Stanford University School of Medicine, Palo Alto, CA, USA.
J Prim Care Community Health. 2023 Jan-Dec;14:21501319221146918. doi: 10.1177/21501319221146918.
This study aims to compare primary care providers and medical assistants in degrees of comfort, confidence, and consistency when addressing behavioral health concerns with patients before and after the implementation of a model of integrated behavioral health in primary care (IBHPC), and evaluate whether these perceptions differ based on increased access to behavioral health clinicians.
This longitudinal study was conducted at 2 primary care clinics in Northern California while implementing an IBHPC model. was administered to assess the comfort, confidence, and consistency of behavioral health practices. Confidential online surveys were distributed to primary care faculty and staff members before and post-implementation. Responses from providers and medical assistants were compared between pre- and post-implementation with linear regression analyses. The relationships between accessibility to behavioral health clinicians and a change in comfort, confidence, and consistency of behavioral health practices were explored using a linear mixed-effects model.
A total of 35 providers and medical assistants completed the survey both before and post-implementation of IBHPC. Over time, there were increasingly positive perceptions about the consistency of behavioral health screening ( = .03) and overall confidence in addressing behavioral health concerns ( = .005). Comfort in addressing behavioral health concerns did not significantly change for either providers or staff over time. Medical assistants were initially more confident and comfortable addressing behavioral health concerns than providers, but providers' attitudes increased post-IBHPC implementation. Improved access to behavioral health clinicians was associated with greater consistency of screening and referral to specialty mental health care ( < .001).
The present study is the first to explore differences in provider and medical assistant perceptions during the course of an IBHPC implementation. Findings underscore the importance of integrating medical assistants, along with providers, into all phases of the implementation process.
本研究旨在比较初级保健提供者和医疗助理在实施初级保健综合行为健康模式（IBHPC）前后，处理患者行为健康问题时的舒适度、信心和一致性程度，并评估这些感知是否因获得更多行为健康临床医生的机会而有所不同。
本纵向研究在加利福尼亚州北部的 2 个初级保健诊所进行，同时实施了 IBHPC 模式。采用调查问卷评估行为健康实践的舒适度、信心和一致性。在实施前后，向初级保健教师和工作人员分发了保密的在线调查。使用线性回归分析比较提供者和医疗助理在实施前后的反应。使用线性混合效应模型探讨了获得行为健康临床医生的机会与行为健康实践舒适度、信心和一致性变化之间的关系。
共有 35 名提供者和医疗助理在实施 IBHPC 前后完成了调查。随着时间的推移，对行为健康筛查的一致性（ = .03）和整体处理行为健康问题的信心（ = .005）的看法越来越积极。提供者和工作人员的行为健康问题处理舒适度并没有随着时间的推移而显著变化。医疗助理在处理行为健康问题方面最初比提供者更有信心和舒适，但在实施 IBHPC 后，提供者的态度有所增加。改善获得行为健康临床医生的机会与筛查和转介至专业心理健康护理的一致性增加相关（ < .001）。
本研究首次在 IBHPC 实施过程中探索了提供者和医疗助理感知的差异。研究结果强调了将医疗助理与提供者一起纳入实施过程所有阶段的重要性。
