Value Perceptions of Integrative Health Care: A Study of Primary Care Physicians and Professional Clinical Counselors

A study was conducted to identify value perceptions of primary care physicians and Professional Clinical Counselors on integrative health care. Surveys were collected from 54 primary care physicians and 33 Professional Clinical Counselors in Central Ohio. Quantitative and qualitative results indicate favorable perceptions and opportunities for professional collaboration.     

Integration: Opportunities and Challenges for Family Therapists in Primary Care

Integration of behavioral and physical health is becoming critical for the overburdened primary care system. Policy changes are needed to accommodate integration nationally. Locally, medical and behavioral health providers are working together to create models that better fit their patients?? comprehensive needs while respecting the clinical, operational, and financial constraints of the current system. Family therapists trained to work in medical settings have an opportunity to emerge as clinical, research, and administrative leaders in this context. However, a paradigm shift is crucial to adapting their systemic orientation to interactions between individual patients, providers, staff, and healthcare and support systems. This article provides family therapists with: (1) an overview of the basic structure and barriers of integration, (2) suggestions on how to deliver quality care despite barriers at the local level, and (3) examples of key advocacy efforts representing possible entryways on a larger scale.     

Getting and Giving Information: Analysis of a Family-Interview Strategy

This paper reports on a videotape study of particular aspects of the two-part interview developed by Selvini-Palazzoli et al. ( 8 , 9 ). The first segment is a “search for information,” the second part the application of an intervention based on the information gathered in the first part. The study focused on the strategies of information retrieval on the premise that they are significant for the quality of information gathered and for the criteria implicitly conveyed by the therapist that in turn have their own substantial impact on the system. We have employed theories of communication, particularly conversational analysis, that are a departure from the epistemological premises of systems theory and communication pragmatics proposed by Selvini-Palazzoli et al. as the theoretical underpinning of their interview technique.     

Pastoral Care in Aged Care Settings: Role and Challenges

Journal of Religion and Health - This mixed methods study explored challenges faced by pastoral care workers. A development phase preceded an on-line survey completed by chaplains and pastoral...     

How Physicians Lost Out to Managed Care: A Case Study of Accommodation and Resistance in a Medical Community

This paper involves a case study of physicians working in an urban Midwestern region. It raises questions surrounding how physicians adapted to, encouraged and resisted the increasing presence of managed care in their work lives. The patterning of physician accommodation to managed care and the failure of physicians to mount any effective organized resistance in Metro has some important implications for theories about professional dominance and decline.     

Principle of Care and Giving to Help People in Need

Theories of moral development posit that an internalized moral value that one should help those in need—the principle of care—evokes helping behaviour in situations where empathic concern does not. Examples of such situations are helping behaviours that involve cognitive deliberation and planning, that benefit others who are known only in the abstract, and who are out‐group members. Charitable giving to help people in need is an important helping behaviour that has these characteristics. Therefore we hypothesized that the principle of care would be positively associated with charitable giving to help people in need, and that the principle of care would mediate the empathic concern–giving relationship. The two hypotheses were tested across four studies. The studies used four different samples, including three nationally representative samples from the American and Dutch populations, and included both self‐reports of giving (Studies 1–3), giving observed in a survey experiment (Study 3), and giving observed in a laboratory experiment (Study 4). The evidence from these studies indicated that a moral principle to care for others was associated with charitable giving to help people in need and mediated the empathic concern–giving relationship. © 2016 The Authors. European Journal of Personality published by John Wiley & Sons Ltd on behalf of European Association of Personality Psychology     

Measuring Productivity in Primary Care Behavioral Health: A Delphi Study

High productivity by behavioral health consultants (BHC) is a defining aspect of the primary care behavioral health (PCBH) model to maximize access to care and is often measured by patient volume. Studies of productivity in health care settings suggest a single productivity target may not be optimal. We used a Delphi method to obtain expert consensus on an operational definition of high productivity by BHCs in the PCBH model. Clinicians, managers, and researchers in PCBH were recruited to participate in a multi-round survey using a modified Delphi technique and develop consensus on PCBH productivity metrics. Ten participants completed all three survey rounds and rated 28 metrics. After three rounds, two direct metrics (average number of billable BHC visits each day; number of patients seen per day) received at least 80% consensus as “Essential”, two received at least 50%, and five received less than 50%. One influencer (level of integration at the practice) received at least 80% consensus as “Very Much” influential, 19 received at least 50%, and eight items received less than 50%. Several themes arose from participant comments. PCBH productivity can be interpreted as being high volume. Numerous practice factors influence how productive a BHC may be. Future studies should determine the feasibility of our metrics in clinical practice, establish productivity expectations based on patient needs and clinic resources, and identify patient-, clinician-, or practice-level moderators of productivity.

