2011 Nov 1;58(10):1355-71. AHRQ Research Studies Database is searchable and includes AHRQ-authored and AHRQ-funded research studies on burnout. Regier DA, Narrow WE, Rae DS, Manderscheid RW, Locke BZ, Goodwin FK. 72. The feasibility of a quantitative synthesis will depend on the number and completeness of reported outcomes and a lack of major heterogeneity. Searches will be run from 2008, with initial searches being conducted through August 2022. Washington, DC: U.S. Bureau of Labor Statistics; 2019 Dec. Report 1084: Table 18, Median usual weekly earnings of full-time wage and salary workers, by detailed occupation and gender, 2018 annual averages (numbers in thousands). Accessed September 23, 2022. Updating an organizations mission and goals requires a clear, shared vision with aligned incentives, resources, and buy-in. This input is intended to ensure that the Key Questions are specific and relevant. 2. Greenberg-Worisek AJ, Kurani S, Finney Rutten LJ, Blake KD, Moser RP, Hesse BW. Thapa BB, Laws MB, Galrraga O. practice/care delivery setting characteristics, such as the policy environment, and geographic location. https://health.gov/healthypeople/priority-areas/social-determinants-health/literature-summaries/discrimination. This project was funded under Contract No. Journal of General Internal Medicine. Washington, DC: The National Academies Press; 2003. https://doi.org/10.17226/12875. This brief provides an overview of the state of the evidence for behavioral health apps and key considerations and concerns related to finding, evaluating, and selecting smartphone and Internet-based behavioral health apps to recommend or prescribe in primary care and integrated care settings. https://www.bls.gov/opub/reports/womens-databook/2019/home.htm. Sources for gray (unpublished) literature will include reports produced by federal and state agencies, healthcare provider organizations, or others. Fiscella K, Goodwin MA, Stange KC. 2021 Sep 1;15:100847. https://doi.org/10.1016/j.ssmph.2021.100847. Telephone: (301) 427-1364, Integrating Behavioral Health & Primary Care, Integrating Behavioral Health and Primary Care Playbook, Medication-Assisted Treatment for Opioid Use Disorder Playbook, Usefulness of Behavioral Health Apps in Primary Care, EvidenceNOW: Managing Unhealthy Alcohol Use, Health Equity and Behavioral Health Integration, Pregnant and Postpartum Women and Behavioral Health Integration, The Role of Primary Care and Integrated Behavioral Health in Polysubstance Use, Stimulant Use Disorders and Behavioral Health Integration, New Provider Training Requirements for Substance Use Disorder To Increase Treatment Access. We will also consider if selected frameworks may be used to present the review results in a way that can more efficiently guide organizations toward strategies that fit with their resources and environments and help stakeholders identify policy changes that can support successful implementation and sustainment. Physicians' perceptions of people with disability and their health care. According to expert consensus from the Agency for Healthcare Research and Quality (AHRQ), integrated behavioral health refers to "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. Because of their role as end-users, individuals are invited to serve as Key Informants and those who present with potential conflicts may be retained. 38. New Provider Training Requirements for Substance Use Disorder To Questions 1, 3, 4, and 5. Downstream strategies include providing clinical care. Specific Criteria for Contextual Question 3. "I am not a junkie": social categorization and differentiation among people who use drugs. 2021 Jan-Dec;12:21501327211049053. https://doi.org/10.1177%2F21501327211049053. Upstream strategies include to improve community conditions. 37. Accessed September 23, 2022. The goal is to provide healthcare systems and clinical practices seeking to implement behavioral health and primary care integration with a foundation for practical guidance on selection, implementation, sustainability, and ongoing assessment of approaches to integrate behavioral health in primary care. PDF Strategies for Interating Behavioral Health and Primary Care Population level health promotion or prevention programs that are not individualized, integrated care (e.g. 2016 Aug 23;316(8):826-34. https://doi.org/10.1001/jama.2016.11232. Bombard Y, Baker GR, Orlando E, Fancott C, Bhatia P, Casalino S, Onate K, Denis JL, Pomey MP. Cochrane Database of Systematic Reviews. 