Benefits of integrated behavioral health services: The physician perspective.

Abstract: Contents: M.E. Maruish, Preface. Part I:General Considerations. M.E. Maruish, Introduction. C.J. Peek, R. Heinrich, Integrating Behavioral Health and Primary Care. M. Evers-Szostak, Integration of Behavioral Health Care Services in Pediatric Primary Care Settings. L.R. Derogatis, L.L. Lynn, II, Screening and Monitoring Psychiatric Disorder in Primary Care Populations. C.L. Ofstead, D.S. Gorban, D.L. Lum, Integrating Behavioral Health Assessment With Primary Care Services. Part II:Assessment Instruments. S.R. Hahn, K. Kroenke, J.B.W. Williams, R.L. Spitzer, Evaluation of Mental Disorders With the PRIME-MD. G.R. Grissom, K.I. Howard, Directions and COMPASS-PC. J. Shedler, The Shedler QPD Panel (Quick PsychoDiagnostics Panel): A Psychiatric "Lab Test" for Primary Care. L.R. Derogatis, K.L. Savitz, The SCL-90-R and Brief Symptom Inventory (BSI) in Primary Care. M.E. Maruish, Applications of the Symptom Assessment-45 Questionnaire (SA-45) in Primary Care Settings. P.J. Brantley, S.K. Jeffries, Daily Stress Inventory (DSI) and Weekly Stress Inventory (WSI). P.J. Brantley. D.J. Mehan, Jr., J.L. Thomas, The Beck Depression Inventory (BDI) and the Center for Epidemiologic Studies Depression Scale (CES-D). K.A. Kobak, W.M. Reynolds, The Hamilton Depression Inventory. T.L. Kramer, G.R. Smith, Tools to Improve the Detection and Treatment of Depression in Primary Care. F. Scogin, N. Rohen, E. Bailey, Geriatric Depression Scale. R.J. Ferguson, Using the Beck Anxiety Inventory in Primary Care. L.J. Davis, Self-Administered Alcoholism Screening Test (SAAST). G.J. Demakis, M.G. Mercury, J.J. Sweet, Screening for Cognitive Impairments in Primary Care Settings. H.P. Wetzler, D.L. Lum, D.M. Bush, Using the SF-36 Health Survey in Primary Care. A. Murray, D.G. Safran, The Primary Care Assessment Survey: A Tool for Measuring, Monitoring, and Improving Primary Care. S.R. Hahn, The Difficult Doctor Patient Relationship Questionnaire. Part III:Primary and Behavioral Health Care Integration Projects. P. Robinson, K. Strosahl, Improving Care for a Primary Care Population: Depression as an Example. A. Beck, C. Nimmer, A Case Study: The Kaiser Permanente Integrated Care Project. L. Goldstein, B. Bershadsky, M.E. Maruish, The INOVA Primary Behavioral Health Care Pilot Project. Part IV:Future Directions. K.A. Kobak, J.C. Mundt, D.J. Katzelnick, Future Directions in Psychological Assessment and Treatment in Primary Care Settings.

