Primary care behavioral health

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The primary care behavioral health (PCBH) consultation model is a psychological approach to population-based clinical health care that is simultaneously co-located, collaborative, and integrated within the primary care clinic. The goal of PCBH is to improve and promote overall health within the general population. This approach is important because approximately half of all patients in primary care present with psychiatric comorbidities, and 60% of psychiatric illness is treated in primary care. [1]

Contents

Primary care practice has traditionally adopted a generalist approach whereby physicians are trained in the medical model and solutions to problems typically involve medications, procedures, and advice. Appointment times are short, with the goal of seeing a large number of patients in a day. Many patients present with behavioral health care needs that may overlap with medical disorders and that may exacerbate, complicate, or masquerade as physical symptoms. In addition, many medical problems present with associated psychological sequelae (such as stress, emotional reactions, dysfunctional lifestyle behaviors), that are amenable to change through behavioral interventions that can improve outcomes for these health problems.

The PCBH model enables early identification and behavioral/medical intervention that can prevent some acute problems from becoming chronic health care problems (such as chronic pain, diabetes, COPD, hypertension, obesity), which are the cause of many medical visits to primary care clinics. Behavioral health consultants (BHCs) work side-by-side with all members of the clinical care team (including primary care providers (PCPs) and nursing staff) to enhance preventive and clinical care for mental health problems that have traditionally been treated solely by physicians. The role of the BHC is to facilitate systemic change within primary care that facilitates a multidisciplinary approach both from a treatment and reimbursement standpoint. BHCs typically collaborate with physicians to develop treatment plans, monitor patient progress, and flexibly provide care to meet patients' changing needs. [2] Moreover, the integrated care model increases behavioral health accessibility, fosters communication between patients and their primary care team, and improves patients' experiences receiving primary care. [3]

Associated terms

Primary care psychology
Provision of clinical mental health services through a population-based focus on the common problems confronting a majority of individuals. Such issues treated in primary care may include response to physical illness, stress, affective concerns, substance use and abuse, and developmental and situational issues among others. Primary care psychologists are co-located with primary care providers and usually share the same physical space in practice. Primary care psychologists may retain the traditional session length of specialty care or may adhere to a brief, consultative approach that is solution-focused. [4] Primary care psychologists may often be trained in health psychology programs, but not exclusively so.
Behavioral health consultant
Behavioral health consultants and primary care physicians collaborate within the same system. The behavioral health provider works as part of the medical team to meet the wide range of needs with which patients present. [5]
Collaborative care
This model uses databases or what are known as registries to track and monitor patients with certain conditions. Typical examples in primary care include diabetes and depression. Often the person managing the registry is a nurse or mental health professional who performs follow-up phone calls and assists the primary care team in following evidence-based protocols. There is often also a consulting psychiatrist who oversees the provision of care in primary care. [6]

Rationale

Primary care has often been termed the de facto mental health system in the United States. [7] Research shows that approximately half of all mental health care services are provided solely by primary care providers. [8] Furthermore, primary care practitioners prescribe about 70% of all psychotropic medications and 80% of antidepressants. [9] Thus, while it seems there are various "specialty" mental health clinics and psychiatrists alike, the primary care environment continues to lend itself to an array of psychiatric issues. One reason is that physical health problems can contribute to psychological dysfunction and vice versa. Examples of the frequent comorbity between medical and psychological problems include: chronic pain can cause depression; panic symptoms can lead to complaints of heart palpitations; and stress can contribute to irritable bowl syndrome. [10] While these mind-body relationships may seem obvious, often the presenting problem is far less clear, with the physical health problem being masked by psychosocial concerns. In fact, of the 10 most common complaints in primary care, less than 16% had a diagnosable physical etiology. [11] The psychosocial impact on primary care is tremendous (approximately 70% of all visits); however, it is curious that few mental health providers have traditionally placed themselves where the demand for their services is arguably the greatest.

