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Moon KJ, Hasenstab KA, Bryant I, Chang LV, Seiber EE, Norris AH, Nawaz S. Service trends among non-obstetrics/gynecology providers in the U.S.: Long-acting reversible contraception insertions, removals, and re-insertions. Sex Reprod Healthc 2023; 38:100919. [PMID: 37839215 DOI: 10.1016/j.srhc.2023.100919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/30/2023] [Accepted: 09/28/2023] [Indexed: 10/17/2023]
Abstract
This study evaluates trends in long-acting reversible contraception (LARC) services among obstetrician/gynecologists (OB/GYNs) and non-OB/GYNs in the U.S. during 2012-2018. Using public and private insurance claims from the Symphony Health database, we calculated the percentage of LARC insertions, removals, and reinsertions performed by OB/GYNs and non-OB/GYNs. We then assessed time trends with linear regression. The proportion of LARC services that were performed by non-OBGYNs increased modestly between 2012 and 2018. Increases were similar for insertions, removals, and reinsertions. Further research is needed to understand trends in LARC service provision within primary care to better tailor medical training and policy interventions.
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Affiliation(s)
- Kyle J Moon
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA
| | - Kathryn A Hasenstab
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA
| | - Ian Bryant
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA; Department of Economics, University of Cincinnati Linder College of Business, Cincinnati, OH, USA
| | - Lenisa V Chang
- Department of Economics, University of Cincinnati Linder College of Business, Cincinnati, OH, USA
| | - Eric E Seiber
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA; Division of Health Services Management and Policy, Ohio State University College of Public Health, Columbus, OH, USA
| | - Alison H Norris
- Division of Epidemiology, Ohio State University College of Public Health, Columbus, OH, USA; Division of Infectious Diseases, Ohio State University College of Medicine, Columbus, OH, USA
| | - Saira Nawaz
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA; Division of Health Services Management and Policy, Ohio State University College of Public Health, Columbus, OH, USA.
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2
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Nyirandagijimana B, Nshimyiryo A, Mukasakindi H, Odhiambo J, Uwimana E, Mukamurenzi V, Bienvenu R, Ndikubwimana JS, Uwamaliya C, Kundu P, Park PH, Mpunga T, Raviola GJ, Kateera F, Rusangwa C, Smith SL. Decentralized, primary-care delivered epilepsy services in Burera District, Rwanda: Service use, feasibility, and treatment. eNeurologicalSci 2020; 22:100296. [PMID: 33319078 PMCID: PMC7724371 DOI: 10.1016/j.ensci.2020.100296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 03/06/2020] [Accepted: 11/25/2020] [Indexed: 11/30/2022] Open
Abstract
Background Integrating epilepsy care into primary care settings could reduce the global burden of illness attributable to epilepsy. Since 2012, the Rwandan Ministry of Health and the international nonprofit Partners In Health have collaboratively used a multi-faceted implementation program- MESH MH—to integrate and scale-up care for epilepsy and mental disorders within rural primary care settings in Burera district, Rwanda. We here describe demographics, service use and treatment patterns for patients with epilepsy seeking care at MESH-MH supported primary care health centers. Methods and findings This was a retrospective cohort study using routinely collected data from fifteen health centers in Burera district, from January 2015 to December 2016. 286 patients with epilepsy completed 3307 visits at MESH-MH participating health centers over a two year period (Jan 1st 2015 to Dec 31st 2016). Men were over twice as likely to be diagnosed with epilepsy than women (OR 2.38, CI [1.77–3.19]), and children under 10 were thirteen times as likely to be diagnosed with epilepsy as those 10 and older (OR 13.27, CI [7.18–24.51]). Carbamazepine monotherapy was prescribed most frequently (34% of patients). Conclusion Task-sharing of epilepsy care to primary care via implementation programs such as MESH-MH has the potential to reduce the global burden of illness attributable to epilepsy. Primary-care delivered epilepsy services in rural Rwanda are described. High epilepsy service use, treatment uptake and follow-up was observed. Primary-care integration could increase epilepsy treatment availability globally.
