Family Medicine Physicians’ Perspectives Regarding Rural Behavioral Health Care: Informing Ideas for Increasing Access to High-Quality Services

Jensen, Emily Jordan; Mendenhall, Tai J.; Futoransky, Catherine; Clark, Kirby

doi:10.1007/s11414-021-09752-6

Cited by 7 publications

(3 citation statements)

References 33 publications

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“…Our findings support efforts to provide increased preventive mental health services, especially for those living in low-income and rural areas. Although barriers to mental health care for patients with cancer or cancer survivors in these areas likely reflect a complex web of access problems, 42 the increased use of telemedicine for medical and mental health care could be a possible way to increase access to care. 43 …”

Section: Discussionmentioning

confidence: 99%

Analysis of Suicide After Cancer Diagnosis by US County-Level Income and Rural vs Urban Designation, 2000-2016

et al. 2021

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IMPORTANCE Studies suggest the risk of suicide among people with cancer diagnosis is higher compared with the general population. However, little is known about how suicide risk among people diagnosed with cancer might vary according to area-level income and rurality. OBJECTIVETo examine whether the risks and patterns of suicide mortality among people with a cancer diagnosis differ by US county-level median income and rural or urban status. DESIGN, SETTING, AND PARTICIPANTS A retrospective, population-based cohort study following up individuals who were diagnosed with cancer between January 1, 2000, and December 31, 2016, was conducted. The Surveillance, Epidemiology, and End Results Program 18 registries (SEER 18) database was used to obtain data on persons diagnosed with a first primary malignant tumor. Comparisons with the general US population were based on mortality data collected by the National Center for Health Statistics. Analyses were conducted from February 22 to October 14, 2020. EXPOSURES County-level median household income and urban or rural status. MAIN OUTCOMES AND MEASURES Standardized mortality ratios (SMRs) of suicide deaths and annual percentage changes (APCs) of SMRs. RESULTSThe SEER 18 database included 5 362 782 persons with cancer diagnoses living in 635 counties. Most study participants were men (51.2%), White (72.2%), and older than 65 years (49.7%). Among them, 6357 persons died of suicide (SMR, 1.41; 95% CI,. People with cancer living in the lowest-income counties had a significantly higher risk (SMR, 1.94; 95% CI, 1.76-2.13) than those in the highest-income counties (SMR, 1.30; 95% CI, 1.26-1.34). Those living in rural counties also had significantly higher SMR than those in urban counties (SMR, 1.81; 95% CI, 1.35; 95% CI,. For all county groups, the SMRs were the highest within the first year following cancer diagnosis. However, among people living in the lowest-income counties, the risk remained significantly high even after 10 or more years following cancer diagnosis (SMR, 1.83; 95% CI, 1.31-2.48). The comparative risk of suicide mortality within 1 year following cancer diagnosis significantly decreased over the years but then plateaued in the highest-

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Section: Discussionmentioning

confidence: 99%

Analysis of Suicide After Cancer Diagnosis by US County-Level Income and Rural vs Urban Designation, 2000-2016

et al. 2021

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“…This finding does not reflect what is happening in rural residency practices, nor can we conclude that what works in urban practices will work in rural practices, especially when prior literature has shown that urban and rural locations differ in their behavioral health needs, 34 rates of collocation with BH providers, 26 and experiences with providing high-quality integrated behavioral healthcare. 35 In rural residency practices, providers are likely to work in medically underserved areas and may prioritize training residents with the adaptive and comprehensive skills they need for resource-lean practice environments, which may counter prioritizing development of BH integration models of care. [36][37][38] Therefore, including rural residencies and examining their potential differences in BH integration as compared to urban residencies would be valuable for future studies.…”

Section: Discussionmentioning

confidence: 99%

Integrated Behavioral Health in Primary Care Residency and Nonresidency Practices

Mollis

West

et al. 2023

Fam Med

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Background and Objectives: Integrated behavioral health (BH) is becoming a preferred model of care for primary care because it improves patient outcomes and satisfaction. Little is known about whether residency practices are consistently modeling this preferred care model relative to real-world nonresidency practices. The study compared levels of BH integration, patient health outcomes, and satisfaction with care between residency practices and nonresidency practices with colocated BH providers. Methods: Baseline data were collected in 2018-2019 from 44 practices and their adult patients with chronic conditions participating in a cluster-randomized, pragmatic trial to improve BH integration. The sample included 18 (40.9%) residency and 26 (59.1%) nonresidency practices, with 1,817 (45.3%) patients from residency practices and 2,190 (54.7%) patients from nonresidency practices. Outcomes including BH integration levels (the Practice Integration Profile), patient health outcomes (the PROMIS-29), and patient satisfaction with care (the Consultation and Relational Empathy scale) were compared between residency and nonresidency practices using multivariate regression analyses. Results: No differences were found between BH integration levels, patient health outcomes, and patient satisfaction with care between residency and nonresidency practices. In a sample of primary care practices with colocated BH providers, residencies had BH integration and patient outcomes similar to real-world practices. Conclusions: Primary care practices with residency programs reported comparable levels of BH integration, patient health outcomes, and patient satisfaction compared to practices without residency programs. Both types of practices require interventions and resources to help them overcome challenges associated with dissemination of high levels of BH integration.

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“…A larger proportion of the U.S. population is moving toward urban areas, increasing difficulty for rural communities to attract and maintain adequate access to health care resources (Caldwell et al, 2016). Access to health care is further complicated by difficulty recruiting and sustaining behavioral health services in rural communities (Andrilla et al, 2018; Jensen et al, 2021; Thomas et al, 2012). Especially in the Midwest, population distribution is dense in urban areas.…”

mentioning

confidence: 99%

Implementing an APRN-Led Integrated Behavioral Health Clinic in a Rural Community

Cook¹,

Burge

Mathews³

et al. 2023

J Am Psychiatr Nurses Assoc

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OBJECTIVE: A rural primary care clinic implemented an advance practice providers, including nurse practitioner (APRN)-led integrated behavioral health program to facilitate holistic health care delivery. METHODS: Implementation was facilitated by Health Resources and Services Administration Grant funding to a state University College of Nursing. The College formed an academic-practice partnership with a Federally Qualified Health Center (FQHC) to implement integrated care in a rural satellite clinic administered by the FQHC. An interdisciplinary team (two family APRNs, a psychiatric APRN, a licensed behavioral health provider, and the Grant Project Director who is a Psychiatric APRN and a licensed Psychologist) provided the integrated care based on the University of Washington’s Collaborative Care Model. RESULTS: This brief report describes the implementation of integrated care during the clinic’s first year, services provided, lessons learned, community response, and improvement in anxiety and depressive symptoms for patients who were treated for behavioral health problems. An exemplar illustrates how collaborative care addressed one patient’s behavioral health and primary care needs. CONCLUSIONS: APRN-led collaborative care can expand access to holistic, affordable care in rural areas to improve mental health. Adaptation and flexibility in traditional roles may be necessary and determining post-grant access to funding for services will be necessary for sustainability.

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Family Medicine Physicians’ Perspectives Regarding Rural Behavioral Health Care: Informing Ideas for Increasing Access to High-Quality Services

Cited by 7 publications

References 33 publications

Analysis of Suicide After Cancer Diagnosis by US County-Level Income and Rural vs Urban Designation, 2000-2016

Analysis of Suicide After Cancer Diagnosis by US County-Level Income and Rural vs Urban Designation, 2000-2016

Integrated Behavioral Health in Primary Care Residency and Nonresidency Practices

Implementing an APRN-Led Integrated Behavioral Health Clinic in a Rural Community

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