Entrepreneurs in integrated care face some of the same challenges in empirically demonstrating impact, regardless of the model of care they espouse. In this editorial, 2 leading model developers reflect on the state of the science in primary care integration, including research gaps and promising research underway. We asked these leaders to discuss conceptual areas of shared concern, and we present those with reference to the metaphor of the translational research bridge. Their insights resonate with one another and suggest a role for collaboration to advance empirical support for the implementation of integrated care.

A barrier cited by primary care administrators in integrating behavioral health is financial risk. Fee-for-service billing mechanisms remain complex and there is little empirical guidance on cost-effective models. This study was an economic evaluation of an integrated care model in a pediatric private practice clinic. The study evaluated cost benefits by examining specific delivery indices such as concerns presented, time spent, billing codes used, and reimbursement received in regards to pediatric primary care visits by comparing days when an on-site Behavioral Health Consultant (BHC) was available versus Non-BHC Days. All 3 hypotheses were supported: 1) more patients were seen in clinic on BHC Days; 2) more revenue was generated on BHC Days; and 3) incorporation of the BHC was cost-effective. Findings showed that time saved by having a BHC onsite increased provider productivity, resulting in an additional $1,142 in revenue generated on a BHC Day when compared to a Non-BHC Day.

The Primary Care Behavioral Health (PCBH) model of service delivery is being used increasingly as an effective way to integrate behavioral health services into primary care. Despite its growing popularity, scientifically robust research on the model is lacking. In this article, we provide a qualitative review of published PCBH model research on patient and implementation outcomes. We review common barriers and potential solutions for improving the quantity and quality of PCBH model research, the vital data that need to be collected over the next 10 years, and how to collect those data.

Background: Primary care may be a key setting for suicide prevention as many patients visit their General Practitioner (GP) in the weeks leading up to their death. Comparatively little is known about GPs’ perspectives on risk assessment, treatment adherence, management of and interactions with suicidal patients prior to the patient’s suicide and the services available in primary care for suicide prevention. Aim: This study aimed to explore primary care data on a clinical sample of individuals who died by suicide and were in recent contact with mental health services in order to: investigate the frequency and nature of general practice consultations; examine risk assessment, treatment adherence and management in primary and secondary care; gain GPs’ views on patient non-adherence to treatment and service availability for the management of suicidal patients. Method: A mixed-methods study design including data from the National Confidential Inquiry on 336 patients who died by suicide, data from 286 patient coroner files, primary care medical notes on 291 patients and 198 semi-structured face–to-face interviews with GPs across the North West of England. We collected data on GPs' views on the treatment and management of patients in the year prior to suicide, suicide prevention generally and local mental health service provision. Quantitative data were analysed using SPSS. Interviews were transcribed verbatim and analysed using a thematic approach. Results: Overall, 91% of individuals consulted their GP on at least one occasion in the year before suicide. GPs reported concerns about their patient’s safety in 27% of cases, but only 16% of them thought that the suicide could have been prevented. The overall agreement in the rating of risk between primary and specialist care was poor (overall kappa = 0.127; p = 0.10). Non-adherence was reported for 43% of patients. The main reasons for non-adherence were lack of insight, reported side effects and multiple psychiatric diagnoses. We obtained qualitative data from GPs on their interpretations of suicide attempts or self-harm, professional isolation and GP responsibilities when managing suicidal patients. Limitations: Our findings may not be generalisable to people who died by suicide and were not under the care of specialist services. GPs recruited for the study may have had different views from GPs who have never experienced a patient suicide. Our findings may not be representative of the rest of the UK although many of the issues identified are likely to apply across services. Conclusion: Suicide prevention in primary care is challenging. Possible strategies for future suicide prevention in general practice include: increasing GP awareness of suicide-related issues and improving training and risk assessment skills; increasing awareness in primary care about why patients may not want treatments offered by focusing on each individual’s situational context; removing barriers to accessing therapies and treatments; and, better liaison and collaboration between services to improve patient outcomes.

<p>Primary care multi-disciplinary teams were central to recent reform plans for Canadian primary care, in response to limited resources and increasing demands. Health Information Technology was also an integral part of those plans as supporting infrastructure for the modernization of healthcare services, facilitating coordination, collaboration and access to services. As provider-centric Health Information Technology matures, attention turns to the patient. The hallmark of patient-centered applications is the electronic Personal Health Record System (PHR). These systems have grown beyond simple repositories of personal health information, extending to a range of information collection, sharing, self-management and exchange functions.</p> <p>The implementation of PHRs in primary care multi-disciplinary teams involves many stakeholders including patients, physician, allied health professionals and support staff. There is significant literature on physician and patient perspectives on all PHR functions. However, little attention has been given to the other stakeholders: allied health professionals and support staff.</p> <p>In this study, we explored the views of Allied Health Professionals (AHPs) and support staff, working in a primary care clinic adopting a patient-centered, multi-disciplinary model called the Family Health Team (FHT) model. Participants provided their insight on benefits, concerns and recommendations regarding the implementation of MyOSCAR, a PHR, at their clinic. Qualitative data was collected through semi-structured one-on-one interviews that were analyzed to extract common themes and summarize participant views. Process diagrams were produced to highlight opportunities for improvement of current work processes through the integration of MyOSCAR functions.</p> <p>As more teams are created in primary care and they attempt to implement new technologies, it is important to get a complete picture of all stakeholder views. This is the first study that focuses on the views of AHPs and support staff, contributing to the literature on PHR implementations. Findings from this study can contribute to future PHR implementations by informing planning and implementation.</p> / Master of Science (MSc)

