School of Nursing, Texas A&M University, Bryan, TX, USA.
Public Health Rep. 2023 May-Jun;138(1_suppl):36S-41S. doi: 10.1177/00333549231152192.
Integrated behavioral health can improve primary care and mental health outcomes. Access to behavioral health and primary care services in Texas is in crisis because of high uninsurance rates, regulatory restrictions, and lack of workforce. To address gaps in access to care, a partnership formed among a large local mental health authority in central Texas, a federally designated rural health clinic, and the Texas A&M University School of Nursing to create an interprofessional team-based health care delivery model led by nurse practitioners in rural and medically underserved areas of central Texas. Academic-practice partners identified 5 clinics for an integrated behavioral health care delivery model. From July 1, 2020, through December 31, 2021, a total of 3183 patient visits were completed. Patients were predominantly female (n = 1719, 54%) and Hispanic (n = 1750, 55%); 1050 (33%) were living at or below the federal poverty level; and 1400 (44%) were uninsured. The purpose of this case study was to describe the first year of implementation of the integrated health care delivery model, barriers to implementation, challenges to sustainability, and successes. We analyzed data from multiple sources, including meeting minutes and agendas, grant reports, direct observations of clinic flow, and interviews with clinic staff, and identified common qualitative themes (eg, challenges to integration, sustainability of integration, outcome successes). Results revealed implementation challenges with the electronic health record, service integration, low staffing levels during a global pandemic, and effective communication. We also examined 2 patient cases to illustrate the success of integrated behavioral health and highlighted lessons learned from the implementation process, including the need for a robust electronic health record and organizational flexibility.
综合行为健康可以改善初级保健和精神健康结果。由于高未保险率、监管限制和劳动力短缺，德克萨斯州的行为健康和初级保健服务陷入危机。为了解决获得护理方面的差距，一个大型的中德州当地心理健康管理局、一个联邦指定的农村健康诊所和德克萨斯 A&M 大学护理学院之间建立了合作伙伴关系，在中德州农村和医疗资源不足的地区创建了一个由护士从业者领导的跨专业团队为基础的医疗保健提供模式。学术实践合作伙伴确定了 5 家诊所来实施综合行为健康护理模式。从 2020 年 7 月 1 日至 2021 年 12 月 31 日，共完成了 3183 次患者就诊。患者主要为女性（n = 1719，54%）和西班牙裔（n = 1750，55%）；1050 人（33%）生活在联邦贫困线或以下；1400 人（44%）没有保险。本案例研究的目的是描述综合医疗保健提供模式实施的第一年、实施的障碍、可持续性的挑战和成功。我们分析了来自多个来源的数据，包括会议记录和议程、赠款报告、对诊所流程的直接观察以及对诊所工作人员的访谈，并确定了常见的定性主题（例如，整合的挑战、整合的可持续性、成果的成功）。结果显示，电子健康记录、服务整合、大流行期间的低人员配备水平以及有效的沟通方面存在实施挑战。我们还研究了 2 个患者病例，以说明综合行为健康的成功，并强调了实施过程中吸取的教训，包括对强大的电子健康记录和组织灵活性的需求。
