Overcoming Barriers to Integrating Behavioral Health and Primary Care Services

Grazier, Kyle L.; Smiley, Mary L.; Bondalapati, Kirsten S.

doi:10.1177/2150131916656455

Cited by 38 publications

(30 citation statements)

References 27 publications

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“…Obstacles to providing integrated care may include lack of coordination across medical and behavioral health care delivery, limited resources for behavioral health and substance use treatment, patient reluctance to discuss behavioral health issues with their primary care provider, financial and insurance coverage limitations, and challenges in navigating complex healthcare systems. The integration of primary care and behavioral health has garnered attention from researchers and practitioners in recent years, leading to the development of guides and recommendations on care integration [27–29]. Based on our findings, we recommend that primary care settings implement integrated care strategies, such as routinely assessing all patients for behavioral health needs (e.g.…”

Section: Discussionmentioning

confidence: 90%

Characteristics and behavioral health needs of patients with patterns of high hospital use: implications for primary care providers

Rentas

Buckley²,

Wiest³

et al. 2019

BMC Health Serv Res

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BackgroundA small percentage of patients relies extensively on hospital-based care and account for a disproportionately high share of health care spending in the United States. Evidence shows that behavioral health conditions are common among these individuals, but understanding of their behavioral health needs is limited. This study aimed to understand the behavioral health characteristics and needs of patients with high hospital utilization patterns in Camden, New Jersey.MethodsThe sample consisted of patients in a care management intervention for individuals with patterns of high hospital utilization who were referred for behavioral health assessments (N = 195). A clinical psychologist conducted the assessments, which informed a multiaxial evaluation with diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders and a Mental Status Examination, to facilitate accurate diagnosis. Demographic characteristics, housing instability, exposure to trauma, and health care service utilization data were also collected through self-report and chart reviews.ResultsNinety percent of patients were diagnosed with a psychiatric and/or active substance use disorder. Depression was the most common psychiatric disorder and alcohol use was the most common substance use disorder. However, only 10% of patients with an active substance use disorder were in treatment, and only 17% of patients with a mental health diagnosis were receiving mental health treatment. Nearly all (91%) patients reported having a primary care provider at the time of assessment and most had seen their primary care provider within three months of their last hospital discharge. Non-medical barriers to health and wellness, specifically housing instability and exposure to trauma, were also common (35 and 61% of patients, respectively) among patients.ConclusionFindings highlight the importance of identifying and treating patients with behavioral health needs in the primary care setting. Developing connections with community agencies who provide behavioral health and substance use treatment can enhance primary care providers’ efforts to address their patients’ non-medical barriers to treatment, as can embedding behavioral health providers within primary care offices. The study also underscores the need for trauma-informed care in primary care settings.

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Section: Discussionmentioning

confidence: 90%

Characteristics and behavioral health needs of patients with patterns of high hospital use: implications for primary care providers

Rentas

Buckley²,

Wiest³

et al. 2019

BMC Health Serv Res

View full text Add to dashboard Cite

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“…7 Organizations that have reported success integrating care services share the traits of prioritizing vulnerable populations, extensive community collaboration, team approaches, diversified funding, and being data driven. 48…”

Section: Discussionmentioning

confidence: 99%

Homeless Patients Associate Clinician Bias With Suboptimal Care for Mental Illness, Addictions, and Chronic Pain

Gilmer

Buccieri

2020

J Prim Care Community Health

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Objective: To determine how accessible health care services are for people who are experiencing homelessness and to understand from their perspectives what impact clinician bias has on the treatment they receive. Methods: Narrative interviews were conducted with 53 homeless/vulnerably housed individuals in Ontario, Canada. Visit history records were subsequently reviewed at 2 local hospitals, for 52 of the interview participants. Results: Of the 53 participants only 28% had a primary care provider in town, an additional 40% had a provider in another town, and 32% had no access to a primary care provider at all. A subset of the individuals were frequent emergency department users, with 15% accounting for 75% of the identified hospital visits, primarily seeking treatment for mental illness, pain, and addictions. When seeking primary care for these 3 issues participants felt medication was overprescribed. Conversely, in emergency care settings participants felt prejudged by clinicians as being drug-seekers. Participants believed they received poor quality care or were denied care for mental illness, chronic pain, and addictions when clinicians were aware of their housing status. Conclusion: Mental illness, chronic pain, and addictions issues were believed by participants to be poorly treated due to clinician bias at the primary, emergency, and acute care levels. Increased access to primary care in the community could better serve this marginalized population and decrease emergency department visits but must be implemented in a way that respects the rights and dignity of this patient population.

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“…A multidisciplinary approach with engaging patients and their families was recommended to increase the readiness of the staff and patients to accept the pharmacist service. Emphasizing the potential long-term healthcare cost reduction secondary to the pharmacist collaboration and having more than one source of funding and cutting unnecessary expenses were suggested to overcome the financial barrier [59,60].…”

Section: Discussionmentioning

confidence: 99%

A systematic review of pharmacist input to metabolic syndrome screening, management and prevention

et al. 2020

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Background Metabolic syndrome is a cluster of factors that increase the risk of cardiovascular disease and include: diabetes and prediabetes, abdominal obesity, elevated triglycerides, low high-density lipoprotein cholesterol and high bloodpressure. However, the role of the pharmacist in the metabolic syndrome has not yet been fully explored. Aim of the review This systematic review aimed to critically appraise, synthesise, and present the available evidence on pharmacists' input to the screening, prevention and management of metabolic syndrome. Method The final protocol was based on the "Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P)". Studies published in English from January 2008 to March 2020 reporting any pharmacist activities in the screening, prevention or management of metabolic syndrome were included. Databases searched were Medline, Cumulative Index to Nursing and Allied Health Literature, International Pharmaceutical Abstracts, Cochrane and Google Scholar. Studies were assessed for quality by two researchers, data extracted and findings synthesised using a narrative approach. Results Of the 39,430 titles reviewed, ten studies were included (four were randomised controlled trials). Most studies focused on pharmacist input to metabolic syndrome screening and management. Screening largely involved communicating metabolic parameters to physicians. Management of metabolic syndrome described pharmacists collaborating with members of the multidisciplinary team. A positive impact was reported in all studies, including achieving metabolic syndrome parameter goals, reverting to a non-metabolic syndrome status and, improved medication adherence. The populations studied were paediatrics with risk factors, adults with comorbidities and psychiatric patients. Integration of the pharmacist within the multidisciplinary team, an easy referral process and accessibility of service were potential facilitators. Inadequate funding was the key barrier. Conclusion The studies describing pharmacist input in metabolic syndrome provide limited evidence of positive outcomes from screening and management as part of collaborative practice. Further work is required to provide more robust evidence of effectiveness and cost-effectiveness while considering key barriers.

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Overcoming Barriers to Integrating Behavioral Health and Primary Care Services

Abstract: While significant barriers to integrating behavioral health and primary care services exist, case studies of organizations that have successfully overcome these barriers share certain common factors.

Cited by 38 publications

References 27 publications

Characteristics and behavioral health needs of patients with patterns of high hospital use: implications for primary care providers

Characteristics and behavioral health needs of patients with patterns of high hospital use: implications for primary care providers

Homeless Patients Associate Clinician Bias With Suboptimal Care for Mental Illness, Addictions, and Chronic Pain

A systematic review of pharmacist input to metabolic syndrome screening, management and prevention

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