Health system transformation project social determinants of health investment strategy. Ongoing collaboration and coordination of care are required; activities may include screening and diagnosis, acute and long-term interventions, and followup and maintenance. 2021 Jan-Dec;12:21501327211049053. https://doi.org/10.1177%2F21501327211049053. Defining and measuring core processes and structures in integrated Delivery of brief cognitive behavioral therapy for medically ill patients in primary care: a pragmatic randomized clinical trial. 71. Potential peer reviewers must disclose any financial conflicts of interest greater than $5,000 and any other relevant business or professional conflicts of interest. https://www.gao.gov/products/gao-19-274. 5600 Fishers Lane However, because the purpose of the questions falls into three distinct categories (Scan, Key, and Contextual), the specific criteria for each are further defined below. 6 exp obstetrics/ Home | Agency for Healthcare Research and Quality Journal of Clinical Psychology in Medical Settings. Accessed September 23, 2022. AHRQ's Patient Safety Networkis another rich source of studies on burnout. Accessed September 23, 2022. 17. United States Government Accountability Office. The EPC will complete a disposition of all peer review comments. Int J Nurs Stud Adv. 2017 Mar 1;174(3):246-55. https://doi.org/10.1176/appi.ajp.2016.16050507. Engaging patients to improve quality of care: A systematic review. Outcomes of interest include but not limited to:PATIENT LEVELHealth outcomes: CLINICIAN AND PRACTICE LEVELClinician Outcomes. 2. Integration of mental health/substance abuse and primary care. Accessed September 23, 2022. 95. Integrated behavioral health is high-value care. AHRQ Pub. 14 exp health behavior/ or exp attitude to health/ Integrated Behavioral Health has been defined as "the care that results from a practice team of primary care and behavioral health clinicians, working together with patients and families, using a systematic and cost-effective approach to provide patient-centered care for a defined population. Barriers to healthcare access among US adults with mental health challenges: A population-based study. 46. https://www.pewtrusts.org/en/research-and-analysis/articles/2020/03/26/african-americans-often-face-challenges-accessing-substance-use-treatment. Key Informants are the end-users of research; they can include patients and caregivers, practicing clinicians, relevant professional and consumer organizations, purchasers of health care, and others with experience in making health care decisions. Sun M, Oliwa T, Peek ME, Tung EL. https://www.commonwealthfund.org/publications/fund-reports/2002/mar/diverse-communities-common-concerns-assessing-health-care. Role of the Funder XIII. This webinar, hosted by the Central East ATTC, will bring together experts from across disciplines to discuss the history of xylazine use, what is known about its current scope of use and consequences, the effects of xylazine on people, and wound . From our preliminary review of the literature, the majority of the available evidence is unlikely to be large randomized controlled trials (RCTs) with patient-level randomization that assess effectiveness. 41. 2020 Oct;44(5):523-30. https://doi.org/10.1007/s40596-020-01276-z. Accessed September 23, 2022. 13. Technical Experts constitute a multi-disciplinary group of clinical, content, and methodological experts who provide input in defining populations, interventions, comparisons, or outcomes and identify particular studies or databases to search. Ross KM, Klein B, Ferro K, McQueeney DA, Gernon R, Miller BF. Office of the Surgeon General; Center for Mental Health Services; National Institute of Mental Health. Abramson CM, Hashemi M, Snchez-Jankowski M. Perceived discrimination in US healthcare: Charting the effects of key social characteristics within and across racial groups. 2015;169(10):929-937. https://doi.org/10.1001/jamapediatrics.2015.1141. 2021 Feb;40(2):297-306. https://doi.org/10.1377%2Fhlthaff.2020.01452. PDF Integrating Behavioral Health and Primary Care - Agency for Healthcare Grading the Strength of Evidence (SOE) for Major Comparisons and Outcomes. To sign up for updates or to access your subscriberpreferences, please enter your email address below. Patient outcomes associated with primary care behavioral health services: A systematic review. Literature Search Strategies to Identify Relevant Studies to Answer the Questions. An official website of the Department of Health & Human Services. These disparities are reflected in differences in health outcomes such as life expectancy, quality of life, and morbidity and mortality rates based on gender, race, socioeconomic status, sexual orientation and gender identity, physical ability, age, weight, geographic region, housing status, and immigration status.1,2, Disparities in health and healthcare disproportionately impact people who are racial and ethnic minorities; have disabilities; reside in rural communities; are lesbian, gay, bisexual, transgender, and queer (LGBTQ); are women; experience homelessness; have behavioral health conditions; are immigrants; and have lower incomes.1,2 People that fall within multiple social, economic, or other classifications commonly cope with intersecting inequities and compounding disparities in health and healthcare - referred to as intersectionality.3, Mental health, substance use, and physical health have mutually influencing interactions, and all correlate with histories of trauma and with lower income.10,11 People with mental health and substance use disorders have a higher prevalence of other chronic conditions, such as cardiovascular disease, stroke, high blood pressure, diabetes, cancer, HIV and hepatitis, and vice versa.10,11,12,13,14,15, Fragmented and uncoordinated healthcare and social service systems compound underlying social, economic, and environmental inequities and make it difficult to fully address the entire array of biological, psychological, and social problems and illnesses that people bring into the healthcare system. 25. Downstream tactics include medical interventions. 