Benefits of integrated behavioral health services: The physician perspective.
TL;DR: Primary care physicians may be motivated to integrate behavioral health services into their clinics knowing that other physicians believe that it directly and indirectly improves patient care and physician stress.
Abstract: Introduction There are benefits of integrating a behavioral health specialist in primary care; however, little is known about the physicians' perspectives. The purpose of this study was to explore primary care physicians' beliefs regarding the benefits of integrated care for both patients and themselves. Method Fifteen senior staff physicians and 78 residents completed surveys regarding their opinions of referring to a psychologist in a patient-centered medical home. Results The top reasons that physicians believed their patients followed through with a visit with an integrated psychologist included that they recommended it (79.5%) and that patients can be seen in the same primary care clinic (76.9%). The overwhelming majority of physicians were satisfied with having access to an integrated psychologist (97.4%). Physicians believed that integrated care directly improves patient care (93.8%), is a needed service (90.3%), and helps provide better care to patients (80.9%). In addition, physicians reported that having an integrated psychologist reduces their personal stress level (90.1%). Conclusion Primary care physicians may be motivated to integrate behavioral health services into their clinics knowing that other physicians believe that it directly and indirectly improves patient care and physician stress.
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TL;DR: It is demonstrated that this modest marketing effort significantly increased the number of individuals who were referred for cognitive impairment screening, and this increase was maintained over time.
Abstract: INTRODUCTION Cognitive impairment is a growing concern that is costly for individuals and health care systems and is often undiagnosed. Early recognition of cognitive impairment allows patients and families the opportunity to discuss long-term care planning and to arrange financial and legal affairs. Identification of cognitive impairment allows for better evaluation and accommodation of functional deficits. Most individuals with cognitive impairment receive care exclusively through primary care. Primary care providers are typically overburdened, and subsequently cognitive impairment may be unrecognized and untreated. Efficient methods of detecting cognitive impairment are needed in primary care. METHOD The present investigation examined the effect of a simple marketing strategy on the frequency of referral for cognitive screening in primary care. The frequency of referral for cognitive screening was measured for the 12 months prior to and following the marketing effort. Data for the period 2 years after the marketing effort were examined to determine if increases in referral for cognitive screening were maintained. RESULTS Results demonstrate that this modest marketing effort significantly increased the number of individuals who were referred for cognitive impairment screening, and this increase was maintained over time. Also, the majority of those who were evaluated screened positive for cognitive impairment. DISCUSSION This brief marketing effort increased the frequency of referral for cognitive screening and identified individuals with cognitive impairment in primary care. Implications for future research and for management of cognitive impairment in primary care are detailed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
2 citations
11 Oct 2021
TL;DR: In this article, effective and appropriate provision of mental healthcare has long been a struggle globally, resulting in significant disparity between prevalence of mental illness and access to care, and a significant number of individuals suffer from mental health disorders.
Abstract: Introduction:Effective and appropriate provision of mental healthcare has long been a struggle globally, resulting in significant disparity between prevalence of mental illness and access to care. ...
1 citations
TL;DR: A sample of the most commonly used measures of concussion symptomology is reviewed and psychologists’ role in their application in a pediatric practice is explored and other issues such as accessibility and the appropriateness of application with child and adolescent patients are discussed.
Abstract: An estimated 1.1 to 1.9 million children and adolescents in the United States are treated for a sports- or recreationally-related concussion each year. The importance of formalized assessment and measurement of concussion symptoms has been widely recognized as a component of best-practice treatment. The present paper reviews a sample of the most commonly used measures of concussion symptomology and explores psychologists' role in their application in a pediatric practice. In addition, other issues such as accessibility and the appropriateness of application with child and adolescent patients are discussed. Literature is reviewed from journals pertaining to pediatric and adolescent medicine, sports medicine, neuropsychology, and testing and measurement.
1 citations
Cites background from "Benefits of integrated behavioral h..."
...Although there is little research on the role of psychologists in pediatric concussion care, many physicians recognize the contributions of integrated psychologists as needed to improve the overall care of patients [3]....
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DOI•
01 Jan 2020
TL;DR: This study suggests that biases in detection of MH needs in integrated primary care are less pronounced than in non-integrated primary care and that longstanding disparities in MH treatment may persevere in this newer model of primary care.
