Goldman Matthew L, Smali Ekaterina, Richkin Talia, Pincus Harold Alan, Chung Henry
Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, USA.
Comprehensive Crisis Services, San Francisco Department of Public Health, 1380 Howard St, San Francisco, CA, 94103, USA.
Community Ment Health J. 2022 Jan;58(1):136-144. doi: 10.1007/s10597-021-00802-z. Epub 2021 Feb 27.
Primary care practices are in great need of practical guidance on the steps they can take to build behavioral health integration (BHI) capacities, particularly for smaller practice settings with fewer resources. 11 small primary care sites (≤ 5 providers) throughout New York State utilized a continuum framework of core components of BHI in combination with technical assistance. Surveys were collected at baseline, 6-months, and 12-months. Semi-structured interviews and focus groups were conducted during site visits, and a stakeholder roundtable was facilitated to address broader themes. Data were analyzed using qualitative thematic analysis. Practices reported successful engagement with the framework and actively participated in planning and advancing BHI operations. Greater success was observed in practices with existing on-site BHI services, identified champions for BHI, early and sustained training and involvement of providers and administrators, use of collaborative agreements with external behavioral health providers, and capacity to successfully receive reimbursements for BHI services. Advancing health information technologies was a challenge across sites. Financing and policy factors were viewed as critically important to advance integration efforts. The pilot of a continuum framework offers lessons for primary care practices and policymakers to advance integrated BH care.
基层医疗实践非常需要关于如何建立行为健康整合（BHI）能力的实用指导，特别是对于资源较少的小型医疗机构。纽约州的11个小型基层医疗点（≤5名医护人员）采用了BHI核心组成部分的连续统一框架，并结合技术支持。在基线、6个月和12个月时收集了调查数据。在实地考察期间进行了半结构化访谈和焦点小组讨论，并组织了一次利益相关者圆桌会议以探讨更广泛的主题。使用定性主题分析对数据进行了分析。各医疗点报告称成功地参与了该框架，并积极参与了BHI运营的规划和推进。在已有现场BHI服务、确定了BHI倡导者、医护人员和管理人员得到早期和持续培训及参与、与外部行为健康提供者签订合作协议以及能够成功获得BHI服务报销的医疗点中，观察到了更大的成功。推进健康信息技术在各个医疗点都是一项挑战。融资和政策因素被视为推进整合工作的至关重要因素。连续统一框架的试点为基层医疗实践和政策制定者推进综合BH护理提供了经验教训。
