Approaches to Behavioral Health Integration at High Performing Primary Care Practices

Blasi, Paula R.; Cromp, DeAnn; McDonald, Sarah; Hsu, Clarissa; Coleman, Katie; Flinter, Margaret; Wagner, Edward H.

doi:10.3122/jabfm.2018.05.170468

Cited by 16 publications

(10 citation statements)

References 37 publications

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“…Different communities are undergoing COVID-19 surges at different time points in the U.S.; knowing that initial increases in demand for mental health services may be concentrated in primary care provides important information for healthcare systems looking to prepare for these needs. For example, integrating primary care with behavioral healthcare [ 33 , 34 ] could help organizations to better address the needs of these patients. However, transitioning quickly to supporting primary care with integrated behavioral health care may not be easy for organizations.…”

Section: Discussionmentioning

confidence: 99%

Disparities in outpatient visits for mental health and/or substance use disorders during the COVID surge and partial reopening in Massachusetts

Yang

Landrum

Zhou

et al. 2020

General Hospital Psychiatry

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Objective To examine changes in outpatient visits for mental health and/or substance use disorders (MH/SUD) in an integrated healthcare organization during the initial Massachusetts COVID-19 surge and partial state reopening. Methods Observational study of outpatient MH/SUD visits January 1st-June 30th, 2018–2020 by: 1) visit diagnosis group, 2) provider type, 3) patient race/ethnicity, 4) insurance, and 5) visit method (telemedicine vs. in-person). Results Each year, January–June 52,907–73,184 patients were seen for a MH/SUD visit. While non-MH/SUD visits declined during the surge relative to 2020 pre-pandemic (−38.2%), MH/SUD visits increased (9.1%)—concentrated in primary care (35.3%) and non-Hispanic Whites (10.5%). During the surge, MH visit volume increased 11.7% while SUD decreased 12.7%. During partial reopening, while MH visits returned to 2020 pre-pandemic levels, SUD visits declined 31.1%; MH/SUD visits decreased by Hispanics (−33.0%) and non-Hispanic Blacks (−24.6%), and among Medicaid (−19.4%) and Medicare enrollees (−20.9%). Telemedicine accounted for ~5% of MH/SUD visits pre-pandemic and 83.3%–83.5% since the surge. Conclusions MH/SUD visit volume increased during the COVID surge and was supported by rapidly-scaled telemedicine. Despite this, widening diagnostic and racial/ethnic disparities in MH/SUD visit volume during the surge and reopening suggest additional barriers for these vulnerable populations, and warrant continued monitoring and research.

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Section: Discussionmentioning

confidence: 99%

Disparities in outpatient visits for mental health and/or substance use disorders during the COVID surge and partial reopening in Massachusetts

Yang

Landrum

Zhou

et al. 2020

General Hospital Psychiatry

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“…In this study, we used a comparative case study design of nine purposefully selected primary care practices with reputations and evidence of being particularly innovative and successful. [63][64][65][66]103 These practices were selected as a contrast to the growing literature noting a lack of effective leadership in practices, which inhibits successful change. 21,104 This literature serves as a comparator group to the nine practices used in this study.…”

Section: Methodsmentioning

confidence: 99%

Leading Innovative Practice: Leadership Attributes in LEAP Practices

et al. 2020

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An onslaught of policies from the federal government, states, the insurance industry, and professional organizations continually requires primary care practices to make substantial changes; however, ineffective leadership at the practice level can impede the dissemination and scale‐up of these policies. The inability of primary care practice leadership to respond to ongoing policy demands has resulted in moral distress and clinician burnout. Investments are needed to develop interventions and educational opportunities that target a broad array of leadership attributes. Context Over the past several decades, health care in the United States has undergone substantial and rapid change. At the heart of this change is an assumption that a more robust primary care infrastructure helps achieve the quadruple aim of improved care, better patient experience, reduced cost, and improved work life of health care providers. Practice‐level leadership is essential to succeed in this rapidly changing environment. Complex adaptive systems theory offers a lens for understanding important leadership attributes. Methods A review of the literature on leadership from a complex adaptive system perspective identified nine leadership attributes hypothesized to support practice change: motivating others to engage in change, managing abuse of power and social influence, assuring psychological safety, enhancing communication and information sharing, generating a learning organization, instilling a collective mind, cultivating teamwork, fostering emergent leaders, and encouraging boundary spanning. Through a secondary qualitative analysis, we applied these attributes to nine practices ranking high on both a practice learning and leadership scale from the Learning from Effective Ambulatory Practice (LEAP) project to see if and how these attributes manifest in high‐performing innovative practices. Findings We found all nine attributes identified from the literature were evident and seemed important during a time of change and innovation. We identified two additional attributes—anticipating the future and developing formal processes—that we found to be important. Complexity science suggests a hypothesized developmental model in which some attributes are foundational and necessary for the emergence of others. Conclusions Successful primary care practices exhibit a diversity of strong local leadership attributes. To meet the realities of a rapidly changing health care environment, training of current and future primary care leaders needs to be more comprehensive and move beyond motivating others and developing effective teams.

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“…Referrals to IPC team members are primarily through physicians, and the COVID-19 response has highlighted the need for reconsideration of this traditional referral model to improve access to the range of services embedded within interprofessional models of primary care. The literature has identified referral processes as a critical component of supporting access to and fostering integrated primary care [23,24]. Moving forward teams need to consider how patients can have direct access to team members to best support patients managing the direct and indirect consequences of COVID-19.…”

Section: Personal Impactmentioning

confidence: 99%

Interprofessional primary care during COVID-19: a survey of the provider perspective

et al. 2021

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Background Interprofessional primary care (IPC) teams provide comprehensive and coordinated care and are ideally equipped to support those populations most at risk of adverse health outcomes during the COVID-19 pandemic, including older adults, and patients with chronic physical and mental health conditions. There has been little focus on the experiences of healthcare teams and no studies have examined IPC practice during the early phase of the COVID-19 pandemic. The objective of the study was to describe the state of interprofessional health provider practice within IPC teams during the COVID-19 pandemic. Methods Observational cross-sectional design. A web-based survey was deployed to IPC providers working in team-based primary care clinics in the province of Ontario, Canada. The survey included 26 close-ended and six open-ended questions. Close-ended questions were analyzed using descriptive statistics. Content analysis was used to analyze the open-ended questions. Results 445 surveys were included in the final analysis. Service delivery shifted from in-person care (77% pre-COVID-19) to telephone (76.5% during the COVID-19 pandemic). Less than half of the respondents (40%) reported receiving any training for virtual delivery. Wait times to access team members were reported to have decreased. There has also been a shift in what IPC providers report as the most commonly seen conditions, with increases in visits related to mental health concerns, acute infections (including COVID-19), social isolation, and resource navigation. Respondents also reported a reduction in healthcare provision for multiple chronic conditions including diabetes, cardiovascular disease, and chronic pain. Conclusions IPC teams are rapidly shifting their practice to supporting their patients during the pandemic. A surge in mental health issues has been seen and is expected to continue to increase in response to COVID-19. Understanding early experiences can help plan for future pandemic waves.

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Approaches to Behavioral Health Integration at High Performing Primary Care Practices

Cited by 16 publications

References 37 publications

Disparities in outpatient visits for mental health and/or substance use disorders during the COVID surge and partial reopening in Massachusetts

Disparities in outpatient visits for mental health and/or substance use disorders during the COVID surge and partial reopening in Massachusetts

Leading Innovative Practice: Leadership Attributes in LEAP Practices

Interprofessional primary care during COVID-19: a survey of the provider perspective

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