Primary care integration in rural areas: A community-focused approach.

Selby-Nelson, Emily M.; Bradley, Joshua M.; Schiefer, Rebekah A.; Hoover-Thompson, Alysia

doi:10.1037/fsh0000352

Cited by 19 publications

(16 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Unlike urban models which are fixed, rural PHC services are highly needs-based and flexible and this is exacerbated in line with emerging pandemic and local conditions. 46 Other than treating regular clients and managing potentially infectious patients, new or revamped preventative clinics may be needed, including targeted vaccination clinics, prescription services by phone and advanced care planning. These serve to better position the community and free up the available primary resources for responding to new infectious cases.…”

Section: Responsementioning

confidence: 99%

<p>Rural Pandemic Preparedness: The Risk, Resilience and Response Required of Primary Healthcare</p>

O’Sullivan

Leader

Couch

et al. 2020

RMHP

View full text Add to dashboard Cite

Pandemic situations present enormous risks to essential rural primary healthcare (PHC) teams and the communities they serve. Yet, the pandemic policy development for rural contexts remains poorly defined. This article draws on reflections of the rural PHC response during the COVID-19 pandemic around three elements: risk, resilience, and response. Rural communities have nuanced risks related to their mobility and interaction patterns coupled with heightened population needs, socioeconomic disadvantage, and access and health service infrastructure challenges. This requires specific risk assessment and communication which addresses the local context. Pandemic resilience relies on qualified and stable PHC teams using flexible responses and resources to enable streams of pandemicrelated healthcare alongside ongoing primary healthcare. This depends on problem solving within limited resources and using networks and collaborations to enable healthcare for populations spread over large geographic catchments. PHC teams must secure systems for patient retrieval and managing equipment and resources including providing for situations where supply chains may fail and staff need rest. Response consists of rural PHC teams adopting new preventative clinics, screening and ambulatory models to protect health workers from exposure whilst maximizing population screening and continuity of healthcare for vulnerable groups. Innovative models that emerge during pandemics, including telehealth clinics, may bear specific evaluation for informing ongoing rural health system capabilities and patient access. It is imperative that mainstream pandemic policies recognize the nuance of rural settings and address resourcing and support strategies to each level of rural risk, resilience, and response for a strong health system ready for surge events.

show abstract

Section: Responsementioning

confidence: 99%

<p>Rural Pandemic Preparedness: The Risk, Resilience and Response Required of Primary Healthcare</p>

O’Sullivan

Leader

Couch

et al. 2020

RMHP

View full text Add to dashboard Cite

show abstract

“…One limitation is that distance between hub and extension clinics (and therefore the length of time patients needed to drive) varied, which may have differentially impacted show, cancel, and schedule rates for different clinics. Furthermore, typical of rural community resources, limited public transportation and possible financial strain of travel and securing a vehicle may have impacted access (Selby-Nelson et al, 2018). Future research may aim to investigate the relationship between distance between clinic and patient's home with show rate.…”

Section: Limitations and Future Directionsmentioning

confidence: 99%

Hub-extension model and access to pediatric behavioral integrated primary care.

