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Journal ArticleDOI

Benefits of integrated behavioral health services: The physician perspective.

01 Mar 2016-Families, Systems, & Health (Fam Syst Health)-Vol. 34, Iss: 1, pp 51-55
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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Journal ArticleDOI
TL;DR: Results of pediatricians’ experiences working in an integrated healthcare setting are discussed with regard to their implications for clinical practice and research.
Abstract: An integrated healthcare model incorporates behavioral health services into a medical setting to address patients’ physical, emotional, and behavioral healthcare concerns. The integrated healthcare model has been associated with positive patient satisfaction and health outcomes, yet limited studies have examined, using qualitative methods, physicians’ experiences of working alongside behavioral health consultants (BHCs) in integrated healthcare settings. Data was gathered through semi-structured interviews with pediatricians (N=4) working in an integrated healthcare model. Participants shared that as pediatricians they received personal, educational, and organizational benefits from an integrated healthcare model. Pediatricians also reported increased knowledge in effectively addressing mental health concerns for their patients and decreased physician stress-levels. Results of pediatricians’ experiences working in an integrated healthcare setting are discussed with regard to their implications for clinical practice and research.

Cites background or result from "Benefits of integrated behavioral h..."

  • ...Research has shown that physicians, including pediatricians, support the integration of BHCs because of ease of internal referral process, the reduction of mental health stigma, improvement of patient care, and lowering physician stress (Funderburk et al., 2010; Miller-Matero et al., 2016; Yamada et al., 2019)....

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  • ...…most studies on physicians’ perspectives of integrated health care have been collected only through instruments designed with Likert-type response items (Campbell et al., 2018; Ede et al., 2015; Godoy et al., 2017; Miller-Matero et al., 2016; Muther et al., 2016; Westheimer et al., 2008)....

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  • ...This is consistent with quantitative research on physicians’ perspectives on integrated health care models (Funderburk et al., 2010; Miller-Matero et al., 2016; Yamada et al., 2019)....

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  • ...…shown that physicians, including pediatricians, support the integration of BHCs because of ease of internal referral process, the reduction of mental health stigma, improvement of patient care, and lowering physician stress (Funderburk et al., 2010; Miller-Matero et al., 2016; Yamada et al., 2019)....

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  • ...research on physicians’ perspectives on integrated health care models (Funderburk et al., 2010; Miller-Matero et al., 2016; Yamada et al., 2019)....

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Journal ArticleDOI
TL;DR: The results of this pilot suggest that IBH training implementation is feasible, desirable, timely, and may improve resident ability to work on an IBH team.
Abstract: Objective Workforce development is essential for the dissemination of team-based integrated behavioral healthcare. There is limited literature on training family medicine residents to function within an integrated behavioral health (IBH) system. The purpose of this pilot study was to assess the feasibility and value of an IBH competency-based curriculum for family medicine residents across multiple programs. Methods Residency programs were recruited using professional listservs and networks to test a competency-based, multi-modal curriculum for preparing residents to practice IBH in primary care. Faculty instructors who led the workshop were invited to complete semi-structured interviews to examine the feasibility and appropriateness of the curriculum. Interview data were analyzed using thematic analysis to identify, analyze, and report patterns. Residents completed a survey of perceived IBH skill and knowledge before and after training. A paired-sample t-test was used to determine significant differences pre- and post-training. Results All five instructors completed interviews. Results suggest IBH training is valuable. Instructors gave specific feedback on online modules, implementation flexibility, and adjusting faculty development to differing levels of experience. Nineteen of forty residents (48%) completed anonymous pre-, post-, and retrospective-training surveys. Residents reported an increase in competence after training. Conclusion The results of this pilot suggest that IBH training implementation is feasible, desirable, timely, and may improve resident ability to work on an IBH team. Training should accommodate variations in program structure and faculty expertise.
Journal ArticleDOI
TL;DR: In this paper , the authors compare primary care providers and medical assistants in degrees of comfort, confidence, and consistency when addressing behavioral health concerns with patients before and after the implementation of a model of integrated behavioral health in primary care, and evaluate whether these perceptions differ based on increased access to behavioral health clinicians.
Abstract: Objectives: This study aims to compare primary care providers and medical assistants in degrees of comfort, confidence, and consistency when addressing behavioral health concerns with patients before and after the implementation of a model of integrated behavioral health in primary care (IBHPC), and evaluate whether these perceptions differ based on increased access to behavioral health clinicians. Methods: This longitudinal study was conducted at 2 primary care clinics in Northern California while implementing an IBHPC model. The Integrated Behavioral Health Staff Perceptions Survey was administered to assess the comfort, confidence, and consistency of behavioral health practices. Confidential online surveys were distributed to primary care faculty and staff members before and post-implementation. Responses from providers and medical assistants were compared between pre- and post-implementation with linear regression analyses. The relationships between accessibility to behavioral health clinicians and a change in comfort, confidence, and consistency of behavioral health practices were explored using a linear mixed-effects model. Results: A total of 35 providers and medical assistants completed the survey both before and post-implementation of IBHPC. Over time, there were increasingly positive perceptions about the consistency of behavioral health screening (P = .03) and overall confidence in addressing behavioral health concerns (P = .005). Comfort in addressing behavioral health concerns did not significantly change for either providers or staff over time. Medical assistants were initially more confident and comfortable addressing behavioral health concerns than providers, but providers’ attitudes increased post-IBHPC implementation. Improved access to behavioral health clinicians was associated with greater consistency of screening and referral to specialty mental health care (P < .001). Conclusion: The present study is the first to explore differences in provider and medical assistant perceptions during the course of an IBHPC implementation. Findings underscore the importance of integrating medical assistants, along with providers, into all phases of the implementation process.
References
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Journal ArticleDOI
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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Journal ArticleDOI
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

Journal ArticleDOI
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

Journal ArticleDOI
19 May 2010-JAMA
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

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211 citations

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INTRODUCTION There are benefits of integrating a behavioral health specialist in primary care; however, little is known about the physicians' perspectives.