Despite the availability of outpatient mental health resources, research indicates that patients are still driven to the primary care setting. In fact, studies show that as little as 10% of patients actually follow through when being referred by a physician to receive outpatient mental health treatment. [12] Many experts believe this low completion rate is tied to the stigma that often surrounds mental health care, causing patients to deny or refuse to seek help for psychiatric needs. [13] As a general rule, patients who do choose to address their mental health concerns express a preference for services in primary care likely due to its familiarity and less stigmatizing environment. [14] However, as many medical providers will admit, their training has left them ill-prepared to appropriately treat the psychiatric sequalae that presents in their clinic. The PCBH model has sought to address this dilemma by providing access to mental health services on site to more effectively target the biological, psychological, and social aspects of patient care. Resulting from close collaboration between physicians and mental health providers, the patients' needs are more adequately met by care that is more comprehensive and collaborative between physicians and mental health providers. Furthermore, the patients are more likely to follow through with primary care services, with referral rates around 80–90%. [12]

The behavioral health consultant model

Behavioral health consultants are culturally competent generalists who provide treatment for a wide variety of mental health, psychosocial, motivational, and medical concerns, including management of anxiety, depression, substance abuse, smoking cessation, sleep hygiene, and diabetes among others. BHCs also provide support and management for patients with severe and persistent mental illness and tend to be familiar with psychopharmacological interventions. [5] Paralleling general medicine, patients who require more extensive mental health treatment are typically referred to specialty care. BHC appointments are typically 15–30 minutes long with the goal of utilizing brief interventions to reduce functional impairment for the population as a whole. BHCs tend to provide focused feedback to PCPs with succinct, action oriented recommendations to help effectively manage patients' needs. BHC interventions tend to be more cost effective [15] and offer increased access to care, with improved patient and provider satisfaction. [16]

Evidence base

A comparison of an enhanced-referral system to a BHC model found that more than 80% of medical providers rated communication between themselves and the BHC as occurring "frequently," relative to less than 50% in an enhanced-referral model of care. Providers strongly preferred an integrated care model to the enhanced-referral model. [17] Another single-site study at an urban community health center found that embedding BHCs resulted in reduced referrals to specialty mental health (8% of depressed patients were referred) along with improved adherence to evidence-based guidelines for the care of depression and reduced prescriptions for antidepressants. [18] Moreover, a recent literature review revealed that improved outcomes in mental health care were associated with several fundamental characteristics, including collaboration and co-location with PCP and mental health providers, as well as systematic follow-up, medication compliance, patient psycho-education, and patient input into treatment modality. [19] In general the number of empirical investigations that have examined the clinical impact and cost-offset of the BHC model is still limited, although a growing body of evidence supports the utility of other integrated behavior health programs (with varying degrees of integration) in academic settings, Veterans Affairs Medical Centers, and community health care settings. [20] A 2011 Cochrane review found that counselling in primary care settings resulted in significantly greater clinical effectiveness in short term mental health outcomes compared to usual care but provided no longer term benefits. [21] Since all of the studies reviewed were from the United Kingdom, how well these findings can be generalized to other settings is unknown. [21]

Depression care

Specifically targeting depression, Schulberg, Raue, & Rollman (2002) [22] reviewed 12 randomized controlled trials (RCTs) that examined evidence-based treatments for major depression (interpersonal psychotherapy & cognitive-behavior therapy) and problem-solving therapy, compared to usual care by PCP's (i.e. antidepressant medication, drug placebo, or unspecified control). The authors concluded that evidence-based psychotherapies adapted for the primary care setting are comparable to pharmacotherapy alone and superior to PCP's usual care. The use of brief evidence-based psychotherapies, such as those reviewed by Schulberg et al., 2002, are fundamental within the PCBH model. The PCBH model emphasizes a problem-focused and functional-contextual approach to assessment and treatment of behavioral health and mental disorders. [2] Wolf and Hopko's (2008) [23] recent review of treatments for depression in primary care concluded that adaptations of CBT for depression in primary care are "probably efficacious." Research also shows that providing basic training in CBT to PCPs is not enough to produce robust clinical outcomes (King et al., 2002); [24] highlighting the importance of the BHC's integrated role in primary care. With respect to the impact of behavioral health consultation on pharmacological treatment of major and minor depression, compared to usual care Katon et al. (1995) [25] found improved medication adherence, increased patient satisfaction with treatment, and overall greater improvements in mood over time for major depression. Inclusion of a behavioral health professional in the treatment of depression in primary care improves outcomes, patient and physician satisfaction, and costs less than usual care. [26] The PCBH model prioritizes the usage of treatment algorithms based on scientific guidelines that include pharmacological and psychotherapeutic interventions. [27] This approach seeks to ensure that patients receive the safest and most effective treatments available.

