Sunday, July 3, 2016

2016 NAPCRG Annual Meeting being held November 12-16 in Colorado Springs

We're looking forward to this November 12-16 in Colorado Springs to the 2016 North American Primary Care Research Group Annual Meeting. Here are some abstracts from the IBH-PC team that have been accepted for presentation. Please let us know if you will be there. 

Development and Validation of a Measure of Primary Care Behavioral Health Integration

Rodger Kessler Ph.D. ABPP, Andrea Auxier Ph.D., Juvena Hitt B.S., Benjamin Littenberg M.D., C.R. Macchi Ph.D., Daniel Mullin Psy.D. MPH, Connie van Eeghen Dr.P.H., Jon van Luling B.A.,

There are a large number of initiatives co-locating, behavioral clinicians within primary care practices. These take a variety of formats and models, from embedded specialty mental health and substance providers to integrated systems of care. While many are identified as collaborative or integrated care, there is no method to validly identify elements or levels of collaboration or integration, and thus an inability to systematically contrast elements and levels to clinical, operational and financial outcomes.

We will report on the development and validation of the Practice Integration Profile (PIP), a thirty item electronic survey completed by primary care medical and behavioral practitioners and practice administrators. The PIP is based on the AHRQ Lexicon of Collaborative Care, and evaluates and provides scores on six domains as well as generates a total score.

169 surveys were returned. mean total score was 55 (0-100). There was high internal consistency, and the measure discriminates between exemplar practices, primary care practices with behavioral health, primary care without behavioral health, and community mental health centers. Test retest differences averaged 1.5 points.

The Practice Integration Profile is a rapidly administered measure of integration level, acceptable to primary care practices, that can be used to assist practices to make decisions about clinical care and assist researchers to identify factors and levels of integration activities that may be associated with outcomes of care.

Variability in the Implementation of Integrated Behavioral Health

Rodger S. Kessler PhD ABPP, Andrea Auxier PhD, Juvena Hitt BS, Benjamin Littenberg MD, CR Macchi PhD, Daniel Mullin PsyD, Connie van Eeghen DrPH, Jonathan van Luling BA

Context: Behavioral Health (BH) includes mental health care, substance use disorder care, health behavior change, and attention to family and other psychosocial factors including management of depression, anxiety, stress, chronic pain, and other common conditions. Most patients with BH needs present to primary care, but traditional models of referral to specialty BH services often fail. Therefore, many practices have attempted to integrate BH and primary care. The most basic form of Integrated Behavioral Health (IBH) is simple co-location of BH and medical services at the same address. More advanced integration addresses shared infrastructure and care planning and practice-wide systems to identify, engage, treat and follow patients with BH needs. It not clear how much practices vary in their approach to implementing IBH. 

Objective: Determine the variability of IBH across practices. 

Design: On-line survey comparing “integrated practices” (defined as at least physical co-location of BH and medical services) to non-integrated practices. 

Setting: 237 outpatient practices in 36 US states delivering adult primary care, BH, or both. 

Participants: 336 medical and BH providers, practice managers and other practice staff. 

Measures: The Practice Integration Profile (PIP), a novel 30-item online survey completed by BH providers, medical providers, managers, and staff about their own practice. It assesses six domains and a total score derived from the AHRQ Lexicon for Behavioral Health and Primary Care Integration. 

Results: Wide variability was seen in all measures of integration even among apparently “integrated” practices. For instance, the PIP Total Score ranged from 0 to 100 among all practices and 23-100 among “integrated” practices. 

Conclusions: Practices vary widely in the degree of integration they have achieved. Even practices with apparently high levels of integration show very large variation in the implementation of integration. Co-location of behavioral and medical providers is not enough to achieve high levels of Integrated Behavioral Health.

- Ben Littenberg

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