Toward a Unified Integration Approach: Uniting Diverse Primary Care Strategies Under the Primary Care Behavioral Health (PCBH) Model

Sandoval, Brian; Bell, Jennifer; Khatri, Parinda; Robinson, Patricia J.

doi:10.1007/s10880-017-9516-9

Cited by 29 publications

(18 citation statements)

References 42 publications

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“…The Primary Care Community Health-based model of service delivery includes patient-centered care delivery strategies that can improve clinical outcomes, cost, and patient and primary care provider satisfaction with services. [18] Implementing pain management approach in Primary Care setting, potentially providing a more effective, safe, and more satisfactory alternative to opioid-based chronic pain treatment. [19]…”

Section: Discussionmentioning

confidence: 99%

Chronic musculoskeletal pain among elderly in rural Tamil Nadu: Mixed-method study

Kirubakaran¹,

Dongre

2019

J Family Med Prim Care

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Objectives: (1) To determine the prevalence of chronic pain of musculoskeletal origin at different body sites among elderly (≥60 years). (2) To study the determinants of chronic pain and the healthcare seeking behavior among elderly with chronic pain. (3) To explore the perceptions of chronic pain among elderly. Materials and Methods: This study was done in 55 field practice villages of the Rural Health Training Centre (RHTC) of the Department of Community Medicine, SMVMCH, Puducherry. An Exploratory Mixed-Method study design, where a qualitative phase (in-depth interviews [IDI]) followed the quantitative phase (Survey). A representative sample of 850 respondents was selected by two-stage cluster sampling. A trained investigator did a house-to-house visit and interviewed selected elderly respondents by using predesigned and pretested questionnaire. The intensity of chronic pain was measured using the Functional Rating Scale and Numeric Rating Scale. The manual content analysis was done for qualitative data. Multiple logistic regression was performed on quantitative data. Results: Qualitative data were described under two broad themes: (1) perceptions of elderly people about chronic pain and 2) healthcare seeking and coping mechanisms. Prevalence of chronic pain among the elderly respondents was found to be 47.6%. Most common site for chronic pain was knee joint (64.5%) followed by a low backache (21.7%). Most of the older people with chronic pain had mild-to-moderate and tolerable pain. Two predictors for chronic pain were the age of the respondent (adjusted OR -1.03, 95% CI = 1.01–1.05) and the presence of at least one chronic morbidity (adjusted OR -1.37, 95% CI = 1.03–1.82). Conclusions and Recommendations: Since the chronic pain was found to be associated with aging and the presence of at least one of the chronic morbidities, it is crucial for treating community physicians to consider the comorbid conditions while managing chronic pain in elderly. Considering the complex nature of chronic pain in old age, the primary care physician should be trained in drug and context-specific nondrug interventions to address the biomedical causes and other cognitive-behavior factors, respectively, through active support from their family and neighborhood.

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Section: Discussionmentioning

confidence: 99%

Chronic musculoskeletal pain among elderly in rural Tamil Nadu: Mixed-method study

Kirubakaran¹,

Dongre

2019

J Family Med Prim Care

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“…Primary care settings are integrating behavioral health providers in greater numbers using a variety of clinical models . One model, Primary Care Behavioral Health (PCBH), calls for a Behavioral Health Consultant (BHC) to be included as a full member of the care team and for the BHC to provide treatment according to a primary care model of brief, focused, high‐volume interventions instead of conducting traditional independent psychotherapy sessions . Behavioral Health Consultants in this model are available for same‐day interventions and educate the rest of the team to improve behavioral health knowledge and skills.…”

