PDF(Pubmed)
Abstract：
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.
摘要：
综合行为健康可以改善初级保健和心理健康结果。由于高的无保险率，德克萨斯州的行为健康和初级保健服务处于危机之中，监管限制，缺乏劳动力。为了解决获得护理方面的差距，在德克萨斯州中部的一个大型地方精神卫生机构之间建立了合作伙伴关系，联邦指定的农村卫生诊所,和德克萨斯农工大学护理学院，在德克萨斯州中部农村和医疗服务不足的地区创建一个跨专业的基于团队的医疗保健提供模式。学术实践合作伙伴确定了5个诊所的综合行为保健提供模式。从2020年7月1日至2021年12月31日，共完成3183例患者就诊。患者主要是女性（n=1719，54％）和西班牙裔（n=1750，55％）；1050（33％）生活在或低于联邦贫困水平；1400（44％）没有保险。本案例研究的目的是描述实施综合医疗服务模式的第一年，实施障碍，对可持续性的挑战，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，直接观察临床流量，以及对诊所工作人员的采访，并确定了共同的定性主题(例如，整合的挑战，一体化的可持续性,结果成功)。结果显示了电子健康记录的实施挑战，服务集成,在全球大流行期间，人员配备水平低，和有效的沟通。我们还检查了2例患者病例，以说明综合行为健康的成功，并强调了从实施过程中吸取的教训。包括需要强大的电子健康记录和组织灵活性。
