Outcomes of a Partnered Facilitation Strategy to Implement Primary Care-mental Health

Overview

Journal J Gen Intern Med

Publisher Springer

Specialty General Medicine

Date 2014 Oct 31

PMID 25355087

Citations 147

Authors

JoAnn E Kirchner

Mona J Ritchie

Jeffery A Pitcock

Louise E Parker

Geoffrey M Curran

John C Fortney

Affiliations

Soon will be listed here.

Abstract

Background: Implementing new programs and practices is challenging, even when they are mandated. Implementation Facilitation (IF) strategies that focus on partnering with sites show promise for addressing these challenges.

Objective: Our aim was to evaluate the effectiveness of an external/internal IF strategy within the context of a Department of Veterans Affairs (VA) mandate of Primary Care-Mental Health Integration (PC-MHI).

Design: This was a quasi-experimental, Hybrid Type III study. Generalized estimating equations assessed differences across sites.

Participants: Patients and providers at seven VA primary care clinics receiving the IF intervention and national support and seven matched comparison clinics receiving national support only participated in the study.

Intervention: We used a highly partnered IF strategy incorporating evidence-based implementation interventions.

Main Measures: We evaluated the IF strategy using VA administrative data and RE-AIM framework measures for two 6-month periods.

Key Results: Evaluation of RE-AIM measures from the first 6-month period indicated that PC patients at IF clinics had nine times the odds (OR=8.93, p<0.001) of also being seen in PC-MHI (Reach) compared to patients at non-IF clinics. PC providers at IF clinics had seven times the odds (OR=7.12, p=0.029) of referring patients to PC-MHI (Adoption) than providers at non-IF clinics, and a greater proportion of providers' patients at IF clinics were referred to PC-MHI (Adoption) compared to non-IF clinics (β=0.027, p<0.001). Compared to PC patients at non-IF sites, patients at IF clinics did not have lower odds (OR=1.34, p=0.232) of being referred for first-time mental health specialty clinic visits (Effectiveness), or higher odds (OR=1.90, p=0.350) of receiving same-day access (Implementation). Assessment of program sustainability (Maintenance) was conducted by repeating this analysis for a second 6-month time period. Maintenance analyses results were similar to the earlier period.

Conclusion: The addition of a highly partnered IF strategy to national level support resulted in greater Reach and Adoption of the mandated PC-MHI initiative, thereby increasing patient access to VA mental health care.

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