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.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4239280 | PMC |
| http://dx.doi.org/10.1007/s11606-014-3027-2 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Addressing unmet mental health needs of older adults in Turbo, Colombia: a multi-component psychosocial intervention feasibility study.
Int J Equity Health
January 2025
National School of Public Health, University of Antioquia, Medellín, Colombia.
Background: Older adults have lived through extreme and stressful live events in Colombia, including during the armed conflict. Without adequate mental health resources in place, the aim of this study was to feasibility test a co-produced community-integrated intervention for older adults to improve their mental health and well-being in Turbo, Colombia.
Methods: Based on a systematic review and meta-analysis of community-based mental health interventions for older adults in LMICs, qualitative interviews with older adults and local stakeholders, as well as a mental health needs assessment survey of the local older adult population in Turbo, Colombia, we consulted older adults in the region to co-produce a community-based intervention.
Cost-utility of behavioural activation for mitigating psychological impacts of COVID-19 on socially isolated older adults with depression and multiple long-term conditions compared with usual care: results from a pragmatic randomised controlled trial.
BMJ Ment Health
January 2025
Health Sciences, University of York, York, UK.
Background: Depression alongside multiple long-term conditions (MLTCs) in older adults poses a critical public health challenge, worsening physical and mental health and increasing healthcare costs. COVID-19 restrictions further exacerbated these impacts. Behavioural activation (BA) shows promise as a remote intervention for depression during isolation, but its cost-effectiveness for depressed, socially isolated older adults remains uncertain.
View Article and Find Full Text PDFNeighborhood Disadvantage and the Association of Hurricanes Sandy and Harvey With Veterans' Mental Health.
JAMA Netw Open
January 2025
Department of Occupational and Environmental Health, University of Iowa, Iowa City.
Importance: Hurricanes are associated with a wide range of adverse health effects in the general population and are increasing in frequency and severity due to global climate change. Due to prior military exposures and distinct sociodemographic characteristics, US veterans may be more vulnerable than the general population to negative health effects of hurricanes.
Objective: To evaluate whether acute care mental health visits among US veterans were associated with exposure to hurricanes.
Engaging With a Community of Practice in Dementia: Impacts on Skills, Knowledge, Networks and Accessing Support.
Health Expect
February 2025
Department of Primary Care & Mental Health, University of Liverpool, Liverpool, UK.
Background: To deliver implementable, meaningful research and advance knowledge, different stakeholders need to be brought together regularly via a suitable platform or community of practice. The Liverpool Dementia & Ageing Research Forum, set up in 2019, is a public/professional community of practice, providing in-person and remote events and activities to connect people living with dementia, unpaid carers, health and social care professionals, Third Sector representatives and commissioners. The aim of this study was to qualitatively explore the experiences and impacts of engaging with Forum events by different stakeholders.
View Article and Find Full Text PDFImplementing brief behavioral treatment for insomnia in Department of Veterans Affairs Primary Care Mental Health Integration clinics: Reach outcomes from a hybrid type 3 effectiveness-implementation trial.
Psychol Serv
January 2025
Center for Health Equity Research and Promotion, Department of Veterans Affairs Pittsburgh Healthcare System.
Chronic insomnia is one of the most common health problems among veterans and can significantly impact health, function, and quality of life. Brief behavioral treatment for insomnia (BBTI), an adaptation of cognitive behavioral therapy for insomnia (CBT-I), was developed to help increase access to care outside of specialty settings. However, training providers alone is rarely sufficient, and implementation strategies are needed for successful uptake, adoption, and sustainable delivery of care.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!