Anxiety care

Although less empirical attention has been directed toward improving treatment of anxiety disorders in primary care, Stanley et al. [28] found 8 sessions of CBT delivered in a co-located model, superior to usual care for generalized anxiety disorder. Additionally, a collaborative care approach that packaged brief CBT with pharmacotherapy reduced disability, increased remitted symptoms, and decreased anxiety sensitivity for individuals diagnosed with panic disorder relative to usual care and demonstrated greater improvement in depression, anxiety, and disability measures at 6 month follow-up,. [29] [30] Further, clinical guidelines for the treatment of generalized anxiety disorder and panic disorder in primary care recommend behavior therapy and/or SSRI. [31]

Health behavior change

In regard to other health behaviors, strict utilization of the BHC model has shown significant improvements in sleep difficulties, [32] while less integrated models of behavioral health have produced favorable outcomes for smoking cessation, [33] diabetes adherence, [34] and pain disorders. [35] Whitlock et al., [36] suggest brief behavioral interventions have only a modest impact on health behavior change. However, they also suggested that within a population-based model of care modest changes in behavioral health "translate to significant effects."

Alternative models of care

Traditional outpatient psychotherapy

Commonly called "specialty" care, traditional outpatient psychotherapy usually involves treatment of mental health concerns in an outpatient clinic or another setting independent of medical care. Sessions are usually 50 minutes in length and the duration of treatment may vary from weeks to years depending on the mental health concern. Typically, little contact occurs between therapists and patients' physicians or psychiatrists, and coordination of care may be difficult, time consuming, and expensive. The payment and access systems for specialty mental health are also usually distinct from and more cumbersome than that for primary care treatment.

Co-located care model

Behavioral health providers and PCPs practice within the same office or building but maintain separate care delivery systems, including records and treatment plans. However, behavioral health providers and PCPs may consult one another for enhanced treatment outcomes. [5]

Policy

Funding has been a barrier to the implementation of the PCBH consultant model. The cost of treatment and lack of affordable health care has been a barrier for many people with mental illness to receive treatment. In the private sector insurance market mental health treatment is often segregated from other medical care, isolated in separate systems of care and payment. Typically this makes it more difficult for patients to access services readily, if at all. For uninsured patients the United States federal government can provide (depending on eligibility criteria) Medicaid which provides insurance coverage for a large number of individuals with severe and persistent mental illness. The federal government provides money to each state to fund Medicaid programs and provides general mandates on how the money must be spent. Because the federal government has special relationships with Veteran's Administration hospitals and clinics and federally qualified health centers and because several federal agencies have identified integrated care as key targets for improved primary care, the PCBH model has been able to take root in these systems whereas only a few PCBH programs exist in private insurance environments. One major barrier in some states (states can set some of their own rules with regard to Medicaid) is the prohibition of same-day billing. This makes it impossible for a PCBH program since the fundamental concept behind PCBH is the provision of services (medical and mental health visit) on the same day. Typically eligible professionals for Medicaid reimbursement in federally qualified health centers include psychiatrists, psychologists and licensed clinical social workers. Access to care and payment tends to be less restrictive with Medicare, another federal program for persons without private insurance.

The other major issue impacting the development of the PCBH model is the dearth of well-trained mental health workers. At present professional training programs with an emphasis in primary care are limited in number which has led to the growth of internships of varying kinds to train students and retrain professionals (see training programs below).

PCBH and health disparities in the United States

As the population of the United States becomes more diverse, the approach to population-based care must also adjust accordingly. Projections published by the U.S. Census Bureau estimate that by the year 2042 White, non-Hispanic people will no longer be the majority of the population in the United States. [37] According to the 2010 census, White, non-Hispanic people are no longer the majority of the population in Texas, California, the District of Columbia, Hawaii, and New Mexico. [38] The changing population of the United States is generating a need to incorporate cultural competence into the way primary care services are delivered. These changes in the population are concurrent with increasing evidence of disparities in the quality of care that is provided to historically underserved populations within the United States. Underserved populations have low levels of access and utilization based on economic, cultural, and systemic barriers to care.

Behavioral health providers in primary care settings have an opportunity to directly impact health care disparities by designing "…strategies to enhance cooperative or healthy behavior". [39] "The premise is that mismatches in models (i.e., expectations about illness and health interactions) between the patient and the health provider may render medical care 'psychologically' inaccessible to ethnic minorities, resulting in poorer health outcomes for these populations (possibly via noncompliance)." [40] Strategies that help bridge mismatches improve treatment outcomes and make care more accessible for underserved populations.