Abstract: Background: The NHS policy of constructing multispecialty community providers (MCPs) rests on a complex set of assumptions about how health systems can replace hospital use with enhanced primary care for people with complex, chronic or multiple health problems, while contributing savings to health-care budgets. Objectives: To use policy-makers’ assumptions to elicit an initial programme theory (IPT) of how MCPs can achieve their outcomes and to compare this with published secondary evidence and revise the programme theory accordingly. Design: Realist synthesis with a three-stage method: (1) for policy documents, elicit the IPT underlying the MCP policy, (2) review and synthesise secondary evidence relevant to those assumptions and (3) compare the programme theory with the secondary evidence and, when necessary, reformulate the programme theory in a more evidence-based way. Data sources: Systematic searches and data extraction using (1) the Health Management Information Consortium (HMIC) database for policy statements and (2) topically appropriate databases, including MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Applied Social Sciences Index and Abstracts (ASSIA). A total of 1319 titles and abstracts were reviewed in two rounds and 116 were selected for full-text data extraction. We extracted data using a formal data extraction tool and synthesised them using a framework reflecting the main policy assumptions. Results: The IPT of MCPs contained 28 interconnected context–mechanism–outcome relationships. Few policy statements specified what contexts the policy mechanisms required. We found strong evidence supporting the IPT assumptions concerning organisational culture, interorganisational network management, multidisciplinary teams (MDTs), the uses and effects of health information technology (HIT) in MCP-like settings, planned referral networks, care planning for individual patients and the diversion of patients from inpatient to primary care. The evidence was weaker, or mixed (supporting some of the constituent assumptions but not others), concerning voluntary sector involvement, the effects of preventative care on hospital admissions and patient experience, planned referral networks and demand management systems. The evidence about the effects of referral reductions on costs was equivocal. We found no studies confirming that the development of preventative care would reduce demands on inpatient services. The IPT had overlooked certain mechanisms relevant to MCPs, mostly concerning MDTs and the uses of HITs. Limitations: The studies reviewed were limited to Organisation for Economic Co-operation and Development countries and, because of the large amount of published material, the period 2014–16, assuming that later studies, especially systematic reviews, already include important earlier findings. No empirical studies of MCPs yet existed. Conclusions: Multidisciplinary teams are a central mechanism by which MCPs (and equivalent networks and organisations) work, provided that the teams include the relevant professions (hence, organisations) and, for care planning, individual patients. Further primary research would be required to test elements of the revised logic model, in particular about (1) how MDTs and enhanced general practice compare and interact, or can be combined, in managing referral networks and (2) under what circumstances diverting patients from in-patient to primary care reduces NHS costs and improves the quality of patient experience.

Abstract: Objective This paper examines how and why to improve care systems for disease management and health promotion for the growing population of cancer survivors with cardiovascular multi-morbidities. Method We reviewed research characterizing cancer survivors' and their multiple providers' common sense cognitive models of survivors' main health threats, preventable causes of adverse health events, and optimal coping strategies. Results Findings indicate that no entity in the health care system self-identifies as claiming primary responsibility to address longstanding unhealthy lifestyle behaviors that heighten survivors' susceptibility to both cancer and cardiovascular disease (CVD) and whose improvement could enhance quality of life. Conclusions To address this gap, we propose systems-level changes that integrate health promotion into existing survivorship services by including behavioral risk factor vital signs in the electronic medical record, with default proactive referral to a health promotionist (a paraprofessional coach adept with mobile technologies and supervised by a professional expert in health behavior change). By using the patient's digital tracking data to coach remotely and periodically report progress to providers, the health promotionist closes a gap, creating a connected care system that supports, reinforces, and maintains accountability for healthy lifestyle improvement. No comparable resource solely dedicated to treatment of chronic disease risk behaviors (smoking, obesity, physical inactivity, treatment nonadherence) exists in current models of integrated care. Integrating health promotionists into care delivery channels would remove burden from overtaxed PCPs and instantiate a comprehensive, actionable systems-level schema of health risks and coping strategies needed to have preventive impact with minimal interference to clinical work flow. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Abstract: The aim of the study is to analyze how the patient’s rights are respected in Romanian hospitals and how important is communication for the medical staff. During this study, we have analyzed the results of an application form with 152 indicators, from Reference no. 6 “Patient’s rights and communication”, from Accreditation Standards, used by The National Authority of Quality Management in Healthcare, in 146 Romanian hospitals, from a total of 433 medical units. The study revealed that there are some recurrent problems related to patient’s rights and communication, such as: access in hospitals of people with disabilities, aspects related to informed consent, or communication between medical staff and patients or caregivers.

Abstract: INTRODUCTION Although there is a rapid increase in the integration of behavioral health services in primary care, few studies have evaluated the effectiveness of these services in real-world clinical settings, in part due to the difficulty of translating traditional mental health research designs to this setting. Accordingly, innovative approaches are needed to fit the unique challenges of conducting research in primary care. The development and implementation of one such approach is described in this article. METHOD A continuously populating database for psychotherapy services was implemented across 5 primary care clinics in a large health system to assess several levels of patient care, including service utilization, symptomatic outcomes, and session-by-session use of psychotherapy principles by providers. RESULTS Each phase of implementation revealed challenges, including clinician time, dissemination to clinics with different resources, and fidelity of data collection strategy across providers, as well as benefits, including the generation of useful data to inform clinical care, program development, and empirical research. DISCUSSION The feasible and sustainable implementation of data collection for routine clinical practice in primary care has the potential to fuel the evidence base around integrated care. The current project describes the development of an innovative approach that, with further empirical study and refinement, could enable health care professionals and systems to understand their population and clinical process in a way that addresses essential gaps in the integrated care literature. (PsycINFO Database Record

Abstract: A self-assessment scale has been developed and found to be a reliable instrument for detecting states of depression and anxiety in the setting of an hospital medical outpatient clinic. The anxiety and depressive subscales are also valid measures of severity of the emotional disorder. It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.

