Integrating Behavioral Health and Primary Care: Consulting, Coordinating and Collaborating Among Professionals
Integrating Behavioral Health and Primary Care: Consulting, Coordinating and Collaborating Among Professionals
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DOI：
10.3122/jabfm.2015.s1.150042
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发表时间：
2015-09-01
影响因子：
2.9
通讯作者：
Miller, Benjamin F.
中科院分区：
文献类型：
--
作者：
Cohen, Deborah J.;Davis, Melinda;Miller, Benjamin F.
目的：本文试图描述来自不同背景的临床医生如何相互作用以提供综合行为和初级卫生保健，以及形成这种相互作用的背景因素。方法：这是一个比较案例研究，其中一个多学科团队使用浸入结晶方法来分析来自实践操作观察、实践成员访谈和实施日记的数据。观察到的实践来自两项研究：共同推进护理，这是一个位于科罗拉多州的11个实践示范项目；以及整合劳动力研究，该研究由美国各地的8个实践组成。结果：初级保健和行为健康临床医生在综合环境中使用3种人际关系策略：咨询、协调和合作（3c）。当临床医生向其他专业人员寻求建议、验证护理计划或证实患者需求的感知时，咨询就发生了。协调包括两名专业人员并行或来回工作，以实现共同的病人护理目标，同时分别提供护理。协作是指两个或两个以上的专业人员实时互动，讨论患者的症状，描述他们对治疗的看法，并共同制定护理计划。当病人的护理或情况复杂或新颖时，合作行为就会出现。我们确定了影响3c使用的环境因素，包括：计划患者护理的时间、人员配备、采用简短的治疗方法、临床团队成员的接近程度，以及记录行为的电子健康记录。结论：初级保健和行为卫生临床医生通过相互作用，相互咨询、协调、协作，解决患者的问题。组织可以创建支持这些合作的综合护理环境，卫生专业培训计划应该使临床医生能够在实践中常规地执行所有3c。
Purpose: This paper sought to describe how clinicians from different backgrounds interact to deliver integrated behavioral and primary health care, and the contextual factors that shape such interactions.Methods: This was a comparative case study in which a multidisciplinary team used an immersion-crystallization approach to analyze data from observations of practice operations, interviews with practice members, and implementation diaries. The observed practices were drawn from 2 studies: Advancing Care Together, a demonstration project of 11 practices located in Colorado; and the Integration Workforce Study, consisting of 8 practices located across the United States.Results: Primary care and behavioral health clinicians used 3 interpersonal strategies to work together in integrated settings: consulting, coordinating, and collaborating (3Cs). Consulting occurred when clinicians sought advice, validated care plans, or corroborated perceptions of a patient's needs with another professional. Coordinating involved 2 professionals working in a parallel or in a back-and-forth fashion to achieve a common patient care goal, while delivering care separately. Collaborating involved 2 or more professionals interacting in real time to discuss a patient's presenting symptoms, describe their views on treatment, and jointly develop a care plan. Collaborative behavior emerged when a patient's care or situation was complex or novel. We identified contextual factors shaping use of the 3Cs, including: time to plan patient care, staffing, employing brief therapeutic approaches, proximity of clinical team members, and electronic health record documenting behavior.Conclusion: Primary care and behavioral health clinicians, through their interactions, consult, coordinate, and collaborate with each other to solve patients' problems. Organizations can create integrated care environments that support these collaborations and health professions training programs should equip clinicians to execute all 3Cs routinely in practice.