64. Families, Systems, & Health. Accessed September 23, 2022. 20. An increasing number of studies have demonstrated that integrating behavioral health into primary care can result in better access, improvements in health outcomes for patients, and less stress for providers.10-13 Based on this evidence, studies and practice change efforts have sought to implement and evaluate comprehensive models such as the Collaborative Care Model and the Primary Care Behavioral Health Model or to apply specific strategies, such as co-locating providers, sharing medical records, or jointly developing and monitoring care plans. Proposals for approaches that have not been implemented, Descriptions of approaches that have not been evaluated (for KQ2). The six-minute walking test (6MWT) is commonly used as a measure of fatigability for the assessment of state fatigue throughout . PDF Ibh Basics Webinar #1 Integrated Behavioral Health: the What and How Special attention will be directed towards effective measures that support the transition of patients using . Multicomorbidity of chronic diseases and substance use disorders and their association with hospitalization: Results from electronic health records data. The authors of this report are responsible for its content. Implement Sci. American Medical Association. https://doi.org/10.1001/jamanetworkopen.2020.29650. https://www.ahrq.gov/news/blog/ahrqviews/achieve-health-equity.html. Question 3 (Contextual). Peer reviewers are invited to provide written comments on the draft report based on their clinical, content, or methodological expertise. A scoping review of associations between cannabis use and anxiety in adolescents and young adults. Patients and family members are partners in making decisions about their health care. Accessed September 23, 2022. Accessed September 23, 2022. 2012 May;42(5):525-38. https://doi.org/10.1016/j.amepre.2012.01.019. Are there models or standards for how frequently the effectiveness of approaches to integration should be reassessed? Accessed September 23, 2022. We will include descriptive reports of integration programs that exist or existed, but will exclude proposed, hypothetical, and simulated approaches. Balasubramanian BA, Cohen DJ, Jetelina KK, Dickinson LM, Davis M, Gunn R, Gowen K, DeGruy FV, Miller BF, Green LA. J Natl Med Assoc. Accessed September 23, 2022. 21. Behavioral Health Using Smart Devices to Implement an Evidence-based eHealth System for Older Adults Description This research aims to develop and test a voice-activated smart system that will promote self-management and provide coping tools, motivation, and social support to help older adults with multiple chronic conditions. Efforts to integrate behavioral health and primary care are rooted in growing recognition that perpetuating separate systems is no longer tenable. https://www.ncbi.nlm.nih.gov/books/NBK44246/. https://www.gao.gov/products/gao-22-104597. The baseline requirement is that the practice design of the approach is one that facilitates interaction among primary care and behavioral health providers in the provision of care including referral, followup, and continued coordination of care (see Table 1). To sign up for updates or to access your subscriberpreferences, please enter your contact information below. Within the EPC program, the Key Informant role is to provide input into the decisional dilemmas and help keep the focus on Key Questions that will inform health care decisions. The specifics of how we synthesize the data will be driven by the types and quantity of data available. Background and Objectives II. The search strategies were developed by a research librarian with expertise in conducting searches for systematic reviews and reviewed by the TEP. Countries with healthcare systems that do not provide information relevant to the U.S. Thota AB, Sipe TA, Byard GJ, Zometa CS, Hahn RA, McKnight-Eily LR, Chapman DP, Abraido-Lanza AF, Pearson JL, Anderson CW, Gelenberg AJ, Hennessy KD, Duffy FF, Vernon-Smiley ME, Nease DE Jr, Williams SP; Community Preventive Services Task Force. https://www.ahrq.gov/cpi/about/otherwebsites/integrationacademy.ahrq.gov/index.html. What is health equity and what difference does a definition make? Randomized trial of an integrated behavioral health home: The health outcomes management and evaluation (HOME) study. Practical Tools for Primary Care Practice | Agency for Healthcare Telephone: (301) 