Primary Care Integration of Psychiatric and Behavioral Health Services: A Primer for Providers and Case Report of Local Implementation.

Mental health conditions are common, disabling, potentially life-threatening, and costly; however, they are mostly treatable with early detection and intervention. Unfortunately, mental healthcare is in significantly short supply both nationally and locally, and particularly in small, rural, and relatively isolated communities. This article provides physicians and other health practitioners with a primer on the basic rationale and principles of integrating behavioral healthcare - particularly psychiatric specialty care - in primary care settings, including effective use of teleconferencing. Referring to a local-based example, this paper describes the programmatic components (universal screening, telephone availability, mutually educational team rounds, as-needed consultations, etc) that operationalize and facilitate successful primary care integration, and illustrates how these elements are applied to population segments with differing needs for behavioral healthcare involvement. Lastly, the article discusses the potential value of primary care integration in promoting quality, accessibility, and provider retention; discusses how new developments in healthcare financing could enhance the sustainability of primary care integration models; and summarizes lessons learned.

One Model of Residency Journal Clubs With Multifaceted Support.

PROBLEM: The field of medical education is represented by a fairly wide variety of models for utilizing journal clubs as an effective teaching tool, each with varying levels of empirical support. Our own prior attempts at developing and implementing an effective journal club required improvements. INTERVENTION: Our intervention consisted of an innovative, effective journal club model that has more well-defined elements that are readily adaptable for other residency programs. The collective strategies were based on the previous literature and our own experiences. CONTEXT: Our intervention was implemented in a department of psychiatry within a university-based medical school. Study participants came from a psychiatry department's residency programs (N = 36) during academic year 2011-2012 with senior residents having the option to attend journal club. Using a multifaceted approach, measures included attendance, presession quizzes, postsession evaluations, and a final postcourse evaluation of 11 dimensions (e.g., goals, objectives). OUTCOME: Thirty-one (86%) trainees attended journal club-a substantial increase from previous years. The presession-quiz median was 4.4 total correct out of 6 questions (range = 3.3-5.3), indicating that the articles were generally read before the session. The postsession-evaluation median was 4.6 (1-5 scale, 5 the highest; range = 4.1-4.8), indicating sessions were well received. The final postcourse-evaluation overall mean was 3.9 (1-5 scale, 5 the highest; subscale M range = 3.4-4.5). Qualitative and quantitative analyses of the postcourse evaluation indicated the following positive aspects: educational objectives generally met, overall structured format, quality of discussions, individuals involved (e.g., course directors, trainees, faculty facilitators), and availability of food. Areas of possible improvement included time management within the sessions, more contemporary and clinically relevant articles, consistency in faculty moderators, and evaluation process. Engagement in learning appeared to have been dramatically increased through five strategies: (a) meaningful incentives; (b) assigned, engaged consistently prepared faculty; (c) meaningful evaluation; (d) prejournal club preparations that helped residents assimilate critical appraisal with time-and-task-management skills; and (e) a planning group that developed and improved curricula and instruction to meet the objectives of the course. LESSONS LEARNED: Overall, effective, and successful journal clubs require systematic planning, implementation, modification, and refinement.