By establishing a role in primary care, the front-line of health-care delivery, behavioral health providers gain direct access to patients and providers. Healthy People 2010, published in 2007, recommended "that early intervention efforts to protect and promote mental health, including screening and the promotion of mental health awareness, become an essential component of primary care visits and school health assessments.". [41] This objective has been largely retained in the proposed objectives for Healthy People 2020. [42] As Hass and deGruy pointed out, "The primary care patient may or may not believe that she has a mental problem, and may or may not be ready to agree to psychological treatment ... primary care psychologists [must] make services accessible and understandable to patients…". [43] Because of the difference in how patients, particularly those from underserved groups, may express their distress and respond to the stigma of mental illness providing Behavioral Health services through primary care will likely make services more psychologically and physically accessible.

Providing culturally-competent, population based care can difficult to conceptualize, particularly in the context of the fast-paced environment of primary care. Hunter et al. propose "a patient-centered, culturally competent approach for effective communication and care…that includes the Explanatory model of health and illness, Social and environmental factors affecting adherence, Fears and concerns about medication and side effects, Treatment understanding model of culturally competent practice". [5] By adopting this kind of approach, Behavioral Health providers can help primary care providers meet the medical, psychological, and cultural needs of the patient.

History

In the early 1960s, Kaiser Permanente, an early HMO, uncovered that 60% of physician visits were either individuals who were somatizing stress or whose physical condition was exacerbated by emotional factors. [7] These findings prompted Kaiser to explore various strategies to better manage psychosocial complaints, with ultimate goal of cost reduction. Psychotherapy, which was offered as a prepaid benefit, was studied as a method to reduce primary care visits while also more properly (and less expensively) addressing the problem at hand. Studies revealed that by participating in brief psychotherapy, medical utilization reduced by 65%. [7] The initiatives at Kaiser Permanente set in motion a large body of research on medical cost-offset, a term for the reduction in medical costs that occurs as a result of a patient receiving appropriately designed behavior health services in lieu of more expensive medical services. The National Institute of Mental Health (NIMH) funded several replications examining medical cost offset in the years to follow, with reductions of cost around 30 to 65%. [44] One important trend that emerged in this literature was the greater the collaboration between primary care, the better the cost offset. Likewise, the more "traditional" the behavioral interventions, the less the medical cost offset.

In 1981, the Health Care Financing Administration (HCFA) sponsored the Hawaii Medicaid Project, a seven-year prospective study examining the impact of a new, collaborative behavioral health system among 36,000 Medicaid beneficiaries and 91,000 federal employees in Honolulu. This landmark trial compared the medical cost-offset among patients who received brief and targeted interventions, those who received a 52-session annual psychotherapy benefit, and those who received no treatment. The results showed that the brief, targeted interventions reduced saved $350 per patient per year while psychotherapy actually increased costs by $750 per year. [45] The Hawaii Medicaid Project became the prototype for cost offset research and spawned future projects among managed care organizations, with goal of reducing costs. In 1987, Humana followed suit by studying brief behavioral intervention among Medicare recipients in Florida, with the intention of reducing medical utilization among recent widows and widowers. Known as the Bereavement Program, Humana learned after 2 years $1400 could be saved per patient via brief group intervention for bereavement. [46] In the 1990s, other HMOs and regional group practices began to integrate behavioral health services into primary care, including Kaiser Permanente, Healthcare Partners, Group Health Cooperative of Puget Sound, Kaiser Group Health of Minnesota, and Duke University Medical Center. [7]

In the years to follow, behavioral health integration started to gain support from a federal level, as United States Department of Veterans Affairs (VA) systems began to conduct research around the impact of primary care psychologists, beginning with the Healthcare Network of Upstate New York (VISN2). In the last decade, additional VA systems have followed suit with primary care behavioral health programs of their own to meet the increasing mental health demands of soldiers returning from war. More recently, federal support has begun to take hold by increasing funding for integrated behavioral health services for various federally qualified health centers (FQHCs) in the United States. Primary care behavioral health was seen as a solution in FQHCs to address the mental health needs of the Medicaid and uninsured populations, with the goal of better treatment and reduced overall costs.