427-1364, Powered by the Evidence-based Practice Centers, Strategies for Integrating Behavioral Health and Primary Care, https://effectivehealthcare.ahrq.gov/products/strategies-integrating-behavioral-health/protocol, Comment on Key Questions and Draft Reports, 25 Years of the AHRQ Evidence-based Practice Center Program, II. [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] How are care team member roles and their work flows defined in different approaches to integrating behavioral health and primary care? 92. An official website of the Department of Health & Human Services. If a small number of studies are identified, we will describe their strengths and limitations. 5. https://www.ama-assn.org/delivering-care/health-equity/what-health-equity. https://doi.org/10.1001/jamanetworkopen.2021.3789. 2022 Feb 1;41(2):203-11. https://doi.org/10.1377/hlthaff.2021.01423. Accessed September 23, 2022. Cost-effectiveness and net benefit of enhanced treatment of depression for older adults with diabetes and depression. The Agency for Healthcare Research and Quality (AHRQ) posted the Key Questions on the AHRQ Effective Health Care Website for public comment. Agency for Healthcare Research and Quality. Integrated primary care can improve a practice's ability to effectively: Address behavioral health and medical conditions, African Americans often face challenges accessing substance use treatment. 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. General hospital psychiatry. Patients are active participants and partners in making decisions about their healthcare. Stress-linked physical symptoms (e.g., insomnia, fatigue), Complex overlapping medical conditions and psychosocial risk factors, Experiences of trauma, adverse experiences, or stressful life events, Models that use telehealth for integration. Different approaches to integrating behavioral health and primary care services, including program/model components and strategies to integrate care. For more on integrated behavioral health, visit theLexicon page. For Question 1, recent frameworks, including those referenced in the Background above, will be used to develop functional and/or conceptual categories to describe the strategies we identify and provide the basis for qualitative synthesis. Accessed September 23, 2022. Accessed September 23, 2022. U.S. Army Health Clinic Vilseck U.S. Army Health Clinic Vilseck is located on Rose Barracks at the southern tip of the Grafenwoehr Training Area and provides quality ambulatory care for more than 15,000 Soldiers and their families, while coordinating and facilitating inpatient and specialty care with nearby German host nation medical facilities and DoD partners. Fatigue is among the most common symptoms in MS, resulting in reduced mobility and quality of life. 2018 Oct;8(5):649-59. https://doi.org/10.1093/tbm/ibx001. Each full-text article will be independently reviewed for eligibility by two team members, including any articles suggested by peer reviewers or that arise from the public posting process. Patient Educ Couns. 45. Accessed September 23, 2022. Rockville, MD 20857 Eliason MJ, Streed Jr C, Henne M. Coping with stress as an LGBTQ+ health care professional. 50. 2017 Mar 1;30(2):130-9. https://www.jabfm.org/content/jabfp/30/2/130.full.pdf (PDF - 135 KB). [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] Psychol Med. Office of the Surgeon General; Center for Mental Health Services; National Institute of Mental Health. Slomski A. This protocol will be registered in the international prospective register of systematic reviews (PROSPERO). Technical Experts do not do analysis of any kind; neither do they contribute to the writing of the report. The de facto US mental and addictive disorders service system: Epidemiologic catchment area prospective 1-year prevalence rates of disorders and services. Review Questions (Scan, Key, and Contextual) III. 52. 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 . 2021 Jul 23:1-27. https://doi.org/10.1080/00918369.2021.1945338. 