• J Am Board Fam Med · Sep 2015

    Comparative Study

    Integrating Behavioral Health and Primary Care: Consulting, Coordinating and Collaborating Among Professionals.

    • Deborah J Cohen, Melinda Davis, Bijal A Balasubramanian, Rose Gunn, Jennifer Hall, Frank V deGruy, C J Peek, Larry A Green, Kurt C Stange, Carla Pallares, Sheldon Levy, David Pollack, and Benjamin F Miller.
    • From the Department of Family Medicine (D.C., M.D., R.G., J.H., S.L.) and Department of Medical Informatics and Clinical Epidemiology (D.C.), Oregon Health & Science University, Portland; Oregon Rural Practice-based Research Network (M.D.), Portland; Department of Epidemiology, Human Genetics, and Environmental Sciences (B.B.), University of Texas Health Science Center Houston School of Public Health, Dallas; Harold Simmons Comprehensive Cancer Center (B.B.), UT Southwestern Medical Center, Dallas, TX; Department of Family Medicine (F.V.Dg., L.A.G., B.F.M.), University of Colorado School of Medicine, Aurora; Department of Family Medicine and Community Health (C.J.P.), University of Minnesota Medical School, Minneapolis; Departments of Family Medicine, Epidemiology & Biostatistics, Sociology, and the Case Comprehensive Cancer Center and Clinical & Translational Science Collaborative (K.S.), Case Western Reserve University, Cleveland, OH; Plan de Salud del Valle, Inc. (C.P.), Brighton, CO; Department of Psychiatry (D.P.), Oregon Health & Science University, Portland. cohendj@ohsu.edu.
    • J Am Board Fam Med. 2015 Sep 1; 28 Suppl 1: S21-31.

    PurposeThis paper sought to describe how clinicians from different backgrounds interact to deliver integrated behavioral and primary health care, and the contextual factors that shape such interactions.MethodsThis was a comparative case study in which a multidisciplinary team used an immersion-crystallization approach to analyze data from observations of practice operations, interviews with practice members, and implementation diaries. The observed practices were drawn from 2 studies: Advancing Care Together, a demonstration project of 11 practices located in Colorado; and the Integration Workforce Study, consisting of 8 practices located across the United States.ResultsPrimary care and behavioral health clinicians used 3 interpersonal strategies to work together in integrated settings: consulting, coordinating, and collaborating (3Cs). Consulting occurred when clinicians sought advice, validated care plans, or corroborated perceptions of a patient's needs with another professional. Coordinating involved 2 professionals working in a parallel or in a back-and-forth fashion to achieve a common patient care goal, while delivering care separately. Collaborating involved 2 or more professionals interacting in real time to discuss a patient's presenting symptoms, describe their views on treatment, and jointly develop a care plan. Collaborative behavior emerged when a patient's care or situation was complex or novel. We identified contextual factors shaping use of the 3Cs, including: time to plan patient care, staffing, employing brief therapeutic approaches, proximity of clinical team members, and electronic health record documenting behavior.ConclusionPrimary care and behavioral health clinicians, through their interactions, consult, coordinate, and collaborate with each other to solve patients' problems. Organizations can create integrated care environments that support these collaborations and health professions training programs should equip clinicians to execute all 3Cs routinely in practice.© Copyright 2015 by the American Board of Family Medicine.

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