Hemming Patrick, Hewitt Amber, Gallo Joseph J, Kessler Rodger, Levine R B
Department of Medicine, Duke University.
Fam Med. 2017 May;49(5):361-368.
Behavioral health integration (BHI) entails integrated behavioral health clinicians (IBHCs) providing care-generally for mental health and substance abuse disorders and behavioral comorbidity- within the operational functioning of primary care. Because limited data exist regarding BHI in residency, we studied its impact on resident education by examining whether increased behavioral health (BH) co-management improved residents' perceived ability to treat BH conditions.
We included residents from internal and family medicine training programs using BHI in residents' continuity clinics and assessed the level of co-management between primary care and IBHCs and the following domains: (1) confidence in managing BH conditions, (2) barriers to BH provision, (3) perception of autonomy when working with IBHCs, (4) satisfaction with the clinic, and (5) perceived educational value of BH learning modes.
Altogether, 117 residents participated in our survey (73.1% response rate). Residents who had co-managed ≥ five patients alongside IBHCs reported significantly higher confidence than those who had co-managed < five patients with BH conditions. The association remained significant after adjustment for residents' level of training and specialty. In rating BH learning modes, residents rated most highly active collaboration with IBHCs and observation with feedback from clinic preceptors.
BHI training within residency enhances perceived learning and confidence in providing BH care.
行为健康整合（BHI）要求整合行为健康临床医生（IBHCs）在初级保健的运营过程中提供护理——通常针对心理健康、药物滥用障碍和行为共病。由于关于住院医师培训中BHI的数据有限，我们通过研究增加行为健康（BH）共同管理是否能提高住院医师治疗BH疾病的感知能力，来探讨其对住院医师教育的影响。
我们纳入了在住院医师连续性诊所中使用BHI的内科和家庭医学培训项目的住院医师，并评估了初级保健与IBHCs之间的共同管理水平以及以下几个方面：（1）管理BH疾病的信心，（2）提供BH服务的障碍，（3）与IBHCs合作时的自主感，（4）对诊所的满意度，以及（5）对BH学习模式的感知教育价值。
共有117名住院医师参与了我们的调查（回复率为73.1%）。与IBHCs共同管理≥5例患者的住院医师报告的信心显著高于共同管理<5例BH疾病患者的住院医师。在对住院医师的培训水平和专业进行调整后，这种关联仍然显著。在对BH学习模式进行评分时，住院医师对与IBHCs的积极合作以及接受诊所带教老师反馈的观察评价最高。
住院医师培训中的BHI培训增强了对提供BH护理的感知学习和信心。