Made available in DSpace on 2016-04-29T14:16:15Z (GMT). No. of bitstreams: 1 Elaine Cristina Silva.pdf: 1961461 bytes, checksum: 106cec8f6d1e04fc9d53b996c7939acf (MD5) Previous issue date: 2012-09-04 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / The National Health System (Sistema Único de Saúde - SUS) has completed more than two decades in 2012, bringing in its history the contradictions and inequalities of Brazilian society, expressed mainly by the lack of access to goods and services produced collectively, but unequally appropriate, of the which highlight the universal access to health . There is a reality that pushes the Brazilian population to obtain access to health care wherever possible , not respecting the proposal of health care model of health policy that advocates the Basic Health Units (Unidades Básicas de Saúde - UBS) as the gateway for the system (ALMEIDA et al., 2002; ROCHA, 2005; SIMONS, 2008; JESUS and ASSIS, 2010). In everyday practice, it is significant the demand of the users for urgent and emergency services as a gateway to the health system (CECÍLIO, 1997). We adopt as central categories of analysis health in its multiple dimensions approached and understood as a result of the conditions of life and work; and "access" as a central category of analysis of social policies, conceptualized as the result of the effective availability, accessibility, acceptability and accommodation of health services (PENCHANSKY and THOMAS, 1981), such that they can guarantee full attendance, articulated and continued to the users. The purpose of this study was: to analyze the universal access to health, taking as the empirical field the Adult Emergency Care Center in the city of Barueri. In the systematic observation of the health care professionals, there is a perception that the users are seeking the emergency services and emergency inappropriately. We started from the hypothesis that, in view of users, the UBS s do not are the only entrance to the health system, may be appealed to emergency services and emergency according with their care needs. Methodology: bibliographical and documentary research; questionnaire applied to a sample of the systematic type - to 100 users of the Adult Emergency Care Center Barueri, in a typical week; and semi structured interviews with coordination of the service. Results: The study revealed that only 7% of demands that arrived at the Adult Emergency Care Center Barueri were not relevant to that level of attention. On the other hand, a significant portion of users believes that the demand for primary care should occur only when if needs, not considering the idea of continuity and longitudinality of care on this level / O Sistema Único de Saúde (SUS) completou mais de duas décadas em 2012, trazendo na sua história as contradições e desigualdades da sociedade brasileira, expressas sobretudo pela falta de acesso a bens e serviços produzidos coletivamente, mas apropriados de modo desigual, dos quais destacamos o acesso universal à saúde . Uma realidade que impulsiona a população brasileira a obter acesso ao sistema de saúde por onde for possível , não respeitando a proposta de modelo assistencial da política de saúde que preconiza as Unidades Básicas de Saúde (UBS) como a porta de entrada para o sistema (ALMEIDA et al., 2002; ROCHA, 2005; SIMONS, 2008; JESUS e ASSIS, 2010). Na prática cotidiana, é expressiva a demanda dos usuários pelos serviços de urgência e emergência como porta de entrada ao sistema de saúde (CECÍLIO, 1997). Adotamos como categorias centrais de análise a saúde abordada em suas múltiplas dimensões e compreendida como resultado das condições de vida e trabalho. E acesso , como categoria central de análise das políticas sociais, conceituada como o resultado da efetiva disponibilidade, acessibilidade, aceitabilidade e acomodação dos serviços de saúde (PENCHANSKY e THOMAS, 1981), de modo que possam garantir atendimento integral, articulado e continuado aos usuários. O objetivo deste estudo foi: analisar a universalização do acesso à saúde, tomando como campo empírico o Pronto Atendimento Adulto Central no Município de Barueri. Na observação assistemática dos profissionais da área de saúde, há uma percepção de que os usuários buscam os serviços de urgência e emergência inadequadamente. Partiu-se da hipótese de que, na perspectiva dos usuários, as UBS não se constituem como a única porta de entrada ao sistema de saúde, podendo-se recorrer aos serviços de urgência e emergência de acordo com as suas necessidades de atendimento. Metodologia: pesquisa bibliográfica, documental, questionário aplicado a uma amostra do tipo sistemática, a 100 usuários do Pronto Atendimento Adulto Central de Barueri, em uma semana típica e entrevista semiestruturada com a coordenação do serviço. Resultados: o estudo revelou que apenas 7% das demandas que chegavam ao Pronto Atendimento Adulto Central de Barueri não eram pertinentes àquele nível de atenção. Por outro lado, parte significativa dos usuários considera que a demanda para a atenção básica deve ocorrer apenas quando se precisa, desconsiderando a ideia de continuidade e longitudinalidade do atendimento nesse nível