Abstract: Objectives: To develop a 10-minute cognitive screening tool (Montreal Cognitive Assessment, MoCA) to assist first-line physicians in detection of mild cognitive impairment (MCI), a clinical state that often progresses to dementia. Design: Validation study. Setting: A community clinic and an academic center. Participants: Ninety-four patients meeting MCI clinical criteria supported by psychometric measures, 93 patients with mild Alzheimer's disease (AD) (Mini-Mental State Examination (MMSE) score≥17), and 90 healthy elderly controls (NC). Measurements: The MoCA and MMSE were administered to all participants, and sensitivity and specificity of both measures were assessed for detection of MCI and mild AD. Results: Using a cutoff score 26, the MMSE had a sensitivity of 18% to detect MCI, whereas the MoCA detected 90% of MCI subjects. In the mild AD group, the MMSE had a sensitivity of 78%, whereas the MoCA detected 100%. Specificity was excellent for both MMSE and MoCA (100% and 87%, respectively). Conclusion: MCI as an entity is evolving and somewhat controversial. The MoCA is a brief cognitive screening tool with high sensitivity and specificity for detecting MCI as currently conceptualized in patients performing in the normal range on the MMSE.

Abstract: Background: Insomnia is a prevalent health complaint that is often difficult to evaluate reliably. There is an important need for brief and valid assessment tools to assist practitioners in the clinical evaluation of insomnia complaints.Objective: This paper reports on the clinical validation of the Insomnia Severity Index (ISI) as a brief screening measure of insomnia and as an outcome measure in treatment research. The psychometric properties (internal consistency, concurrent validity, factor structure) of the ISI were evaluated in two samples of insomnia patients.Methods: The first study examined the internal consistency and concurrent validity of the ISI in 145 patients evaluated for insomnia at a sleep disorders clinic. Data from the ISI were compared to those of a sleep diary measure. In the second study, the concurrent validity of the ISI was evaluated in a sample of 78 older patients who participated in a randomized-controlled trial of behavioral and pharmacological therapies for insomnia. Change scores on the ISI over time were compared with those obtained from sleep diaries and polysomnography. Comparisons were also made between ISI scores obtained from patients, significant others, and clinicians.Results: The results of Study 1 showed that the ISI has adequate internal consistency and is a reliable self-report measure to evaluate perceived sleep difficulties. The results from Study 2 also indicated that the ISI is a valid and sensitive measure to detect changes in perceived sleep difficulties with treatment. In addition, there is a close convergence between scores obtained from the ISI patient's version and those from the clinician's and significant other's versions.Conclusions: The present findings indicate that the ISI is a reliable and valid instrument to quantify perceived insomnia severity. The ISI is likely to be a clinically useful tool as a screening device or as an outcome measure in insomnia treatment research.

Abstract: {CI}, �3.59 to �1.40], �2.63 [95% CI, �3.73 to �1.54], and �1.63 [95% CI, �2.73 to �0.53] at 6, 12, and 18 months, respectively). At 12 months, response and remission rates (CALM vs UC) were 63.66% (95% CI, 58.95%-68.37%) vs 44.68% (95% CI, 39.76%-49.59%), and 51.49% (95% CI, 46.60%-56.38%) vs 33.28% (95% CI, 28.62%-37.93%), with a number needed to treat of 5.27 (95% CI, 4.18-7.13) for response and 5.50 (95% CI, 4.32-7.55) for remission. Conclusion For patients with anxiety disorders treated in primary care clinics, CALM compared with UC resulted in greater improvement in anxiety symptoms, depression symptoms, functional disability, and quality of care during 18 months of follow-up.