Departments of Psychiatry
Pediatrics.
Pediatrics. 2021 Aug;148(2). doi: 10.1542/peds.2020-001073. Epub 2021 Jul 1.
Because of severe and protracted shortages of pediatric behavioral health (BH) specialists, collaboration between pediatric primary care practitioners (PCPs) and BH specialists has the potential to increase access to BH services by expanding the BH workforce. In a previous study, we demonstrated that phase 1 of a behavioral health integration program (BHIP) enrolling 13 independently owned, community-based pediatric practices was associated with increased access to BH services while averting substantial cost increases and achieving high provider self-efficacy and professional satisfaction. The current study was undertaken to assess whether the initial access findings were replicated over 4 subsequent implementation phases and to explore the practicality of broad dissemination of the BHIP model.
After phase 1, BHIP was extended over 4 subsequent phases in a stepped-wedge design to 46 additional pediatric practices, for a total cohort of 59 practices (354 PCPs serving >300 000 patients). Program components comprised BH education and consultation and support for integrated practice transformation; these components facilitated on-site BH services by an interprofessional BH team. Outcomes were assessed quarterly, preprogram and postprogram launch.
Across combined phases 1 to 5, BHIP was associated with increased primary care access to BH services (screening, psychotherapy, PCP BH visits, psychotropic prescribing) and performed well across 7 standard implementation outcome domains (acceptability, appropriateness, feasibility, fidelity, adoption, penetration, and sustainability). Emergency BH visits and attention-deficit/hyperactivity disorder prescribing were unchanged.
These findings provide further support for the potential of integrated care to increase access to BH services in pediatric primary care.
由于儿科行为健康（BH）专家严重短缺且持续时间长，因此儿科初级保健医生（PCP）与 BH 专家之间的合作有可能通过扩大 BH 劳动力来增加 BH 服务的可及性。在之前的一项研究中，我们证明了一项行为健康整合计划（BHIP）的第 1 阶段，该阶段涉及 13 家独立拥有的社区儿科实践，与增加 BH 服务的可及性相关联，同时避免了大量成本增加，并实现了高提供者自我效能和专业满意度。本研究旨在评估初始访问结果是否在随后的 4 个实施阶段中得到复制，并探讨广泛传播 BHIP 模型的实用性。
在第 1 阶段之后，BHIP 以逐步楔形设计在 4 个后续阶段扩展到另外 46 个儿科实践中，总共涵盖了 59 个实践（354 名服务> 300,000 名患者的 PCP）。该计划的组成部分包括 BH 教育和咨询以及对综合实践转型的支持；这些组成部分通过一个跨专业的 BH 团队促进了现场 BH 服务。在项目启动前和启动后每季度评估结果。
在第 1 至 5 阶段的综合阶段中，BHIP 与增加初级保健对 BH 服务的可及性（筛查，心理治疗，PCP BH 就诊，精神科药物处方）相关，并且在 7 个标准实施结果领域表现良好（可接受性，适当性，可行性，保真度，采用度，渗透率和可持续性）。紧急 BH 就诊和注意力缺陷/多动障碍的处方则保持不变。
这些发现进一步支持了综合护理在增加儿科初级保健中 BH 服务可及性方面的潜力。
