Jacobs Christine, Brieler Jay A, Salas Joanne, Betancourt Renée M, Cronholm Peter F
Saint Louis University Department of Family and Community Medicine, St Louis, MO.
Department of Family Medicine and Community Health, University of Pennsylvania.
Fam Med. 2018 May;50(5):380-384. doi: 10.22454/FamMed.2018.639260.
Behavioral health integration (BHI) in primary care settings is critical to mental health care in the United States. Family medicine resident experience in BHI in family medicine residency (FMR) continuity clinics is essential preparation for practice. We surveyed FMR program directors to characterize the status of BHI in FMR training.
Using the Council of Academic Family Medicine Educational Research Alliance (CERA) 2017 survey, FMR program directors (n=478, 261 respondents, 54.6% response rate) were queried regarding the stage of BHI within the residency family medicine center (FMC), integration activities at the FMC, and the professions of the BH faculty. BHI was characterized by Substance Abuse and Mental Health Services Agency (SAMHSA) designations within FMRs, and chi-square or ANOVA with Tukey honest significant difference (HSD) post hoc testing was used to assess differences in reported BHI attributes.
Program directors reported a high level of BHI in their FMCs (44.1% full integration, 33.7% colocated). Higher levels of BHI were associated with increased use of warm handoffs, same day consultation, shared health records, and the use of behavioral health (BH) professionals for both mental health and medical issues. Family physicians, psychiatrists, and psychologists were most likely to be training residents in BHI.
Almost half of FMR programs have colocated BH care or fully integrated BH as defined by SAMHSA. Highly integrated FMRs use a diversity of behavioral professionals and activities. Residencies currently at the collaboration stage could increase BH provider types and BHI practices to better prepare residents for practice. Residencies with full BHI may consider focusing on supporting BHI-trained residents transitioning into practice, or disseminating the model in the general primary care community.
在初级保健机构中，行为健康整合（BHI）对美国的精神卫生保健至关重要。家庭医学住院医师在家庭医学住院医师培训（FMR）连续性诊所中的BHI经历是实践的重要准备。我们对FMR项目主任进行了调查，以描述FMR培训中BHI的现状。
使用学术家庭医学教育研究联盟理事会（CERA）2017年的调查，询问FMR项目主任（n = 478，261名受访者，54.6%的回复率）关于住院家庭医学中心（FMC）内BHI的阶段、FMC的整合活动以及行为健康教职人员的专业。BHI由FMR内的药物滥用和精神健康服务管理局（SAMHSA）指定进行特征描述，并且使用卡方检验或方差分析以及Tukey真实显著差异（HSD）事后检验来评估报告的BHI属性的差异。
项目主任报告其FMC中BHI水平较高（44.1%完全整合，33.7%同址设置）。较高水平的BHI与更多地使用温馨交接、当日会诊、共享健康记录以及在心理健康和医疗问题上使用行为健康（BH）专业人员相关。家庭医生、精神科医生和心理学家最有可能在BHI方面培训住院医师。
几乎一半的FMR项目按照SAMHSA的定义同址设置了BH护理或完全整合了BH。高度整合的FMR使用多种行为专业人员和活动。目前处于协作阶段的住院医师培训项目可以增加BH提供者类型和BHI实践，以便更好地让住院医师为实践做好准备。完全实现BHI的住院医师培训项目可能会考虑专注于支持接受过BHI培训的住院医师过渡到实践中，或者在普通初级保健社区中推广该模式。