Related Research Articles

<span class="mw-page-title-main">Cognitive behavioral therapy</span> Therapy to improve mental health

Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. Cognitive behavioral therapy is one of the most effective means of treatment for substance abuse and co-occurring mental health disorders. CBT focuses on challenging and changing cognitive distortions and their associated behaviors to improve emotional regulation and develop personal coping strategies that target solving current problems. Though it was originally designed to treat depression, its uses have been expanded to include many issues and the treatment of many mental health conditions, including anxiety, substance use disorders, marital problems, ADHD, and eating disorders. CBT includes a number of cognitive or behavioral psychotherapies that treat defined psychopathologies using evidence-based techniques and strategies.

<span class="mw-page-title-main">Medical psychology</span> Application of psychological principles to the practice of medicine

Medical psychology or medico-psychology is the application of psychological principles to the practice of medicine, primarily drug-oriented, for both physical and mental disorders.

<span class="mw-page-title-main">Psychotherapy</span> Clinically applied psychology for desired behavior change

Psychotherapy is the use of psychological methods, particularly when based on regular personal interaction, to help a person change behavior, increase happiness, and overcome problems. Psychotherapy aims to improve an individual's well-being and mental health, to resolve or mitigate troublesome behaviors, beliefs, compulsions, thoughts, or emotions, and to improve relationships and social skills. Numerous types of psychotherapy have been designed either for individual adults, families, or children and adolescents. Certain types of psychotherapy are considered evidence-based for treating some diagnosed mental disorders; other types have been criticized as pseudoscience.

<span class="mw-page-title-main">Abnormal psychology</span> Sub-discipline of psychology

Abnormal psychology is the branch of psychology that studies unusual patterns of behavior, emotion, and thought, which could possibly be understood as a mental disorder. Although many behaviors could be considered as abnormal, this branch of psychology typically deals with behavior in a clinical context. There is a long history of attempts to understand and control behavior deemed to be aberrant or deviant, and there is often cultural variation in the approach taken. The field of abnormal psychology identifies multiple causes for different conditions, employing diverse theories from the general field of psychology and elsewhere, and much still hinges on what exactly is meant by "abnormal". There has traditionally been a divide between psychological and biological explanations, reflecting a philosophical dualism in regard to the mind-body problem. There have also been different approaches in trying to classify mental disorders. Abnormal includes three different categories; they are subnormal, supernormal and paranormal.

<span class="mw-page-title-main">Clinical psychology</span> Branch of medicine devoted to mental disorders

Clinical psychology is an integration of human science, behavioral science, theory, and clinical knowledge for the purpose of understanding, preventing, and relieving psychologically-based distress or dysfunction and to promote subjective well-being and personal development. Central to its practice are psychological assessment, clinical formulation, and psychotherapy, although clinical psychologists also engage in research, teaching, consultation, forensic testimony, and program development and administration. In many countries, clinical psychology is a regulated mental health profession.

<span class="mw-page-title-main">Depression (mood)</span> State of low mood and aversion to activity

Depression is a mental state of low mood and aversion to activity. It affects more than 280 million people of all ages. Depression affects a person's thoughts, behavior, feelings, and sense of well-being. Depressed people often experience loss of motivation or interest in, or reduced pleasure or joy from, experiences that would normally bring them pleasure or joy. Depressed mood is a symptom of some mood disorders such as major depressive disorder and dysthymia; it is a normal temporary reaction to life events, such as the loss of a loved one; and it is also a symptom of some physical diseases and a side effect of some drugs and medical treatments. It may feature sadness, difficulty in thinking and concentration and a significant increase or decrease in appetite and time spent sleeping. People experiencing depression may have feelings of dejection or hopelessness and may experience suicidal thoughts. It can either be short term or long term.

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Biological psychiatry or biopsychiatry is an approach to psychiatry that aims to understand mental disorder in terms of the biological function of the nervous system. It is interdisciplinary in its approach and draws on sciences such as neuroscience, psychopharmacology, biochemistry, genetics, epigenetics and physiology to investigate the biological bases of behavior and psychopathology. Biopsychiatry is the branch of medicine which deals with the study of the biological function of the nervous system in mental disorders.

