Residents\u27 Confidence Providing Primary Care With Behavioral Health Integration

BACKGROUND AND OBJECTIVES: Behavioral health integration (BHI) entails integrated behavioral health clinicians (IBHCs) providing care-generally for mental health and substance abuse disorders and behavioral comorbidity- within the operational functioning of primary care. Because limited data exist regarding BHI in residency, we studied its impact on resident education by examining whether increased behavioral health (BH) co-management improved residents\u27 perceived ability to treat BH conditions. METHODS: We included residents from internal and family medicine training programs using BHI in residents\u27 continuity clinics and assessed the level of co-management between primary care and IBHCs and the following domains: (1) confidence in managing BH conditions, (2) barriers to BH provision, (3) perception of autonomy when working with IBHCs, (4) satisfaction with the clinic, and (5) perceived educational value of BH learning modes. RESULTS: Altogether, 117 residents participated in our survey (73.1% response rate). Residents who had co-managed \u3e /= five patients alongside IBHCs reported significantly higher confidence than those who had co-managed andlt; five patients with BH conditions. The association remained significant after adjustment for residents\u27 level of training and specialty. In rating BH learning modes, residents rated most highly active collaboration with IBHCs and observation with feedback from clinic preceptors. CONCLUSIONS: BHI training within residency enhances perceived learning and confidence in providing BH care

Identifying Feasible Interventions to Prevent Long-Term Health Consequences of Psychotropic Medications Prescribed to Children at the Baird School

Introduction: •Many children with behavioral needs struggle in traditional classroom settings. Children receive help through specialized educational institutions, pharmacotherapy, and psychiatric counseling. •While substantial information exists about drug indications and side effects, there is little literature documenting the barriers caregivers face in addressing side effects •Our group conducted a literature review to identify the side effects and associated comorbidities of the six most frequently prescribed psychotropic drugs at the Baird School. •We designed a survey to assess the caregivers’ resources and barriers to minimizing these side effects, and then offered a collection of feasible recommendations.https://scholarworks.uvm.edu/comphp_gallery/1049/thumbnail.jp

How Can I Help You?Eligibility Worker: Navigating Patients Through the Social Services Maze

Introduction: Vermont has programs to assist low income individuals in obtaining basic needs such as health insurance, food security, fuel assistance, housing and transportation. However, these services are often underutilized by eligible individuals. Major barriers to enrollment include lack of knowledge about available programs and their income cutoffs, cumbersome application processes, literacy barriers, and lack of transportation to application sites. In other states, efforts to reduce these barriers have included shortened application forms, removal of asset tests, mail-in applications, media outreach, and eligibility workers placed in outreach agencies. Many studies suggest that the presence of an eligibility worker at a community health center can help overcome some social service enrollment barriers.https://scholarworks.uvm.edu/comphp_gallery/1012/thumbnail.jp

Identifying barriers to care in the Burmese and Bhutanese refugee populations of Burlington, Vermont

Introduction: Many refugees who escape persecution in their own country have trouble navigating and accessing the American health care system. Language barriers often impair effective communication, while financial challenges can be prohibitive after the eight-month government insurance subsidy for new refugees expires. In addition many refugees do not understand the concept of chronic disease, which is a concern considering the overall rise in hypertension (HTN) and type-two diabetes mellitus (T2DM) in the US population. Understanding how refugees access health care, and how well they understand chronic disease, is essential for organizations providing medical care for these populations. Little is known about how the Burmese and Bhutanese refugees experience the Vermont health care system, nor how well they understand chronic diseases such as HTN and T2DM. To address these limitations, we conducted focus groups with these two Vermont refugee populations at the Community Health Center of Burlington, Vermont (CHCB).https://scholarworks.uvm.edu/comphp_gallery/1035/thumbnail.jp

The impact of behavioral and mental health risk assessments on goal setting in primary care

Patient-centered health risk assessments (HRAs) that screen for unhealthy behaviors, prioritize concerns, and provide feedback may improve counseling, goal setting, and health. To evaluate the effectiveness of routinely administering a patient-centered HRA, My Own Health Report, for diet, exercise, smoking, alcohol, drug use, stress, depression, anxiety, and sleep, 18 primary care practices were randomized to ask patients to complete My Own Health Report (MOHR) before an office visit (intervention) or continue usual care (control). Intervention practice patients were more likely than control practice patients to be asked about each of eight risks (range of differences 5.3-15.8 %, p < 0.001), set goals for six risks (range of differences 3.8-16.6 %, p < 0.01), and improve five risks (range of differences 5.4-13.6 %, p < 0.01). Compared to controls, intervention patients felt clinicians cared more for them and showed more interest in their concerns. Patient-centered health risk assessments improve screening and goal setting.Trial RegistrationClinicaltrials.gov identifier: NCT01825746

