VA Center for Integrated Healthcare, VA WNY Healthcare System, Buffalo, NY, USA.
BMC Health Serv Res. 2012 Sep 25;12:337. doi: 10.1186/1472-6963-12-337.
Co-located, collaborative care (CCC) is one component of VA's model of Integrated Primary Care that embeds behavioral health providers (BHPs) into primary care clinics to treat commonly occurring mental health concerns among Veterans. Key features of the CCC model include time-limited, brief treatments (up to 6 encounters of 30 minutes each) and emphasis on multi-dimensional functional assessment. Although CCC is a mandated model of care, the barriers and facilitators to implementing this approach as identified from the perspective of BHPs have not been previously identified.
This secondary data analysis used interview data captured as part of a quality improvement project in 2008. Fourteen BHPs (48% of providers in a regional VA network) agreed to participate in a 30-minute, semi-structured phone interview. The interview included questions about their perceived role as a CCC provider, depiction of usual practice styles and behaviors, and perceptions of typical barriers and facilitators to providing behavioral healthcare to Veterans in CCC. Interviews were transcribed verbatim into a text database and analyzed using grounded theory.
Six main categories emerged from the analysis: (a) Working in the VA Context, (b) Managing Access to Care on the Front Line, (c) Assessing a Care Trajectory, (d) Developing a Local Integrated Model, (e) Working in Collaborative Teams, and (f) Being a Behavioral Health Generalist. These categories pointed to system, clinic, and provider level factors that impacted BHP's role and ability to implement CCC. Across categories, participants identified ways in which they provided Veteran-centered care within variable environments.
This study provided a contextualized account of the experiences of BHP's in CCC. Results suggest that these providers play a multifaceted role in delivering clinical services to Veterans while also acting as an interdependent component of the larger VA behavioral health and primary care systems. Based on the inherent challenges of enacting this role, BHPs in CCC may benefit from additional implementation support in their effort to promote health care integration and to increase access to patient-centered care in their local clinics.
共置协作式医疗护理（CCC）是退伍军人事务部综合初级保健模式的一个组成部分，它将行为健康提供者（BHPs）嵌入初级保健诊所，以治疗退伍军人中常见的心理健康问题。CCC 模式的主要特点包括限时、简短的治疗（最多 6 次每次 30 分钟）和强调多维功能评估。尽管 CCC 是一种强制性的护理模式，但从 BHPs 的角度来看，实施这种方法的障碍和促进因素尚未确定。
这项二次数据分析使用了 2008 年作为质量改进项目一部分所获得的访谈数据。14 名 BHPs（区域退伍军人事务部网络中的 48%的提供者）同意参加一个 30 分钟的半结构化电话访谈。访谈包括他们对作为 CCC 提供者的角色的看法、描述他们的常规实践风格和行为，以及对在 CCC 中向退伍军人提供行为保健的典型障碍和促进因素的看法。访谈被逐字转录到一个文本数据库中，并使用扎根理论进行分析。
分析产生了六个主要类别：（a）在退伍军人事务部环境中工作，（b）在前线管理医疗护理的获取，（c）评估护理轨迹，（d）发展当地综合模式，（e）在协作团队中工作，以及（f）作为行为健康通才。这些类别指出了影响 BHP 角色和实施 CCC 的系统、诊所和提供者层面的因素。在各个类别中，参与者都指出了他们在不同环境中为退伍军人提供以患者为中心的护理的方式。
这项研究提供了对 CCC 中 BHPs 经历的背景化描述。结果表明，这些提供者在为退伍军人提供临床服务方面发挥着多方面的作用，同时也是退伍军人事务部行为健康和初级保健系统的一个相互依存的组成部分。鉴于实施这一角色的固有挑战，CCC 中的 BHPs 可能需要额外的实施支持，以促进医疗保健的整合，并增加他们在当地诊所提供以患者为中心的护理的机会。