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References

  1. ↑ Pirl, W.F.; Beck, B.J.; Safren, S. A.; Kim, H (2001). "A descriptive study of psychiatric consultations in a community primary care center". Primary Care Companion Journal of Clinical Psychiatry. 3 (5): 190–194. doi:10.4088/PCC.v03n0501. PMC   181214 . PMID   15014572.
  2. 1 2 Robinson, P.J. and Reiter, J.T. (2007). Behavioral Consultation and Primary Care (pp 1–16). N.Y.: Springer Science + Business Media.
  3. ↑ Koehler, AN, et al. (2019). "Patient Views of Behavioral Health Providers in Primary Care: A Qualitative Study of 2 Southeastern Clinics." Journal of Patient Experience. https://doi.org/10.1177/2374373519860357
  4. ↑ Garcia-Shelton, P. (2006). "Meeting U.S. health care needs: A challenge to psychology". Professional Psychology: Research and Practice. 37 (6): 676–682. doi:10.1037/0735-7028.37.6.676.
  5. 1 2 3 4 Hunter, C.L., Goodie, J.L., Oordt, M.S., & Dobmeyer A.C., (2009), Integrated behavioral health in primary care: Step-by-step guidance for assessment and intervention. Washington, DC: American Psychological Association.
  6. ↑ Hunkeler, E.; Katon, W.; Tang, L.; Williams, J.; Kroenke, K.; Lin, E.; Harpole, L.; et al. (2006). "Long term outcomes from the IMPACT randomised trial for depressed elderly patients in primary care". BMJ. 332 (7536): 259–63. doi:10.1136/bmj.38683.710255.BE. PMC   1360390 . PMID   16428253.
  7. 1 2 3 4 Cummings, N.A., O'Donohue, W., Hays, S.C., & Follette, V. (2001). Integrated behavioral healthcare: Positioning mental health practice with medical/surgical practice. San Diego: Academic Press.
  8. ↑ Narrow, W.; Reiger, D.; Rae, D.; Manderscheid, R.; Locke, B. (1993). "Use of services by persons with mental and addictive disorders: Findings from the Institute of Mental Health Epidemiologic Catchment Area Program". Archives of General Psychiatry. 50 (2): 95–107. doi:10.1001/archpsyc.1993.01820140017002. PMID   8381266.
  9. ↑ Beardsley, R.; Gardocki, G.; Larson, D.; Hidaldo, J. (1988). "Prescribing of psychotropic medication by primary care physicians and psychiatrists". Archives of General Psychiatry. 45 (12): 1117–1119. doi:10.1001/archpsyc.1988.01800360065009. PMID   2904248.
  10. ↑ O'Donohue, W.T., Cummings, N.A., Cucciare, M.A., Runyan, C.N., & Cummings, J.L. (2006). Integrated behavioral health care: A guide to effective intervention. Amherst, NY: Humanities Books.
  11. ↑ Kroenke, K.; Mangelsdorff, A. (1989). "Common symptoms in ambulatory care: Incidence, evaluation, therapy, and outcome". American Journal of Medicine. 86 (3): 262–266. doi:10.1016/0002-9343(89)90293-3. PMID   2919607.
  12. 1 2 Slay, J.D., & McCleod, C. (1997) Evolving an integration model: The Healthcare Partners experience. In N.A. Cummings, J.L. Cummings, and J. Johnson (Eds.) Behavioral health in primary care: A guide for clinical integration (pp 121–144). New York: International Universities Press.
  13. ↑ Mak, W.W.S.; Poon, C.Y.M.; Pun, L.Y.K.; Cheung, S.F. (2007). "Meta-analysis of stigma and mental health". Social Science & Medicine. 65 (2): 245–261. doi:10.1016/j.socscimed.2007.03.015. PMID   17462800.
  14. ↑ Lang, A.J. (2005). "Mental health treatment preferences of primary care patients". Journal of Behavioral Medicine. 28 (6): 581–586. doi:10.1007/s10865-005-9019-2. PMID   16228695. S2CID   26525324.
  15. ↑ James, L.C. (2009) What administrators should know about the primary care setting. In L.C. James & W.T. O'Donohue (Eds.). The primary care toolkit (pp 13–19). N.Y.: Springer Science + Business Media
  16. ↑ Koehler, A.N.; Sudano, L.E.; Ip, E.; Davis, S.W.; Marion, G.S.; Kirk, J.K. (2020). "Patient experience of an integrated care model in a family practice clinic & FQHC". Int J Psychiatry Med. 55 (5): 357–365. doi:10.1177/0091217420951059.