Lilly

Meadows

Sevecke-Hanrahan

et al. 2020

Clinical Practice in Pediatric Psychology

View full text Add to dashboard Cite

Objective: Investigation into models of integrated behavioral health primary care and innovative adaptations of these models can help address challenges associated with behavioral health service delivery. To date, few studies have examined access to pediatric behavioral health treatment in primary care, and no known studies have investigated access for pediatric patients in a hub-extension model. In this model, behavioral health providers receive referrals from both hub clinics (integrated sites in which behavioral health providers treat patients) and extension clinics (coordinated off-sites without behavioral health providers). Method: This study investigated differences in latency between referrals and intakes, scheduling rates, and intake show rates between patients from extension versus hub clinics using retrospective electronic medical record data from pediatric patients referred for behavioral health in primary care over an 8-month period. Results: During the time frame, 766 patient referrals were placed from 3 hub clinics and 6 extension clinics (483 hub; 283 extension). Of those referred, 98 patients never scheduled (36 hub; 62 extension). Patients were more likely to schedule intakes following referrals from hub clinics (92.3%) than extension clinics (78.1%). In addition, hub patients (M ϭ 14.2, SD ϭ 12.4) scheduled for sooner initial appointments than extension patients (M ϭ 25.0, SD ϭ 19.8). Hub clinic patients were 2.4 times more likely to cancel and 2.2 times more likely to not show than extension clinic patients. Conclusions: Although additional research on the hub-extension model of behavioral health implementation is needed, this study provides a preliminary examination into the innovative alteration of integrated care models. Implications for Impact StatementThis study is the first known examination of the hub-extension model of pediatric integrated primary care. Results indicated patients referred from hub clinics were more likely to be scheduled for an intake with shorter wait times. Hub clinic patients were also more likely to cancel or not show for intake appointments.

show abstract

“…Many patients prefer to receive behavioral health services through their primary care provider's office, rather than seeking out specialty mental health services (Selby-Nelson et al, 2018). To address unmet mental health needs, the practice of colocating behavioral health services in primary care settings is gaining traction.…”

mentioning

confidence: 99%

“…Hoff et al (2020) identify several factors that suggest primary care and behavioral health integration including coordinated care, colocation of behavioral health providers, integrated care (e.g., shared electronic health record [EHR]), and collaborative care (e.g., shared treatment plan) can enhance continuity and quality of care. Previous studies indicate that primary care patients are more inclined to comply with referrals for behavioral health services, when behavioral health services are offered on-site (Selby-Nelson et al, 2018). Rural residents are less likely to receive behavioral health treatment as compared to their urban counterparts, and are more inclined to receive general medical care (Wang et al, 2005).…”

mentioning

confidence: 99%

“…Mental health disparities exist between rural and urban residents within the United States. Rural residents experience disproportionately higher risk factors for chronic illness, substance use disorders, and suicide than their urban counterparts (Selby-Nelson et al, 2018). Barriers related to availability and access to behavioral health services compound the problem for rural residents.…”

mentioning

confidence: 99%

See 1 more Smart Citation

The impact of warm handoffs on patient engagement with behavioral health services in primary care.

Mitchell¹,

Randolph²

2022

Journal of Rural Mental Health

View full text Add to dashboard Cite

Although an integrated primary care-behavioral health model is gaining momentum in healthcare, there is a dearth of research supporting the benefits of warm handoffs. A warm handoff is a formal introduction to a behavioral health clinician by another medical professional, often facilitated in the exam room during the visit. This exploratory study (n = 93) examined association between warm handoffs and initial and subsequent visit rates in a rural New England primary care practice setting. Patients with a warm handoff at the time of referral were much more likely to schedule a behavioral health visit (100% vs. 58%; p = .003). Among all initially referred patients, 92.3% of warm handoff patients had a subsequent behavioral health visit compared to 50% ( p = .005) without the in-person therapist contact. These findings provide evidence that warm handoffs can enhance patient engagement with behavioral health services in primary care settings when there is colocation of behavioral health services. Public Health Significance StatementThis study explored the potential benefit of primary care providers facilitating a referral for counseling in real time by introducing the patient to the on-site behavioral health clinician, a process known as a "warm handoff." Results showed a significantly higher rate of attendance to the first counseling session for patients who were formally introduced in person by their primary care provider than the more traditional method of putting in a request for the behavioral health clinician to call the patient at some point after their medical visit. Results from this study support evidence that warm handoffs may aid a higher rate of patient engagement, which in turn may enhance continuity and quality of care.

show abstract

Primary care integration in rural areas: A community-focused approach.

Cited by 19 publications

References 24 publications

<p>Rural Pandemic Preparedness: The Risk, Resilience and Response Required of Primary Healthcare</p>

<p>Rural Pandemic Preparedness: The Risk, Resilience and Response Required of Primary Healthcare</p>

Hub-extension model and access to pediatric behavioral integrated primary care.

The impact of warm handoffs on patient engagement with behavioral health services in primary care.

Contact Info

Product

Resources

About