Designing a valid randomized pragmatic primary care implementation trial: the my own health report (MOHR) project

BACKGROUND: There is a pressing need for greater attention to patient-centered health behavior and psychosocial issues in primary care, and for practical tools, study designs and results of clinical and policy relevance. Our goal is to design a scientifically rigorous and valid pragmatic trial to test whether primary care practices can systematically implement the collection of patient-reported information and provide patients needed advice, goal setting, and counseling in response. METHODS: This manuscript reports on the iterative design of the My Own Health Report (MOHR) study, a cluster randomized delayed intervention trial. Nine pairs of diverse primary care practices will be randomized to early or delayed intervention four months later. The intervention consists of fielding the MOHR assessment – addresses 10 domains of health behaviors and psychosocial issues – and subsequent provision of needed counseling and support for patients presenting for wellness or chronic care. As a pragmatic participatory trial, stakeholder groups including practice partners and patients have been engaged throughout the study design to account for local resources and characteristics. Participatory tasks include identifying MOHR assessment content, refining the study design, providing input on outcomes measures, and designing the implementation workflow. Study outcomes include the intervention reach (percent of patients offered and completing the MOHR assessment), effectiveness (patients reporting being asked about topics, setting change goals, and receiving assistance in early versus delayed intervention practices), contextual factors influencing outcomes, and intervention costs. DISCUSSION: The MOHR study shows how a participatory design can be used to promote the consistent collection and use of patient-reported health behavior and psychosocial assessments in a broad range of primary care settings. While pragmatic in nature, the study design will allow valid comparisons to answer the posed research question, and findings will be broadly generalizable to a range of primary care settings. Per the pragmatic explanatory continuum indicator summary (PRECIS) framework, the study design is substantially more pragmatic than other published trials. The methods and findings should be of interest to researchers, practitioners, and policy makers attempting to make healthcare more patient-centered and relevant. TRIAL REGISTRATION: Clinicaltrials.gov: NCT0182574

Understanding and applying the RE-AIM framework: Clarifications and resources

Introduction: Understanding, categorizing, and using implementation science theories, models, and frameworks is a complex undertaking. The issues involved are even more challenging given the large number of frameworks and that some of them evolve significantly over time. As a consequence, researchers and practitioners may be unintentionally mischaracterizing frameworks or basing actions and conclusions on outdated versions of a framework. Methods: This paper addresses how the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework has been described, summarizes how the model has evolved over time, and identifies and corrects several misconceptions. Results: We address 13 specific areas where misconceptions have been noted concerning the use of RE-AIM and summarize current guidance on these issues. We also discuss key changes to RE-AIM over the past 20 years, including the evolution to Pragmatic Robust Implementation and Sustainability Model, and provide resources for potential users to guide application of the framework. Conclusions: RE-AIM and many other theories and frameworks have evolved, been misunderstood, and sometimes been misapplied. To some degree, this is inevitable, but we conclude by suggesting some actions that reviewers, framework developers, and those selecting or applying frameworks can do to prevent or alleviate these problems.Ye

Anthropogenic Space Weather

Anthropogenic effects on the space environment started in the late 19th century and reached their peak in the 1960s when high-altitude nuclear explosions were carried out by the USA and the Soviet Union. These explosions created artificial radiation belts near Earth that resulted in major damages to several satellites. Another, unexpected impact of the high-altitude nuclear tests was the electromagnetic pulse (EMP) that can have devastating effects over a large geographic area (as large as the continental United States). Other anthropogenic impacts on the space environment include chemical release ex- periments, high-frequency wave heating of the ionosphere and the interaction of VLF waves with the radiation belts. This paper reviews the fundamental physical process behind these phenomena and discusses the observations of their impacts.Comment: 71 pages, 35 figure

Handbook of Clinical Psychology in Medical SettingsEvidence-Based Assessment and Intervention /

XIV, 774 p. 33 illus.online resource