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Affiliation(s)
| | | | | | - Jackline Odhiambo
- Ministry of Health, Kigali, Rwanda.,Liverpool School of Tropical Medicine, Liverpool, UK
| | | | | | | | | | | | - Priya Kundu
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | - Paul H Park
- Partners In Health, Boston, USA.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, USA
| | | | - Giuseppe J Raviola
- Partners In Health, Boston, USA.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, USA
| | | | | | - Stephanie L Smith
- Partners In Health, Boston, USA.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA.,Department of Psychiatry, Brigham and Women's Hospital, Boston, USA
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3
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Carroll AJ, Jaffe AE, Stanton K, Guille C, Lazenby GB, Soper DE, Gilmore AK, Holland-Carter L. Program Evaluation of an Integrated Behavioral Health Clinic in an Outpatient Women's Health Clinic: Challenges and Considerations. J Clin Psychol Med Settings 2019; 27:207-216. [PMID: 31858362 DOI: 10.1007/s10880-019-09684-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Many women receive their regular check-ups and preventive care through a women's health clinic, including their behavioral health needs. Most of these clinics have not yet developed the capacity to adequately manage behavioral health concerns. We describe our clinical experience integrating behavioral health services into a women's health clinic. In one year, 108 women (54% White, Mage= 35) were referred for behavioral health treatment 47% were identified using a screening questionnaire, 51% were referred by their women's health provider and 2% were self-referred. The most common presenting concerns were anxiety (52%) and depressive symptoms (48%). Sixty-one (56%) patients completed an intake assessment, of whom 33 (54%) engaged in follow-up treatment (M = 3.7 treatment sessions, SD = 3.0). Behavioral health screening and treatment appears to be feasible and effective within a women's health setting. Further research is needed to overcome barriers to referrals and treatment engagement in this population.
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Affiliation(s)
- Allison J Carroll
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, MSC 861, Charleston, SC, 29425, USA.,Bluhm Cardiovascular Institute of Northwestern, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Anna E Jaffe
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, MSC 861, Charleston, SC, 29425, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Kimberley Stanton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, MSC 861, Charleston, SC, 29425, USA.,Psychology Houston, PC, Houston, TX, USA
| | - Constance Guille
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, MSC 861, Charleston, SC, 29425, USA.,Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
| | - Gweneth B Lazenby
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
| | - David E Soper
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
| | - Amanda K Gilmore
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, MSC 861, Charleston, SC, 29425, USA. .,College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas St, MSC 160, Charleston, SC, 29425, USA. .,Department of Health Policy and Behavioral Sciences and Mark Chaffin Center for Healthy Development, School of Public Health, Georgia State University, P. O. Box 3995, Atlanta, GA, 30303, USA.
| | - Lauren Holland-Carter
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, MSC 861, Charleston, SC, 29425, USA.
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Molnar BE, Lees KE, Roper K, Byars N, Méndez-Peñate L, Moulin C, McMullen W, Wolfe J, Allen D. Enhancing Early Childhood Mental Health Primary Care Services: Evaluation of MA Project LAUNCH. Matern Child Health J 2018; 22:1502-1510. [PMID: 29909431 PMCID: PMC6153762 DOI: 10.1007/s10995-018-2548-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objectives The purpose of this study was to evaluate the efficacy of an innovative early childhood mental health intervention, Massachusetts Project LAUNCH. Early childhood mental health clinicians and family partners (paraprofessionals with lived experience) were embedded within community pediatric medical homes. Methods A longitudinal study design was used to test the hypotheses that (1) children who received services would experience decreased social, emotional and behavioral problems over time and (2) caregivers' stress and depressive symptoms would decrease over time. Families who were enrolled in services and who consented to participate in the evaluation study were included in analyses (N = 225). Individual growth models were used to test longitudinal effects among MA LAUNCH participants (children and caregivers) over three time points using screening tools. Results Analyses showed that LAUNCH children who scored in age-specific clinically significant ranges of social, emotional and behavioral problems at Time 1 scored in the normal range on average by Time 3. Caregivers' stress and depressive symptoms also declined across the three time points. Results support hypotheses that the LAUNCH intervention improved social and emotional health for children and caregivers. Conclusions for Practice This study led to sustainability efforts, an expansion of the model to three additional communities across the state and development of an online toolkit for other communities interested in implementation.