5600 Fishers Lane 1 (behavio?ral* adj2 (health* or care or cares or caring or cared) adj5 integrat*).mp. Midstream strategies include addressing individuals' social needs. Am J Prev Med. resources and infrastructure required, such as staffing, payment models, financing, and technology. Agency for Healthcare . Xylazine: Understanding the Latest Emerging Substance AHRQ's Focus on Integrating Behavioral Health and Primary Care (BH/PC) AHRQ published a comprehensive review ("Integration of Mental Health/Substance Abuse and Primary Care") of the available evidence on integrated BH/PC in 2008 AHRQ funded a research agenda conference grant in 2009 which resulted in an early Lexicon draft Midstream tactics include patient screening questions about social factors like housing and food access; use data to inform care and provide referrals and social workers, community health workers, and/or community-based organizations providing direct support/assistance to meet patient social needs. 5 exp pediatrics/ or exp pediatricians/ 26 1 or 23 or 25 Barriers to healthcare access among US adults with mental health challenges: A population-based study. Rather, most will be observational studies and these designs are likely to have limitations that must be considered in terms of the rigorous application of their results.34 Similar to other system-level interventions we have studied, the evidence on behavioral health and primary care integration strategies is more likely to consist of cluster and step wedge trials35-37 and different types of observational studies,19,29,30,38-42 including studies that report outcomes for different groups of patients before and after implementation. Assessment of Methodological Risk of Bias of Individual Studies. 17 11 and 16 www.ahrq.gov Contract No. 81. resources and infrastructure required, such as staffing, financing, payment models, and technology. Scan Question. 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. We will consider how recent frameworks might be used to help standardize the description of integration strategies identified for this review. These characteristics of the studies may limit the ability to generalize the results to other populations and settings. 63. 39. Qualitative data about the body of evidence will be summarized in summary tables and ranges and descriptive analysis and interpretation of the results will be provided. Eliason MJ, Dibble SL, Robertson PA. Lesbian, gay, bisexual, and transgender (LGBT) physicians' experiences in the workplace. 2018 Nov 1;192:316-323. https://doi.org/10.1016%2Fj.drugalcdep.2018.08.013. Accessed September 23, 2022. An analysis of responses to the ICAN Discussion Aid. In 2020, approximately one in five adults in the United States experienced a mental illness and 17 million had a substance use disorder (SUD).2 Prevalence of behavioral health disorders among children and young people is estimated to be between 10% to 20%, but more precise estimates are difficult as few receive care for these illnesses (e.g., only about 20% receive mental health services, and even fewer receive services from a pediatric psychiatrist).3,4 Early evidence suggests the COVID-19 pandemic has fueled an increase in several behavioral health disorders, including anxiety and substance use, in all age groups, with a notable increase among adolescents.5-8 Yet despite the high prevalence of behavioral health disorders in the United States, and their devastating impact, less than half of the 59 million Americans experiencing mental illness in 2020 received any treatment.2 While integration could, and perhaps should occur across all healthcare settings, primary care is where people receive most of their healthcare most of the time.9 Integration of behavioral health and primary care may have the greatest potential to increase access to behavioral healthcare and improve both physical and mental health outcomes for large numbers of people. The Substance Abuse and Mental Health Services Administration (SAMHSA), in close collaboration with the Drug Enforcement Agency (DEA), recently announced new training requirements for practitioners with prescriptive authority treating substance use disorder (SUD). Medical providers appreciate having behavioral health partners available to help with problems the medical team doesnt have enough time or training to address. 2005 Feb;56(2):139-46. https://doi.org/10.1016/j.pec.2004.02.011. 96. https://doi.org/10.1097/MD.0000000000027066. 