Martin Matthew P, White Mark B, Hodgson Jennifer L, Lamson Angela L, Irons Thomas G
Southern Regional Area Health Education Center.
Northcentral University.
Fam Syst Health. 2014 Mar;32(1):101-15. doi: 10.1037/fsh0000017.
The integration of behavioral health services into primary care medical settings may be part of the solution to the fragmented health care system currently found in the United States. Although integrated primary care (IPC) is implemented in various locations across the United States, little information is available about how IPC is specifically practiced. Using a systematic review design, we extracted data from 76 articles to examine 6 categories of IPC program characteristics, including collaboration practices (e.g., shared decision-making, written communication, hallway conversations), program models, behavioral health interventions, behavioral health training and supervision, behavioral health provider type, and setting. Findings show that most IPC programs include psychoeducation, medication, follow-up contact, psychotherapy, and at least 1 care management strategy as part of treatment. Fewer than half of researchers report communication between providers, and even fewer report collaboration as a "shared decision making process." A third of researchers report training and/or supervising behavioral health providers to work in an IPC program, and a fourth report recruiting nurses as behavioral health providers. Of all the studies, family-based interventions were used in 1. We recommend that future researchers report more information about collaboration processes as well as training and supervision of behavioral health providers. We also recommend that researchers develop IPC programs that involve family members in treatment and better implement theory into future IPC programs to support conceptualization and replication of IPC program models.
将行为健康服务整合到初级保健医疗环境中，可能是解决美国目前碎片化医疗体系问题的一部分。尽管综合初级保健（IPC）在美国各地不同场所都有实施，但关于IPC具体实施方式的信息却很少。我们采用系统综述设计，从76篇文章中提取数据，以考察IPC项目特征的6个类别，包括协作实践（如共同决策、书面沟通、走廊交谈）、项目模式、行为健康干预、行为健康培训与监督、行为健康提供者类型以及环境。研究结果表明，大多数IPC项目将心理教育、药物治疗、随访联系、心理治疗以及至少一种护理管理策略作为治疗的一部分。不到一半的研究人员报告了提供者之间的沟通情况，甚至更少有人将协作报告为“共同决策过程”。三分之一的研究人员报告了对行为健康提供者进行培训和/或监督，使其在IPC项目中工作，四分之一的研究人员报告招募护士作为行为健康提供者。在所有研究中，只有1项使用了基于家庭的干预措施。我们建议未来的研究人员报告更多关于协作过程以及行为健康提供者培训与监督的信息。我们还建议研究人员开发让家庭成员参与治疗的IPC项目，并在未来的IPC项目中更好地运用理论，以支持IPC项目模式的概念化和复制。
