Department of Internal Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
Psychosom Med. 2010 Jul;72(6):511-8. doi: 10.1097/PSY.0b013e3181e2c4a0. Epub 2010 May 24.
To assess pragmatic challenges faced when implementing, delivering, and sustaining models of integrated mental health intervention in primary care settings. Thirty percent of primary care patients with chronic medical conditions and up to 80% of those with health complexity have mental health comorbidity, yet primary care clinics rarely include onsite mental health professionals and only one in eight patients receive evidence-based mental health treatment. Integrating specialty mental health into primary care improves outcomes for patients with common disorders, such as depression.
We used key informant interviews documenting barriers to implementation and components that inhibited or enhanced operational success at 11 nationally established integrated physical and mental condition primary care programs.
All but one key informant indicated that the greatest barrier to the creation and sustainability of integrated mental condition care in primary care settings was financial challenges introduced by segregated physical and mental health reimbursement practices. For integrated physical and mental health program initiation and outcome changing care to be successful, key components included a clinical and administrative champion-led culture shift, which valued an outcome orientation; cross-disciplinary training and accountability; use of care managers; consolidated clinical record systems; a multidisease, total population focus; and active, respectful coordination of colocated interdisciplinary clinical services.
Correction of disparate physical and mental health reimbursement practices is an important activity in the development of sustainable integrated physical and mental condition care in primary care settings, such as a medical home. Multiple clinical, administrative, and economic factors contribute to operational success.
评估在初级保健环境中实施、提供和维持综合心理健康干预模式所面临的实用挑战。30%患有慢性疾病的初级保健患者和高达 80%患有健康复杂性的患者都存在心理健康共病，但初级保健诊所很少有现场心理健康专业人员，只有八分之一的患者接受循证心理健康治疗。将专业心理健康纳入初级保健可以改善常见疾病（如抑郁症）患者的治疗效果。
我们使用关键知情人访谈记录了在 11 个全国性的综合身心疾病初级保健项目中实施和操作成功的障碍和促进因素。
除了一位关键知情人外，所有人都表示，在初级保健环境中创建和维持综合心理健康护理的最大障碍是由隔离的身心健康报销实践带来的财务挑战。为了使综合身心健康计划的启动和改变治疗结果取得成功，关键组成部分包括以临床和行政负责人为主导的文化转变，重视结果导向；跨学科培训和问责制；使用护理经理；整合临床记录系统；多疾病、总人口关注；以及积极、尊重地协调相邻的跨学科临床服务。
纠正不同的身心健康报销实践是在初级保健环境中发展可持续的综合身心疾病护理的重要活动，例如医疗之家。多个临床、行政和经济因素有助于实现运营成功。
