Patients Seen, and Interventions Used by Behavioral Health Providers Working in Different Models of Integrated Healthcare in Primary Care Clinics Across the VA Jennifer S. Funderburk, Ph.D. Stephen A. Maisto, Ph.D. Anne Dobmeyer, Ph.D. Christopher Hunter, PH.D.
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Jennifer S. Funderburk, Ph.D. Stephen A. Maisto, Ph.D. Anne Dobmeyer, Ph.D.
Patients Seen, and Interventions Used by Behavioral Health Providers Working in Different Models of Integrated Healthcare in Primary Care Clinics Across the VA. Jennifer S. Funderburk, Ph.D. Stephen A. Maisto, Ph.D. Anne Dobmeyer, Ph.D. Christopher Hunter, PH.D. Acknowledgements. - PowerPoint PPT Presentation
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Patients Seen, and Interventions Used by Behavioral Health
Providers Working in Different Models of Integrated Healthcare
in Primary Care Clinics Across the VA
Jennifer S. Funderburk, Ph.D.Stephen A. Maisto, Ph.D.
Anne Dobmeyer, Ph.D.Christopher Hunter, PH.D.
Acknowledgements•This study was funded by the Center for
Integrated Healthcare pilot grant•This study could not have been completed
without the generosity and hard work of behavioral health providers across the VA, leadership, and fellow research staff
Objectives• Describe the different integrated healthcare
models behavioral health providers reported working in across the VA nationally
• Describe the types of patients seen and clinical interventions used regularly across different integrated healthcare models.
• Discuss the implication of these results on the clinical practice of BHPs within integrated primary care settings.
• Discuss potential avenues for future clinical intervention research.
Purpose of the Study•National prospective descriptive web-
based study examining the types of patients seen and interventions used by VA behavioral health providers (BHPs) integrated into primary care
Method•Recruitment
▫Contacted implementation coordinators of PCMH (N=143) to obtain email addresses for BHPs in their VA
92 coordinators responded (71% response rate)▫33 forwarded recruitment email to BHPs▫8 scheduled a teleconference to present research to
BHPs▫40 provided BHP names and email addresses to
researchers▫Some provided listservs which included non-BHP staff
▫Sent 3 recruitment emails to each BHP asking them to contact us if they were interested
MethodProcedure:
Interested BHPs replied to the recruitment email and scheduled a 5-minute telephone call, where they completed informed consent, learned how to use the web-based questionnaire, and scheduled a day to complete the study
BHPs completed online questionnaires on one randomly assigned day of clinical service
Method•Measures:
▫Demographics & Background (filled out only once):
BHP’s background & clinical training Integrated healthcare setting elements
▫Appointment Questionnaire (filled out after each patient on day of study):
* Largest difference in how much an intervention is used
Results Overview: Similarities•BHPs most likely to be psychologists•CBT most common•Aspects of integrated healthcare context:
▫Shared medical record▫Patients use same waiting area as primary care▫Daily open slots for same-day appointments▫BHP offices located within primary care clinic
•Depression, Anxiety & Adjustment top problems•Most common interventions among the models:
▫Discussing current techniques for relief▫Importance of interpersonal relationships
Results Overview: Differences
• Aspects of integrated healthcare context▫Staff scheduling BHP and primary care appointments▫BHPs presenting at primary care staff meetings
• Top Interventions▫Co-located: Plan to see patient again▫CCC: Pleasurable activities▫Blended-CCC+CM: Educate about CBT
•Depressive and anxious symptomatology are most common within primary care (Funderburk et al., 2011; Bluestein & Cubic, 2009)
•Evidence suggests the efficacy of problem-solving & CBT interventions; could be helpful to be utilized even more (Catalan et al, 1991; Churchill et al., 2001)
Conclusions•Need for effectiveness research
▫ Focused on the interventions regularly used by BHPs▫ Focused on comparing the efficacy in different models of
care•Need for research on barriers
▫ Exploring barriers to BHPs using recommended or preferred interventions (e.g., CBT, problem-solving techniques)
▫ Exploring barriers to sites becoming more integrated•Need for dissemination
▫ Examining how to disseminate findings on evidence-based treatment to providers to help improve practices
▫ Examining the current access to trainings on evidence-based treatments