VA New England Geriatric Research Education and Clinical Center (JM), VA Boston Healthcare System, Jamaica Plain, MA; Department of Psychiatry (JM), Harvard Medical School, Boston, MA.
Geriatric Primary Care Clinic (GH), St. Louis VA Healthcare System, St. Louis, MO.
Am J Geriatr Psychiatry. 2019 Feb;27(2):100-108. doi: 10.1016/j.jagp.2018.09.001. Epub 2018 Sep 13.
To inform geriatric mental health policy by describing the role of behavioral healthcare providers within a geriatric patient-aligned care team (GeriPACT), a patient-centered medical home model of care within the Veterans Health Administration (VHA), serving older veterans with chronic disease, functional dependency, cognitive decline, and psychosocial challenges, and/or those who have elder abuse, risk of long-term care placement, or impending disability.
The authors used mixed methods, consisting of a national survey and site visits between July 2016 and February 2017, at VHA outpatient clinics. The participants, 101 GeriPACTs at 44 sites, completed surveys, and 24 medical providers were interviewed. A standardized survey and semi-structured interview guide were developed based on the program handbook, with input from experts in the VHA Office of Geriatrics and Extended Care Services, guided by the Consolidated Framework for Implementation Science Research.
Of surveyed GeriPACTs, 42.6% had a mental health provider on the team-a psychiatrist (28.7%) and/or psychologist (23.8%). Of these, the mean was 0.27 full-time equivalent psychiatrists and 0.44 full-time equivalent psychologists per team (suggested panel = 800 patients). In surveys, teams with behavioral health providers were more likely to manage psychosocial χ = 8.87, cognitive χ = 8.68, and depressive χ = 11.85 conditions in their panel than those without behavioral health providers.
GeriPACT mental health integration is less than 50%. Population differences between general primary care and geriatric primary care may require different care approaches and provider competencies and need further study.
通过描述行为保健提供者在老年患者一致护理团队（GeriPACT）中的角色，为老年心理健康政策提供信息。该模型是退伍军人健康管理局（VHA）内以患者为中心的医疗之家护理模式，为患有慢性疾病、功能依赖、认知能力下降和心理社会挑战的老年退伍军人服务，或为有虐待老人、长期护理安置风险或即将残疾的患者服务。
作者使用混合方法，包括 2016 年 7 月至 2017 年 2 月期间在 VHA 门诊诊所进行的全国调查和现场访问。101 个 GeriPACT 参与了调查，来自 44 个地点。24 名医疗服务提供者接受了访谈。调查基于该计划手册制定了标准化的调查和半结构化访谈指南，VHA 老年和扩展护理服务办公室的专家提供了意见，并根据实施科学研究综合框架进行了指导。
在所调查的 GeriPACT 中，有 42.6%的团队中有心理健康提供者-精神科医生（28.7%）和/或心理学家（23.8%）。其中，平均每个团队有 0.27 名全职等效精神科医生和 0.44 名全职等效心理学家（建议小组人数为 800 名患者）。在调查中，有行为健康提供者的团队比没有行为健康提供者的团队更有可能管理其小组中的心理社会 χ=8.87、认知 χ=8.68 和抑郁 χ=11.85 状况。
GeriPACT 的心理健康整合不足 50%。一般初级保健和老年初级保健之间的人群差异可能需要不同的护理方法和提供者能力，需要进一步研究。