2018 Dec 27;10:1-12. https://doi.org/10.2147%2FSAR.S183252. This web page highlights AHRQ's Substance Use Collection and other resources to assist with the prevention and treatment of behavioral health problems in primary care settings, including data to quantify these challenges, tools and resources for screening and treatment, and funding for behavioral health research. https://nccdh.ca/glossary/entry/marginalized-populations. Integrating Behavioral Health and Primary Care Provider- and Practice-Level Competencies for Integrated Behavioral Health in Primary Care Literature Review Provider- and Practice-Level Competencies for Integrated Behavioral Health in Primary Care Literature Review Prepared for: Agency for Healthcare Research and Quality Rockville, MD www.ahrq.gov This page covers the following topics: Scan Question. Agency for Healthcare . Patients like the convenience of one-stop shopping. Whether their problem is stress, mental health, substance use, health behaviors, or all of the above, there is no wrong door. 45. How do the barriers, facilitators, and other factors involved in the implementation of behavioral health and primary care interact to affect implementation and sustainability? Grading the strength of evidence (SOE) only applies to questions of effectiveness and therefore will only be conducted for Questions 2 and 5a. practice/care delivery setting characteristics, such as the policy environment, and geographic location. https://www.kff.org/racial-equity-and-health-policy/issue-brief/disparities-in-health-and-health-care-5-key-question-and-answers/. U.S. Army Health Clinic Ansbach is located in the Urlas Kaserne and provides quality ambulatory care for more than 5,500 local Soldiers, civilians and family members, while coordinating and facilitating inpatient and specialty care with nearby German host nation medical facilities and DoD partners. https://doi.org/10.1542%2Fpeds.2013-2516. The mission of the AHRQ Academy is to promote and support the integration of behavioral health into primary and ambulatory care settings with a key focus on providing care for patients using substances, particularly opioids, and for those with mental health conditions. In our synthesis, we will prioritize U.S. national or regional studies over local reports or data from other countries, if we determine they are more relevant. [mp=title, book title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword heading word, organism supplementary concept word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms] https://doi.org/10.1017/S1463423618000403. LowLimited confidence that the estimate of effect lies close to the true effect for this outcome. American Hospital Association. Engaging patients to improve quality of care: A systematic review. https://www.census.gov/library/stories/2019/08/your-health-care-in-womens-hands.html. The Provider- and Practice-Level Competencies for Integrated Behavioral Health in Primary Care: A Literature Review. Accessed September 23, 2022. 80. 5600 Fishers Lane Specific Criteria for Contextual Question 3. 82. 61. Comparators not applicable to other questions. Make updates to include policies and trainings that promote, facilitate, and build capacity for: Select a screening tool for social determinants of health -, Implement screening for social determinants of health -, Establish partnerships and referral processes with social services providers and other community resources (e.g., emergency food providers, income support programs, housing support services, family planning, employment assistance, and transportation assistance services) to ensure that patients can access the services and support, if needed -, Implement screening for ACEs and other trauma -, Establish partnerships and referral processes with community resources (e.g., crisis and distress hotlines, domestic and intimate partner violence shelters, sexual assault and other violence intervention and recovery programs, and trauma support networks) to ensure that patients can access the services and supports, if needed -, Institute outreach and screening to determine the digital access, skills, and preferences of patients - you can use existing tools such as, Determine how to help patients get connected to telehealth technologies and adapt patient care to meet needs and align with preferences - you can use a guide such as, Expand data collection, as needed, to include, Create or update monitoring and reporting tools that make data easily accessible and actionable -. New York, NY: The Commonwealth Fund; 2002 Mar. Journal of Homosexuality. Cully JA, Stanley MA, Petersen NJ, Hundt NE, Kauth MR, Naik AD, Sorocco K, Sansgiry S, Zeno D, Kunik ME. Accessed September 23, 2022. AMA J Ethics. No. 11. Translational Behavioral Medicine. Anda RF, Porter LE, Brown DW. Morning Consult, Bipartisan Policy Center. PDF Strategies for Interating Behavioral Health and Primary Care Similar to assessment of risk of bias for individual studies, the strength of evidence (SOE) for each Question will be initially assessed by one researcher for selected outcomes (see PICOS). Full text for all abstracts deemed appropriate for consideration by at least one of the reviewers will be retrieved. American Journal of Psychiatry. 97. 48. The authors of this report are responsible for its content. 8 exp geriatrics/ 15. Patients commonly report experiencing stigma and discrimination based on race/ethnicity, educational level, income level, sexual orientation, and weight when interacting with the healthcare system.76,77,78,79,80,81 Stigma, discrimination, and racism create negative healthcare experiences for patients, and also prevent providers from providing equitable quality of care (e.g., failing to offer routine services or not adhering to practice standards for communicating with patients, referring patients for screening/diagnostic testing, and making treatment decisions).1,66,82,83,84,85,86,87,88,89, Poverty, transportation barriers, food and housing insecurity, lack of social support, and other social determinants of health are driving factors of disparities in health and healthcare, and are accountable for up to 30% of a persons long-term health outcomes.90,91, Traumatic experiences, such as neglect, abuse, violence and household dysfunction during childhood (referred to as adverse childhood experiences or ACEs) are strongly related to the development of chronic conditions in adulthood, including mental health and substance use disorders.92,93,94 Children in groups or communities that have been marginalized have a disproportionately higher prevalence of ACEs, increasing the risk of negative health behavior and poor health outcomes throughout life.95, ACEs screening can lead to a better understanding of patients backgrounds, increased empathy, and enhanced provider-patient relationships.96 Care must be taken not to use ACEs scores as a diagnostic tool or in a way that may stigmatize or lead to discrimination of patients based upon an ACE score.97, Since the onset of the pandemic, outpatient telehealth visits have increased from 7% to 16%.98Telehealth can expand access to integrated behavioral health care, but disparities in access to and use of telehealth technologies, internet, broadband, and cellular network access must be addressed.99.
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