Mental Health Services, U.S. Department of Veterans Affairs Central Office, Washington, District of Columbia Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
Mental Health Services, U.S. Department of Veterans Affairs Central Office, Washington, District of Columbia.
Gerontologist. 2014 Oct;54(5):868-79. doi: 10.1093/geront/gnt142. Epub 2013 Dec 3.
PURPOSE OF THE STUDY: To promote mental health (MH) service access and quality for veterans with complex and chronic medical, social, and behavioral conditions, the U.S. Department of Veterans Affairs (VA) has integrated a full-time MH provider into each VA home-based primary care (HBPC) team. The goal of the current evaluation is to examine the nature and extent to which MH care processes and practices have been integrated into HBPC nationally. DESIGN AND METHODS: Separate surveys assessing the integration of a wide range of MH care practices and HBPC team processes were sent to MH providers and program directors in each HBPC program in 2010. RESULTS: A total of 132 MH providers representing 119 HBPC programs, and 112 program directors completed the surveys. The most common clinical issues addressed by MH providers were depression, coping with illness and disability, anxiety, caregiver/family stress, and cognitive evaluation. Other team members typically conducted initial MH screenings, with MH providers' time focusing on cases with identified needs. Approximately 40% of MH providers' time was devoted to direct clinical care. Significant time was also spent on team activities, driving, and charting. IMPLICATIONS: Integration of MH services into HBPC is feasible and facilitates service access for a vulnerable population. Mental health care delivery in HPBC generally involves a high degree of interdisciplinary practice. Mental health integration into HBPC may serve as a model for other systems interested in promoting MH care delivery among homebound and other older individuals.
研究目的:为了促进患有复杂和慢性医学、社会和行为问题的退伍军人获得心理健康(MH)服务并提高服务质量,美国退伍军人事务部(VA)已经在每个退伍军人家庭初级保健(HBPC)团队中都配备了一名全职的 MH 服务提供者。本次评估的目的是调查全国范围内 MH 护理流程和实践在多大程度上融入 HBPC。
设计和方法:2010 年,分别向每个 HBPC 项目中的 MH 服务提供者和项目主管发送了评估各种 MH 护理实践和 HBPC 团队流程整合情况的调查问卷。
结果:共有 132 名 MH 服务提供者代表 119 个 HBPC 项目,以及 112 名项目主管完成了调查。MH 服务提供者解决的最常见临床问题是抑郁、疾病和残疾应对、焦虑、照顾者/家庭压力和认知评估。其他团队成员通常会进行初步的 MH 筛查,而 MH 服务提供者的时间则专注于有明确需求的病例。大约 40%的 MH 服务提供者的时间用于直接的临床护理。团队活动、驾驶和图表记录也占用了大量时间。
结论:将 MH 服务纳入 HBPC 是可行的,并且为弱势群体提供了服务机会。HBPC 中的心理健康护理服务通常涉及高度的跨学科实践。将 MH 整合到 HBPC 中可能成为其他有兴趣在居家和其他老年人中促进 MH 护理服务的系统的典范。
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