Abstract: PREDICTORS OF MENTAL HEALTH NEED AND TREATMENT IN SAFETY NET PRIMARY CARE By: Kristen O’Loughlin, M.A. A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science at Virginia Commonwealth University. Virginia Commonwealth University, 2020 Director: Bruce Rybarczyk, Ph.D. Professor, Department of Psychology Many mental health (MH) needs go unidentified in primary care, and certain patients appear to be at higher risk of needs going unidentified and subsequently untreated. Little is known about patterns of detection and treatment in clinics with integrated mental health services. The purpose of this study was to characterize the prevalence of MH needs and evaluate patient characteristics as predictors of both the presence of a MH need and type of MH services received. Subjects were patients receiving care at two safety net primary care clinics with integrated mental health services (N=816; 52.7% Latinx, 15.9% African American), and were classified as either having received integrated MH services in the previous year or as not. Sociodemographic and medical information was extracted from all medical records, and patients who had not received integrated MH services completed a MH needs assessment. The prevalences for depression, suicidal ideation, anxiety and PTSD were within expected ranges. Surprisingly, patient characteristics did not predict the presence of a MH need, though several characteristics predicted the type of MH treatment received. Patients were less likely to receive integrated MH services if they were older (χ2(1) = 7.36, p= .007), Hispanic/Latinx (χ2(1) = 7.97, p= .005), and/or partnered (χ2(1) = 20.65, p= .000). This study suggests that biases in detection of MH needs in integrated primary care Running head: PREDICTORS OF NEED AND TREATMENT 6 may be less pronounced than in non-integrated primary care. However, longstanding disparities in MH treatment may persevere in this newer model of primary care. Running head: PREDICTORS OF NEED AND TREATMENT 7 Predictors of Mental Health Need and Treatment in Safety Net Primary Care Background Untreated mental illness is a major economic and medical burden to the United States. Poor health outcomes have been directly linked to depression (Kinder et al., 2008), anxiety (ElGabalawy et al., 2014), and post-traumatic stress (Andersen et al., 2010; Felitti et al., 1998). Not surprisingly, these mental health needs are often present in patients that interact with the healthcare system at higher frequencies (Greene et al., 2016). Epidemiological research shows that psychiatric disorders are more prevalent in primary care settings than the general population. This puts primary care physicians in a unique position to identify mental health needs early on and connect their patients to appropriate treatment. Unfortunately, mental health services are often challenging for patients to attain even once a need has been identified. The majority of primary care physicians report difficulty in finding and arranging outpatient mental health services (Trude & Stoddard, 2003). Further, only a small percentage of patients follow-up on referrals. Additional barriers to connecting patients to the services they need are cost, stigma, (Mental Health: A Report of the Surgeon General, 1999) transportation, and other logistical barriers (Sadock et al., 2017). To combat these barriers, various forms of collaborative care models have been implemented coordinating care between primary care physicians (PCP) and mental health specialists. The integrated behavioral healthcare (IBHC) model is characterized by having psychologists housed within the primary care clinic, sharing space, medical files, and working collaboratively with physicians (American Psychiatric Association, 2016). This model is particularly efficient in providing populationfocused care for the community in that it is provides emergent, brief interventions on an asneeded basis (Bryan et al., 2009, 2012). Running head: PREDICTORS OF NEED AND TREATMENT 8 IBHC has recently gained significant support, propelling its expansion throughout healthcare systems. Expansion to safety net clinics is particularly important due to the great need for behavioral health services within the populations they serve. Safety net clinics are characterized as serving free or reduced cost services to patients regardless of health insurance status (Sadock et al., 2014). High-utilizer patients of these clinics tend to be low-income, insured by Medicaid or Medicare, and are faced with a high burden of mental health, social, and chronic medical conditions (Bell et al., 2017). Safety net clinics therefore serve a critical role in providing healthcare services to individuals who would otherwise experiences barriers to access. Behavioral health interventions delivered to patients within primary care clinics have shown to improve psychiatric symptoms and distress (Bryan et al., 2009, 2012; Corso et al., 2012; Landis et al., 2013; Mcfeature & Pierce, 2012; Sadock et al., 2017), improve health outcomes (Woltmann et al., 2012), and reduce overall healthcare costs (Jacob et al., 2012; Stephenson et al., 2019). It is clear that psychiatric distress can be effectively managed at a reasonable cost using brief evidence-based interventions within an IBHC model. However, to successfully manage these needs, physicians must first be able to identify patients with need and refer them to the behavioral health clinicians. Currently, research suggests that patients are not being identified in an equitable manner. In the following sections, I will summarize what is known about the prevalence of common psychiatric disorders in primary care, particularly safety net clinics, how well they are identified by physicians, and which patients are at increased risk of non-detection. Our knowledge of biases in physician detection and referral to behavioral health services must be incorporated into improving current integrated safety net clinics. IBHC will not be able to reach Running head: PREDICTORS OF NEED AND TREATMENT 9 its full potential until patients’ mental health needs are more frequently identified and subsequently more patients are connected to treatment.
1 citations
19 Jul 2019
TL;DR: This presentation investigates both the challenges and facilitators of this model of care while demonstrating the benefits of integrative behavioral health.
Abstract: Summary: Integrated behavioral health is a model of care that focuses on providing mental health services in the primary care setting. This presentation investigates both the challenges and facilitators of this model while demonstrating the benefits of integrative behavioral health. Content Outline:
1 citations
Cites background from "Benefits of integrated behavioral h..."
...• Early identification and referral to treatment • Low “no-show” rates for appointments • Decrease in stigmatism • Ease of access (Miller-Matero et al., 2016)....
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References
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TL;DR: 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: 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.
35,518 citations
"Benefits of integrated behavioral h..." refers methods in this paper
...…Assessment to assess for cognitive functioning (Nasreddine et al., 2005), the Hospital Anxiety and Depression Scale to assess for current psychiatric symptoms (Zigmond & Snaith, 1983), and the Insomnia Severity Index to assess for current sleep difficulties (Bastien, Vallières, & Morin, 2001)....
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TL;DR: 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.
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.
16,037 citations
TL;DR: The clinical validation of the Insomnia Severity Index (ISI) indicates that the ISI is a reliable and valid instrument to quantify perceived insomnia severity and is likely to be a clinically useful tool as a screening device or as an outcome measure in insomnia treatment research.
5,143 citations
TL;DR: 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.
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.
409 citations