  17. ↑ Gallo, J.J.; Zubritsky, C.; Maxwell, J.; Nazar, M.; Bogner, H.R.; Quijano, L.M; et al. (2004). "Primary care clinicians evaluate integrated and referral models of behavioral health care for older adults: Results from a multisite effectiveness trial (PRISM-E)". Annals of Family Medicine. 2 (4): 305–309. doi:10.1370/afm.116. PMC   1466686 . PMID   15335128.
  18. ↑ Serrano, N; Monden, K. (2011). "The effect of behavioral health consultation on the care of depression by primary care clinicians". Wisconsin Medical Journal. 110 (3): 113–118. PMID   21748995.
  19. ↑ Craven, MA; Bland, R (May 2006). "Better practices in collaborative mental health care: an analysis of the evidence base". Can J Psychiatry. 51 (6 Suppl 1): 7S–72S. PMID   16786824.
  20. ↑ Koehler, AN, et al. (2022). "Cost Analysis of Integrated Behavioral Health in a Large Primary Care Practice." Journal of Clinical Psychology in Medical Settings. Vol 29. Pages 446–452. https://doi.org/10.1007/s10880-022-09866-9
  21. 1 2 Bower, Peter; Knowles, Sarah; Coventry, Peter A.; Rowland, Nancy (2011-09-07). "Counselling for mental health and psychosocial problems in primary care". The Cochrane Database of Systematic Reviews (9): CD001025. doi:10.1002/14651858.CD001025.pub3. ISSN   1469-493X. PMC   7050339 . PMID   21901675.
  22. ↑ Schulberg, H. C.; Raue, P. J.; Rollman, B. L. (2002). "The effectiveness of psychotherapy in treating depressive disorders in primary care practice: clinical and cost perspectives". General Hospital Psychiatry. 24 (4): 203–212. doi:10.1016/S0163-8343(02)00175-5. PMID   12100831.
  23. ↑ Wolf, N. J.; Hopko, D. R. (2008). "Psychosocial and pharmacological interventions for depressed adults in primary care: a critical review". Clinical Psychology Review. 28 (1): 131–161. doi:10.1016/j.cpr.2007.04.004. PMID   17555857.
  24. ↑ Michael King, O. D. F. T. A. H. D. S.; Turner, R. (2002). "Effectiveness of teaching general practitioners skills in brief cognitive behaviour therapy to treat patients with depression: randomised controlled trial". British Medical Journal. 324 (7343): 947–950. doi:10.1136/bmj.324.7343.947. PMC   102328 . PMID   11964340.
  25. ↑ Katon, W.; Korff, Von; Lin, E.; Walker, E.; Simon, G. E.; Bush, T.; Robinson, P.; et al. (1995). "Collaborative management to achieve treatment guidelines. Impact on depression in primary care ( No. 13)". JAMA: The Journal of the American Medical Association. 273 (13): 1026–1031. doi:10.1001/jama.1995.03520370068039.
  26. ↑ Blount, A. (1998). Integrated Primary Care: the Future of Medical and Mental Health Collaboration. New York: Norton.
  27. ↑ "Moving an Innovative Depression Care Model from Research to Practice: A Conversation With IMPACT Implementation Center Director Jürgen Unützer, MD, MPH, MA". Agency for Healthcare Research and Quality. 2013-04-17. Retrieved 2013-09-24.
  28. ↑ Stanley, M.; Beck, J.; Novy, D.; et al. (2003). "(2003). Cognitive-behavioral treatment of late-life generalized anxiety disorder". Journal of Consulting and Clinical Psychology. 71 (2): 309–319. doi:10.1037/0022-006X.71.2.309. PMID   12699025.
  29. ↑ Roy-Byrne, P.; Craske, M.; Stein, M.; et al. (2005). "A randomized effectiveness trial of cognitive-behavioral therapy and medication for primary care panic disorder". Archives of General Psychiatry. 62 (3): 290–8. doi:10.1001/archpsyc.62.3.290. PMC   1237029 . PMID   15753242.
  30. ↑ Roy-Byrne, P.; Katon, W.; Cowley, D.; Russo, J. (2001). "A randomized effectiveness trial of collaborative care for patients with panic disorder in primary care". Archives of General Psychiatry. 58 (9): 869–76. doi:10.1001/archpsyc.58.9.869. PMID   11545671.
  31. ↑ National Institute for Health and Clinical Excellence. (2001). Generalised anxiety disorder and panic disorder (with or without agoraphobia) in adults: management in primary, secondary and community care. (Clinical guideline 113.). Available from NICE http://guidance.nice.org.uk/CG113.
