PDF(Pubmed)
Abstract：
BACKGROUND: People with diabetes, vascular disease, and asthma often struggle to maintain stability in their chronic health conditions, particularly those in rural areas, living in poverty, or racially or ethnically minoritized populations. These groups can experience inequities in healthcare, where one group of people has fewer or lower-quality resources than others. Integrating behavioral healthcare services into primary care holds promise in helping the primary care team better manage patients\' conditions, but it involves changing the way care is delivered in a clinic in multiple ways. Some clinics are more successful than others in fully integrating behavioral health models as shown by previous research conducted by our team identifying four patterns of implementation: Low, Structural, Partial, and Strong. Little is known about how this variation in integration may be related to chronic disease management and if IBH could be a strategy to reduce healthcare inequities. This study explores potential relationships between IBH implementation variation and chronic disease management in the context of healthcare inequities.
METHODS: Building on a previously published latent class analysis of 102 primary care clinics in Minnesota, we used multiple regression to establish relationships between IBH latent class and healthcare inequities in chronic disease management, and then structural equation modeling to examine how IBH latent class may moderate those healthcare inequities.
RESULTS: Contrary to our hypotheses, and demonstrating the complexity of the research question, clinics with better chronic disease management were more likely to be Low IBH rather than any other level of integration. Strong and Structural IBH clinics demonstrated better chronic disease management as race in the clinic\'s location became more White.
CONCLUSIONS: IBH may result in improved care, though it may not be sufficient to resolve healthcare inequities; it appears that IBH may be more effective when fewer social determinants of health are present. Clinics with Low IBH may not be motivated to engage in this practice change for chronic disease management and may need to be provided other reasons to do so. Larger systemic and policy changes are likely required that specifically target the mechanisms of healthcare inequities.
METHODS: Building on a previously published latent class analysis of 102 primary care clinics in Minnesota, we used multiple regression to establish relationships between IBH latent class and healthcare inequities in chronic disease management, and then structural equation modeling to examine how IBH latent class may moderate those healthcare inequities.
RESULTS: Contrary to our hypotheses, and demonstrating the complexity of the research question, clinics with better chronic disease management were more likely to be Low IBH rather than any other level of integration. Strong and Structural IBH clinics demonstrated better chronic disease management as race in the clinic\'s location became more White.
CONCLUSIONS: IBH may result in improved care, though it may not be sufficient to resolve healthcare inequities; it appears that IBH may be more effective when fewer social determinants of health are present. Clinics with Low IBH may not be motivated to engage in this practice change for chronic disease management and may need to be provided other reasons to do so. Larger systemic and policy changes are likely required that specifically target the mechanisms of healthcare inequities.
摘要：
背景：糖尿病患者，血管疾病,哮喘经常难以维持其慢性健康状况的稳定，特别是那些在农村地区，生活在贫困中，或种族或种族化的人口。这些群体可能会经历医疗保健方面的不平等，一群人比其他人拥有更少或更低质量的资源。将行为医疗服务纳入初级保健服务有望帮助初级保健团队更好地管理患者病情，但它涉及以多种方式改变诊所提供护理的方式。一些诊所在充分整合行为健康模型方面比其他诊所更成功，如我们团队先前进行的研究所示，确定了四种实施模式：低，结构,部分,和坚强。很少有人知道这种整合的变化可能与慢性病管理有关，以及IBH是否可以成为减少医疗保健不平等的策略。本研究探讨了在医疗保健不平等的背景下，IBH实施变化与慢性病管理之间的潜在关系。
方法：建立在先前发表的明尼苏达州102个初级保健诊所的潜在类别分析的基础上，我们使用多元回归来建立IBH潜在类别与慢性病管理中医疗保健不平等之间的关系，然后进行结构方程建模，以研究IBH潜在类别如何缓解这些医疗保健不平等。
结果：与我们的假设相反，并证明了研究问题的复杂性，慢性病管理较好的诊所更可能是低IBH,而不是任何其他整合水平.强大的结构性IBH诊所表现出更好的慢性病管理，因为诊所位置的种族变得更加白化。
结论：IBH可能会改善护理，尽管这可能不足以解决医疗保健不平等；当存在较少的社会健康决定因素时，IBH似乎会更有效。低IBH的诊所可能没有动力参与这种慢性病管理的实践变化，可能需要提供其他原因。可能需要更大的系统性和政策变革，专门针对医疗保健不平等的机制。
方法：建立在先前发表的明尼苏达州102个初级保健诊所的潜在类别分析的基础上，我们使用多元回归来建立IBH潜在类别与慢性病管理中医疗保健不平等之间的关系，然后进行结构方程建模，以研究IBH潜在类别如何缓解这些医疗保健不平等。
结果：与我们的假设相反，并证明了研究问题的复杂性，慢性病管理较好的诊所更可能是低IBH,而不是任何其他整合水平.强大的结构性IBH诊所表现出更好的慢性病管理，因为诊所位置的种族变得更加白化。
结论：IBH可能会改善护理，尽管这可能不足以解决医疗保健不平等；当存在较少的社会健康决定因素时，IBH似乎会更有效。低IBH的诊所可能没有动力参与这种慢性病管理的实践变化，可能需要提供其他原因。可能需要更大的系统性和政策变革，专门针对医疗保健不平等的机制。
