs (“BH e-Suite”). The purpose of this article is to examine whether implementation of the BH e-Suite changes process of care, intermediate clinical outcomes, and patient experiences, and whether its use is acceptable to practice members and BH clinicians. Methods: We conducted a convergent mixed-methods proof-of-concept study, implementing the BH e-Suite across 6 Oregon federally qualified community health centers (“intervention clinics”). We matched intervention clinics to 6 control clinics, based on location and patient panel characteristics, to assess whether process of care (Patient Health Questionnaire-9 [PHQ-9] and Generalized Anxiety Disorder-7 screening) and intermediate outcomes (PHQ-9, Generalized Anxiety Disorder-7 scores) changed postimplementation. Prepost patient surveys were used to assess changes in patient experience. To elucidate factors influencing implementation, we merged quantitative findings with structured observations, surveys, and interviews with practice members. Results: Implementation improved process of care (PHQ-9 screening). During the course of the study, change in intermediate outcomes was not observed. Degree of BH e-Suite implementation varied: 2 clinics fully implemented, 2 partially implemented, and 2 practices did not implement at all. Initial practice conditions (eg, low resistance to change, higher capacity), process characteristics (eg, thoughtful planning), and individual characteristics (eg, high self-efficacy) were related to degree of implementation. Conclusions: Health information technology tools designed for behavioral health integration must fit the needs of clinics for the successful uptake and improvement in patient experiences. Research is needed to further assess the effectiveness of this tool in improving patient outcomes and to optimize broader dissemination of this tool among primary care clinics integrating behavioral health. ( J Am Board Fam Med 2018;31:712–723.)

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Section: Discussionmentioning

confidence: 99%

Evaluation of an Electronic Health Record (EHR) Tool for Integrated Behavioral Health in Primary Care

et al. 2018

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“…4,9 Higher levels of coordination and team-based care between physicians and behavioral health providers not only help to foster effective collaboration, but can also impact patient outcomes and cost effetiveness. [12][13][14] There are some limitations to note. This study was cross sectional and did not track burnout rates across several years for PCPs.…”

Section: Discussionmentioning

confidence: 99%

Associations Between Integrated Care Practice and Burnout Factors of Primary Care Physicians

Zubatsky

Pettinelli

Salas

et al. 2018

Fam Med

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Background and Objectives: Physician burnout is increasingly problematic across many health care settings. Despite this trend, little is known about whether the type of collaboration in these settings may potentially help curb this trend. We explored whether higher levels of integrated care practice are associated with reduced burnout for physicians across settings. Methods: A national survey was sent to health care professionals who work in a variety of medical settings. Primary care physicians (n=288) were a subset of this sample and were asked about their practice demographics and perceptions of burnout. A shortened version of the Maslach Burnout Inventory (MBI) assessed for areas of burnout in physicians. Results: Higher levels of integrated care were associated with higher personal accomplishment (B=1.89, 95% CI:0.47, 3.31) and lower depersonalization (B=-2.48, 95% CI:-4.54, -0.42) in routine practice on the MBI. No significant associations were found between MBI scores and both years of practice at a current site or number of providers at the site. Conclusions: While physician burnout continues to be a worsening problem, integrated care may be an additional strategy to help curb this trend. Administrators need to consider the value of integrated practice in addressing physician wellness—the potentially next big aim of health care.

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“…The answers to these questionnaires should be analyzed along with the symptoms of patients and clinical evaluation. 3 The patient health questionnaire (PHQ-9) is a useful tool for the screening of depression. It is very easily implemented and can offer diagnostic results very quickly in the primary healthcare setting.…”

Section: Introductionmentioning

confidence: 99%

Depression, obstructive sleep apnea and psychosocial health

Jehan¹,

Auguste

Pandi‐Perumal³

et al. 2017

SMDIJ

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Depression and Obstructive sleep apnea (OSA) are the major associated comorbidities. OSA is a rapidly growing problem in the society that is connected to the rising rates of obesity; at the same time, the depression rate is also increasing day by day. Patients with OSA present with sleep problems, anxiety, and depressive symptoms, depressive patients can also present with the same symptoms. The quality of an individual's health can be improved by the early detection of the symptoms of overlapping OSA and depression. By addressing these issues early, the associated healthcare costs and burden can be reduced simultaneously.

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Outcomes of Integrated Behavioral Health with Primary Care

Cited by 77 publications

References 32 publications

Evaluation of an Electronic Health Record (EHR) Tool for Integrated Behavioral Health in Primary Care

Evaluation of an Electronic Health Record (EHR) Tool for Integrated Behavioral Health in Primary Care

Associations Between Integrated Care Practice and Burnout Factors of Primary Care Physicians

Depression, obstructive sleep apnea and psychosocial health

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