  32. ↑ Goodie, J. L.; Isler, W. C.; Hunter, C. L.; Peterson, A. L. (2009). "Using behavioral health consultants to treat insomnia in primary care: A clinical case series". Journal of Clinical Psychology. 65 (3): 294–304. doi:10.1002/jclp.20548. PMID   19152339.
  33. ↑ Fiore, M., Bailey, W., Cohen, S., et al. (2000). Treating Tobacco Use and Dependence. A Clinical Practice Guideline. Rockville, MD: U.S. Dept. of Health and Human Services; AHRQ publication No. 00-0032.
  34. ↑ Ridgeway, N.; Harvill, D.; Harvill, L.; Falin, T.; Forester, G.; Gose, O. (1999). "Improved control of type 2 diabetes mellitus: a practical education/behavior modification program in a primary care clinic". Southern Medical Journal. 92 (7): 667–72. doi:10.1097/00007611-199907000-00004. PMID   10414474.
  35. ↑ Ahles, T., Wasson, J., Seville, J. L., Johnson, D. J., Cole, B. F., Hanscom, B., et al. (2006). A controlled trial of methods for managing pain with or without co-occurring psychological problems. Annals of Family Medicine, 3, 1–13.
  36. ↑ Whitlock, E. P.; Orleans, C. T.; Pender, N.; Allan, J. (2002). "Evaluating primary care behavioral counseling interventions: An evidence-based approach". American Journal of Preventive Medicine. 22 (4): 267–284. CiteSeerX   10.1.1.134.6993 . doi:10.1016/S0749-3797(02)00415-4. PMID   11988383.
  37. ↑ U.S. Department of Health and Human Services. (2001). Mental health: Culture, race, ethnicity. Retrieved November 14, 2008, from http://mentalhealth.samhsa.gov Archived 2010-08-22 at the Wayback Machine /cre/toc.asp
  38. ↑ Humes, K.R., Jones, N.A., & Ramirez, R.R. (2011, March). Overview of Race and Hispanic Origin: 2010 [Census brief]. Retrieved from: https://www.census.gov/ prod/cen2010/briefs/c2010br-02.pdf
  39. ↑ Haley, W.E.; McDaniel, S.H.; Bray, J.H.; Frank, R.G.; Heldring, M.; Johnson, S.B.; Lu, E.G.; et al. (1998). "Psychological practice in primary care settings: Practical tips for clinicians". Professional Psychology: Research and Practice. 29 (3): 237–244. doi:10.1037/0735-7028.29.3.237.
  40. ↑ Armstrong, T., & Swartzman, L. (2001), Cross-cultural differences in illness models and expectations for the health care provider-client/patient interaction. In S. Kazarian and D. Evans (Eds.), Cultural health psychology, (pp. 45–61). San Diego, CA: Academic Press.
  41. ↑ Wright, D., (2007). Progress Review: Mental Health and Mental Disorders. Retrieved from Healthy People 2010: "Healthy People 2020 - Improving the Health of Americans". Archived from the original on 2012-08-02. Retrieved 2011-06-23. default.htm
  42. ↑ U.S. Department of Health and Human Services, Office of Disease Prevention & Health Promotion. (2009). Proposed Healthy People 2020 Objectives. Retrieved March 14, 2010, from http://www.healthypeople.gov/hp2020/objectives/TopicArea.aspx?id=34&%5B%5D TopicArea=Mental+Health+and+Mental+Disorders
  43. ↑ Haas, L.J., & deGruy, F.V. (2004). Primary care, psychology, and primary care psychology. In Haas, L.J. (Ed.), Handbook of Primary Care Psychology, (pp. 5–19). New York: Oxford University Press.
  44. ↑ Jones, K.R., & Vischi, T.R. (1980). The Bethesda Consensus Conference on Medical Offset. Alcohol, drug abuse, and mental health administration report. Rockville, MD: Alcohol, Drug Abuse, and Mental Health Administration.
  45. ↑ Pallack, M.S.; Cummings, N.A.; Dorken, H.; Henke, C.J. (1994). "Medical costs, Medicaid, and managed mental health treatment: The Hawaii study". Managed Care Quarterly. 2 (2): 64–70. PMID   10134004.
  46. ↑ Cummings, N.A. (1997). Approaches in prevention in the behavioral health of older adults. In P. Hartman-Stein (Eds.) Innovative behavioral healthcare for older adults: A guide-for changing times (pp. 1–23). San Francisco: Jossey-Bass.
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