     

Commitment to Work, Care Giving and Seniority: The Case of Nursing

The current study examined whether differences in commitment to paid employment or different levels of private sphere responsibility between women and men could explain the gender segmentation of the paid work force. A survey of a composite sample (N?=?380) of Australian nurses showed that there were no significant differences between women and men in terms of commitment to paid employment although commitment was a predictor of seniority. Primary care-giving status also predicted seniority and women were more likely than men to have care-giving responsibility for dependents. Multiple logistic regression showed that, independent of gender, primary responsibility for care-giving to dependents, rather than commitment to paid employment, explained more of the differing chances for women and men of being in senior positions.     

Withholding Effort in Organizations: Toward Development and Validation of a Measure

Field research into the topic of withholding effort and its variants (shirking, loafing, free riding, and job neglect) has been limited due to a lack of measures that are applicable to organizational settings. This study used a multi-phase process to ascertain a measure of withholding effort that can be used in organizational settings. Items were generated through literature review and discussions with practitioners; culled by the authors; and tested in a field study in multiple, diverse organizations. Exploratory and confirmatory factor analyses found the construct of withholding effort to be multidimensional, but not necessarily as previous theoretical work in the area would suggest. Correlations of the various dimensions of withholding effort scales with existing scales tapping a wide range of employee attitudes were consistent with a priori expectations. Implications for the use of these scales in future workplace research and their practical application in organizations are discussed.     

The Primary Care Prescribing Psychologist Model: Medical Provider Ratings of the Safety, Impact and Utility of Prescribing Psychology in a Primary Care Setting

Family medicine providers at a large family medicine clinic were surveyed regarding their impression of the impact, utility and safety of the Primary Care Prescribing Psychologist (PCPP) model in which a prescribing psychologist is embedded in a primary care clinic. This article describes the model and provides indications of its strengths and weaknesses as reported by medical providers who have utilized the model for the past 2 years. A brief history of prescribing psychology and the challenges surrounding granting psychologists the authority to prescribe psychotropic medication is summarized. Results indicate family medicine providers agree that having a prescribing psychologist embedded in the family medicine clinic is helpful to their practice, safe for patients, convenient for providers and for patients, and improves patient care. Potential benefits of integrating prescribing psychology into primary care are considered and directions for future research are discussed.     

Behavioral Health Integration in Health Care Settings: Lessons Learned from a Pediatric Hospital Primary Care System

Behavioral health integration within primary care has been evolving, but literature traditionally focuses on smaller scale efforts. We detail how behavioral health has been integrated across a large, urban pediatric hospital system’s six primary care clinics (serving over 35,000 children annually and insured predominately through Medicaid) and discuss strategies for success in sustaining and expanding efforts to achieve effective integration of behavioral health into primary care. In a time span of 3 years, the clinics have implemented routine, universal behavioral health screening at well child visits, participated in a 15-month behavioral health screening quality improvement learning collaborative, and integrated the work of psychologists and psychiatrists. Additional work remains to be done in improving family engagement, further expanding services, and ensuring sustainability.     

Conducting a Pragmatic Trial in Integrated Primary Care: Key Decision Points and Considerations

Pragmatic trials testing the effectiveness of interventions under “real world” conditions help bridge the research-to-practice gap. Such trial designs are optimal for studying the impact of implementation efforts, such as the effectiveness of integrated behavioral health clinicians in primary care settings. Formal pragmatic trials conducted in integrated primary care settings are uncommon, making it difficult for researchers to anticipate the potential pitfalls associated with balancing scientific rigor with the demands of routine clinical practice. This paper is based on our experience conducting the first phase of a large, multisite, pragmatic clinical trial evaluating the implementation and effectiveness of behavioral health consultants treating patients with chronic pain using a manualized intervention, brief cognitive behavioral therapy for chronic pain (BCBT-CP). The paper highlights key choice points using the PRagmatic-Explanatory Continuum Indicator Summary (PRECIS-2) tool. We discuss the dilemmas of pragmatic research that we faced and offer recommendations for aspiring integrated primary care pragmatic trialists.

     

Depression in Primary Care: Comorbid Disorders and Related Problems

Identifying and treating depression has been a major focus in primary care over the last decade. Unfortunately, treatments have not been as successful as originally hoped. The current study investigated factors that may contribute to poor outcomes in a sample of VA primary care patients. Results indicate that 15.5% of the patients in this investigation had significant symptoms of depression. The vast majority (89.6%) of these patients also had significant symptoms of at least one additional comorbid psychiatric condition. Furthermore, an association between depression and unhealthy behaviors (smoking, not exercising) was demonstrated. Finally, sexual dysfunction and chronic pain were more frequently observed in individuals with depressive symptoms. These findings illustrate that depression is only one of many problems for most primary care patients identified with depression. A multidisciplinary team in primary care is recommended to provide a coordinated approach to the treatment of depression and its associated problems.