University of Vermont, Burlington, VT, USA.
Arizona State University, Tempe, AZ, USA.
Trials. 2021 Mar 10;22(1):200. doi: 10.1186/s13063-021-05133-8.
Chronic diseases that drive morbidity, mortality, and health care costs are largely influenced by human behavior. Behavioral health conditions such as anxiety, depression, and substance use disorders can often be effectively managed. The majority of patients in need of behavioral health care are seen in primary care, which often has difficulty responding. Some primary care practices are providing integrated behavioral health care (IBH), where primary care and behavioral health providers work together, in one location, using a team-based approach. Research suggests there may be an association between IBH and improved patient outcomes. However, it is often difficult for practices to achieve high levels of integration. The Integrating Behavioral Health and Primary Care study responds to this need by testing the effectiveness of a comprehensive practice-level intervention designed to improve outcomes in patients with multiple chronic medical and behavioral health conditions by increasing the practice's degree of behavioral health integration.
Forty-five primary care practices, with existing onsite behavioral health care, will be recruited for this study. Forty-three practices will be randomized to the intervention or usual care arm, while 2 practices will be considered "Vanguard" (pilot) practices for developing the intervention. The intervention is a 24-month supported practice change process including an online curriculum, a practice redesign and implementation workbook, remote quality improvement coaching services, and an online learning community. Each practice's degree of behavioral health integration will be measured using the Practice Integration Profile. Approximately 75 patients with both chronic medical and behavioral health conditions from each practice will be asked to complete a series of surveys to measure patient-centered outcomes. Change in practice degree of behavioral health integration and patient-centered outcomes will be compared between the two groups. Practice-level case studies will be conducted to better understand the contextual factors influencing integration.
As primary care practices are encouraged to provide IBH services, evidence-based interventions to increase practice integration will be needed. This study will demonstrate the effectiveness of one such intervention in a pragmatic, real-world setting.
ClinicalTrials.gov NCT02868983 . Registered on August 16, 2016.
导致发病率、死亡率和医疗保健费用的慢性疾病在很大程度上受到人类行为的影响。焦虑、抑郁和物质使用障碍等行为健康状况通常可以得到有效管理。大多数需要行为健康护理的患者都在初级保健中接受治疗，但初级保健往往难以应对。一些初级保健实践正在提供综合行为健康护理（IBH），其中初级保健和行为健康提供者在一个地点一起工作，使用团队为基础的方法。研究表明，IBH 与改善患者预后之间可能存在关联。然而，实践往往难以实现高度整合。《综合行为健康与初级保健研究》通过测试一种全面的实践层面干预措施的有效性来满足这一需求，该措施旨在通过增加实践的行为健康整合程度来改善患有多种慢性医学和行为健康状况的患者的结果。
将招募 45 家具有现有现场行为健康护理的初级保健实践参加这项研究。将 43 家实践随机分配到干预组或常规护理组，而 2 家实践将被视为“先锋”（试点）实践，以制定干预措施。该干预措施是一个为期 24 个月的支持性实践变革过程，包括在线课程、实践重新设计和实施手册、远程质量改进辅导服务和在线学习社区。将使用实践整合概况来衡量每个实践的行为健康整合程度。将要求每个实践的大约 75 名患有慢性医学和行为健康状况的患者完成一系列调查，以衡量以患者为中心的结果。将比较两组之间实践行为健康整合程度和以患者为中心的结果的变化。将进行实践层面的案例研究，以更好地了解影响整合的背景因素。
随着鼓励初级保健实践提供 IBH 服务，将需要提供增加实践整合的循证干预措施。这项研究将在实际的现实环境中展示此类干预措施之一的有效性。
ClinicalTrials.gov NCT02868983。注册于 2016 年 8 月 16 日。
