Behavioral health integration in a nurse-led federally qualified health center: Outcomes of care
Behavioral health integration in a nurse-led federally qualified health center: Outcomes of care
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DOI：
10.1097/jxx.0000000000000506
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发表时间：
2021-12-01
影响因子：
1.2
通讯作者：
Barton, Amy J.
中科院分区：
文献类型：
--
作者：
Weber, Mary;Stalder, Sarah;Barton, Amy J.
背景资料：在过去的20年里，有显著的证据表明，在初级保健中，协作护理可以治疗抑郁症和焦虑症。目的：该项目的目的是将行为健康服务的跨专业和协作护理模式整合到为整个生命周期的弱势和服务不足人群提供的常规护士主导的初级保健中。团队成员包括精神科执业护士（PMHNP），一名注册护士和一名病例管理员。方法：开发Access数据库，以跟踪PMHNP所见的客户。三个关键的结果指标随时间进行跟踪：创伤后应激障碍（PTSD）检查表平民版，汉密尔顿抑郁评定量表（HAM-D），和双相抑郁评定量表（BDRS）。对2017年1月至2019年12月的客户结局数据进行了回顾性分析。结果如下：纳入了118名患者，其中大多数为女性（63.6%）、白色（90.7%）和非西班牙裔（69.5%），医疗补助是他们的主要保险（74.6%）。对于每个结果，拟合具有线性和二次函数形式的时间模型。PTSD检查表评分的最终模型具有时间的线性函数形式，BDRS和HAM-D的最终模型具有时间的线性和二次项。所有预测因素均与结局显著相关。对实践的影响：该计划表明，以患者为中心，护士领导的团队治疗抑郁症，双相抑郁症和创伤后应激障碍的方法可以在初级保健中取得成功。
Background: Over the past 20 years, significant evidence has emerged for collaborative care in the treatment of depression and anxiety disorders in primary care. Purpose: The purpose of this project was to integrate an interprofessional and collaborative care model of behavioral health services into routine nurse-led primary care delivered to vulnerable and underserved populations across the lifespan. Team members included psychiatric nurse practitioners (PMHNPs), a registered nurse, and a case manager. Methods: An Access database was developed to track clients seen by the PMHNPs. Three key outcome measures were tracked over time: Posttraumatic Stress Disorder (PTSD) Checklist Civilian Version, Hamilton Depression Rating Scale (HAM-D), and Bipolar Depression Rating Scale (BDRS). A retrospective analysis of client outcome data from January 2017 through December 2019 was conducted. Results: There were 118 patients included who were mostly female (63.6%), White (90.7%), and not Hispanic (69.5%), with Medicaid as their primary insurance (74.6%). For each outcome, models with linear and quadratic function forms for time were fit. The final model for PTSD Checklist Score had a linear functional form for time and the final models for BDRS and HAM-D had linear and quadratic terms for time. All predictors were significantly associated with the outcome. Implications for practice: This program demonstrated that a patient-centered, nurse-led team approach to the treatment of depression, bipolar depression, and PTSD can be successful in primary care.