35. Mental Health: culture, race, and ethnicity: A supplement to mental health: A report of the Surgeon General. Comparators not applicable to other questions. Home | Agency for Healthcare Research and Quality Interventions for High Utilizers of Healthcare 13. The Annals of Family Medicine. Articles reporting simulation or speculation. In the event that information regarding methods or results appears to be omitted from the published results of a study we will attempt to contact the authors to obtain additional information. During topic refinement, Key Informants assisted with generating a list of integration modes and approaches that we will translate into our initial search strategy. A Call for Action to Achieve Health Equity. The findings are stable (i.e., another study would not change the conclusions). The body of evidence has few or no deficiencies. Background: Multiple sclerosis (MS) is a disabling disease affecting the central nervous system and consequently the whole body's functional systems resulting in different gait disorders. Strategies for Integrating Behavioral Health and Primary Care. Woltmann E, Grogan-Kaylor A, Perron B, Georges H, Kilbourne AM, Bauer MS. Providers practicing integrated behavioral health care recognize that both medical and behavioral health factors are important parts of a persons overall health. PDF CREATING A CULTURE OF WHOLE HEALTH - American Psychological Association Grading the strength of evidence (SOE) only applies to questions of effectiveness and therefore will only be conducted for Questions 2 and 5a. An official website of the Department of Health & Human Services. Guideline concordant screening and diagnosis, Functional status (including social and adaptive functioning), Avoidable emergency care or inpatient care for behavioral health crises, Patients receive routine care as soon as wanted, Patients experiencing difficulties or delays in obtaining BH care, Patients with mental health condition received treatment, Costs associated with care delays, fragmentation, poor coordination, redundancy, requested but not completed patient referrals, Health systems/hospitals and community-based primary care practices in the United States (physical or virtual) or in countries with similar healthcare systems, Non-healthcare settings providing outpatient BH/PC (school-based clinics, community centers, churches, shelters). 2006 Mar;36(3):353-63. https://doi.org/10.1017/s0033291705006896. Katon W, Russo J, Sherbourne C, Stein MB, Craske M, Fan MY, Roy-Byrne P. Incremental cost-effectiveness of a collaborative care intervention for panic disorder. https://www.census.gov/library/stories/2019/08/your-health-care-in-womens-hands.html. The Provider- and Practice-Level Competencies for Integrated Behavioral Accessed September 23, 2022. Accessed September 23, 2022. American Journal of Psychiatry. A record of studies excluded at the full-text level with reasons for exclusion will be maintained and made available as an appendix to the final report. 97. Translational Behavioral Medicine. How do individuals with behavioral health conditions contribute to physical and total healthcare spending? Association of integrated team-based care with health care quality, utilization, and cost. 2018;36(4):513-517. https://doi.org/10.1037/fsh0000374. About the AHRQ Academy | The Academy Expand All The search for this question will require an augmented strategy. American Journal of Preventive Medicine. Silver Sneakers). 21 (((behav* adj3 (health* or care or cares or caring or cared) adj5 (integrat* or collaborat* or comprehensiv* or coordinat* or implement* or initiat* or launch* or establish* or introduc* or strateg* or philosoph* or approach*)) or (BHI or IBH) or (integrat* adj5 (team* adj2 (base or based or focus* or align*) adj2 (health* or care or cares or caring or cared))) or (whole person* adj2 (care or cares or caring or cared))) adj10 ((nurs* adj (home* or facility or facilities)) or (assist* adj living) or p?ediatrics or p?ediatrician* or (p?ediatric* adj3 (care or caring or cares or cared or practice*)) or obstetrics or obstetrician* or ((obstetric* or maternal* or prenatal* or antenatal*) adj3 (care or caring or cares or cared or practice*)) or geriatrics or geriatrician* or gerontologist or ((geriatric or gerontolog* or elder*) adj3 (care or caring or cares or cared or practice*)) or (integrat* adj (healthcare* or (health* adj (care or cares or caring or cared)))) or ((primar* adj2 (practi* or care*)) or (family adj2 (medic* or practi* or physician*)) or (general adj2 practi*)))).mp. Princeton, NJ: Robert Wood Johnson Foundation; 2017. https://www.rwjf.org/en/library/research/2017/05/what-is-health-equity-.html. SSM-Population Health. Statements in the report should not be construed as endorsement by either the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.

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