Section: Introductionmentioning

confidence: 99%

Measuring the integration of primary care and behavioral health services

Mullin

Hargreaves

Auxier

et al. 2019

Health Services Research

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Objective To perform a factor analysis of the Practice Integration Profile (PIP), a 30‐item practice‐level measure of primary care and behavioral health integration derived from the Agency for Healthcare Research and Quality's Lexicon for Behavioral Health and Primary Care Integration. Data Sources The PIP was completed by 735 individuals, representing 357 practices across the United States. Study Design The study design was a cross‐sectional survey. An exploratory factor analysis and assessment of internal consistency reliability via Cronbach's alpha were performed. Data Collection Methods Participant responses were collected using REDCap, a secure, web‐based data capture tool. Principal Findings Five of the PIP's six domains had factor loadings for most items related to each factor representing the PIP of 0.50 or greater. However, one factor had items from two PIP domains that had loadings >0.50. A five‐factor model with redistributed items resulted in improved factor loadings for all domains along with greater internal consistency reliability (>0.80). Conclusions Five of the PIP's six domains demonstrated excellent internal consistency for measures of health care resources. Although minor improvements to strengthen the PIP are possible, it is a valid and reliable measure of the integration of primary care and behavioral health.

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“…For patients, the baseline assessment will take place before randomisation and include a set of validated questionnaires: PHQ-9,25 GAD-7,12 German version of the Recovery Assessment Scale,40 EQ-5D,41 Somatic Symptom Disorder–B Criteria Scale42 and Patient Assessment of Chronic Illness Care 43. Following the Medical Research Council guidance on developing and evaluating complex interventions,44 a health-economic evaluation is planned for the main trial.…”

Section: Methods and Analysismentioning

confidence: 99%

“…Both CC and PCBH have been implemented successfully in the US healthcare system 12. However, even in the USA, where the mean number of primary care physicians per practice is much higher than in European countries, such as the UK, France and Germany, small and remote practices especially in rural areas often do not have the resources to employ an additional MHS 13.…”

Section: Introductionmentioning

confidence: 99%

Mental health specialist video consultations for patients with depression or anxiety disorders in primary care: protocol for a randomised controlled feasibility trial

et al. 2019

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IntroductionMost people suffering from depression and anxiety disorders are entirely treated in primary care. Due to growing challenges in ageing societies, for example, patients’ immobility and multimorbidity, the transition to specialised care becomes increasingly difficult. Although the co-location of general practitioners and mental health specialists improves the access to psychosocial care, integrated in-person approaches are not practical for rural and single-doctor practices with limited personnel and financial resources. Treating primary care patients via internet-based video consultations by remotely located mental health specialists bears the potential to overcome structural barriers and provide low-threshold care. The aim of this randomised controlled feasibility trial is to investigate the feasibility of implementing of mental health specialist video consultations in primary care practices.Methods and analysisFifty primary care patients with significant depression and/or anxiety symptomatology will be randomised in two groups receiving either the treatment as usual as provided by their general practitioner or up to five video consultations conducted by a mental health specialist. The video consultations focus on (1) systematic diagnosis plus proactive monitoring using validated clinical rating scales, (2) the establishment of an effective working alliance and (3) a stepped-care algorithm within integrated care adjusting treatments based on clinical outcomes. We will investigate the following outcomes: effectiveness of the recruitment strategies, patient acceptance of randomisation, practicability of the technical and logistical processes related to implementing video consultations in the practices’ workflows, feasibility of the data collection and clinical parameters.Ethics and disseminationThis trial has undergone ethical scrutiny and has been approved by the Medical Faculty of the University of Heidelberg Ethics Committee (S-634/2018). The findings will be disseminated to the research community through presentations at conferences and publications in scientific journals. This feasibility trial will prepare the ground for a large-scale, fully powered randomised controlled trial.Trial registration numberDRKS00015812.

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Toward a Unified Integration Approach: Uniting Diverse Primary Care Strategies Under the Primary Care Behavioral Health (PCBH) Model

Cited by 29 publications

References 42 publications

Chronic musculoskeletal pain among elderly in rural Tamil Nadu: Mixed-method study

Chronic musculoskeletal pain among elderly in rural Tamil Nadu: Mixed-method study

Measuring the integration of primary care and behavioral health services

Mental health specialist video consultations for patients with depression or anxiety disorders in primary care: protocol for a randomised controlled feasibility trial

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