O Programa de Saúde da Família (PSF) incorpora e reafirma os princípios do SUS e está estruturado a partir da Unidade de Saúde da Família, que se propõe a organizar suas ações sob os princípios da integralidade e hierarquização, territorialidade e cadastramento da clientela, a partir de uma equipe multiprofissional. O objetivo do estudo foi avaliar através de gráficos de tendências, se a expansão do PSF foi acompanhada por melhoras na saúde infantil nos municípios do estado do Rio de Janeiro, entre 1998 e 2010. A análise foi feita relacionando graficamente a utilização de serviços hospitalares como internações por pneumonias e desidratação na infância, procedimentos pediátricos, como taxas de aleitamento materno, utilização da terapia de reidratação oral e consultas de puericultura, com a taxa de cobertura do programa. A expansão do PSF pareceu estar relativamente pouco associada com aumento no número de consultas de puericultura, nas taxas de aleitamento materno e na utilização da terapia de reidratação oral e com diminuição nas internações por pneumonia e desidratação. Essas associações aparentemente fracas sugerem que o PSF pode não estar gerando os resultados desejáveis. Evidentemente, estudos adicionais são necessários a fim de analisar essas associações. / The family health program (PSF) incorporates and reaffirms the principles of the SUS and is structured from the family health unit, which aims to organize their actions under the principles of comprehensiveness and tiering, territoriality and customer registration, from a multidisciplinary team. The objective of this study was to evaluate through trend charts, whether the PSF expansion was accompanied by improvements in child health in municipalities of the State of Rio de Janeiro, between 1998 and 2010. The analysis was done by relating graphically using hospital services such as hospitalizations for pneumonia and dehydration in children, Pediatric procedures such as breastfeeding rates, use of oral rehydration therapy and childcare queries, with the coverage rate of the program. The PSF expansion seemed to be relatively little associated with increase in number of childcare queries in breastfeeding rates and the use of oral rehydration therapy and reduction in hospitalizations for pneumonia and dehydration property. These seemingly poor associations suggest that the PSF may not be generating the desired results. Of course, additional studies are needed to examine these associations.

O Programa de Saúde da Família (PSF) incorpora e reafirma os princípios do SUS e está estruturado a partir da Unidade de Saúde da Família, que se propõe a organizar suas ações sob os princípios da integralidade e hierarquização, territorialidade e cadastramento da clientela, a partir de uma equipe multiprofissional. O objetivo do estudo foi avaliar através de gráficos de tendências, se a expansão do PSF foi acompanhada por melhoras na saúde infantil nos municípios do estado do Rio de Janeiro, entre 1998 e 2010. A análise foi feita relacionando graficamente a utilização de serviços hospitalares como internações por pneumonias e desidratação na infância, procedimentos pediátricos, como taxas de aleitamento materno, utilização da terapia de reidratação oral e consultas de puericultura, com a taxa de cobertura do programa. A expansão do PSF pareceu estar relativamente pouco associada com aumento no número de consultas de puericultura, nas taxas de aleitamento materno e na utilização da terapia de reidratação oral e com diminuição nas internações por pneumonia e desidratação. Essas associações aparentemente fracas sugerem que o PSF pode não estar gerando os resultados desejáveis. Evidentemente, estudos adicionais são necessários a fim de analisar essas associações. / The family health program (PSF) incorporates and reaffirms the principles of the SUS and is structured from the family health unit, which aims to organize their actions under the principles of comprehensiveness and tiering, territoriality and customer registration, from a multidisciplinary team. The objective of this study was to evaluate through trend charts, whether the PSF expansion was accompanied by improvements in child health in municipalities of the State of Rio de Janeiro, between 1998 and 2010. The analysis was done by relating graphically using hospital services such as hospitalizations for pneumonia and dehydration in children, Pediatric procedures such as breastfeeding rates, use of oral rehydration therapy and childcare queries, with the coverage rate of the program. The PSF expansion seemed to be relatively little associated with increase in number of childcare queries in breastfeeding rates and the use of oral rehydration therapy and reduction in hospitalizations for pneumonia and dehydration property. These seemingly poor associations suggest that the PSF may not be generating the desired results. Of course, additional studies are needed to examine these associations.

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