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Affiliation(s)
- Beth E. Molnar
- Institute on Urban Health Research, Northeastern University, 360 Huntington Ave., Boston, MA 02115 USA
- Bouvé College of Health Sciences, Institute on Urban Health Research, Northeastern University, 360 Huntington Ave, M/S 314 INV, Boston, MA 02115 USA
| | - Kristin E. Lees
- Institute on Urban Health Research, Northeastern University, 360 Huntington Ave., Boston, MA 02115 USA
| | - Kate Roper
- Massachusetts Department of Public Health, 250 Washington St., Boston, MA 02118 USA
| | - Natasha Byars
- Boston Public Health Commission, 1010 Massachusetts Ave, Boston, MA 02118 USA
| | - Larisa Méndez-Peñate
- Massachusetts Department of Public Health, 250 Washington St., Boston, MA 02118 USA
| | - Christy Moulin
- Boston Public Health Commission, 1010 Massachusetts Ave, Boston, MA 02118 USA
| | - William McMullen
- Institute on Urban Health Research, Northeastern University, 360 Huntington Ave., Boston, MA 02115 USA
| | - Jessica Wolfe
- Institute on Urban Health Research, Northeastern University, 360 Huntington Ave., Boston, MA 02115 USA
| | - Deborah Allen
- Los Angeles County Department of Public Health, 313 N. Figueroa St., Los Angeles, CA 90012 USA
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5
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Freeman DS, Hudgins C, Hornberger J. Legislative and Policy Developments and Imperatives for Advancing the Primary Care Behavioral Health (PCBH) Model. J Clin Psychol Med Settings 2018; 25:210-223. [PMID: 29508113 DOI: 10.1007/s10880-018-9557-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The Primary Care Behavioral Health (PCBH) practice model continues to gain converts among primary care and behavioral health professionals as the evidence supporting its effectiveness continues to accumulate. Despite a growing number of practices and organizations using the model effectively, widespread implementation has been hampered by outmoded policies and regulatory barriers. As policymakers and legislators begin to recognize the contributions that PCBH model services make to the care of complex patients and the expansion of access to those in need of behavioral health interventions, some encouraging policy initiatives are emerging and the policy environment is becoming more favorable to implementation of the PCBH model. This article outlines the necessity for policy change, exposing the policy issues and barriers that serve to limit the practice of the PCBH model; highlights innovative approaches some states are taking to foster integrated practice; and discusses the compatibility of the PCBH model with the nation's health care reform agenda. Psychologists have emerged as leaders in the design and implementation of PCBH model integration and are encouraged to continue to advance the model through the demonstration of efficient and effective clinical practice, participation in the expansion of an appropriately trained workforce, and advocacy for the inclusion of this practice model in emerging healthcare systems and value-based payment methodologies.
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Affiliation(s)
- Dennis S Freeman
- Cherokee Health Systems, 2018 Western Avenue, Knoxville, TN, 37921, USA.
| | - Cathy Hudgins
- Southwest Virginia Area Health Education Center, Blacksburg, VA, USA
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Abstract
Integrated mental health services within health care settings have many benefits; however, several key barriers pose challenges to fully implemented and coordinated care. Collaborative, multistakeholder efforts, such as health networks, have the potential to overcome prevalent obstacles and to accelerate the dissemination of innovative clinical strategies. In addition to engaging clinical experts, efforts should also include the perspectives of families and communities, a grounding in data and evaluation, and a focus on policy and advocacy. This article describes how one community, Washington, DC, implemented a health network to improve the integration of mental health services into pediatric primary care.
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Guerrero AP, Takesue CL, Medeiros JH, Duran AA, Humphry JW, Lunsford RM, Shaw DV, Fukuda MH, Hishinuma ES. Primary Care Integration of Psychiatric and Behavioral Health Services: A Primer for Providers and Case Report of Local Implementation. Hawaii J Med Public Health 2017; 76:147-151. [PMID: 28607831 PMCID: PMC5458579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Mental health conditions are common, disabling, potentially life-threatening, and costly; however, they are mostly treatable with early detection and intervention. Unfortunately, mental healthcare is in significantly short supply both nationally and locally, and particularly in small, rural, and relatively isolated communities. This article provides physicians and other health practitioners with a primer on the basic rationale and principles of integrating behavioral healthcare - particularly psychiatric specialty care - in primary care settings, including effective use of teleconferencing. Referring to a local-based example, this paper describes the programmatic components (universal screening, telephone availability, mutually educational team rounds, as-needed consultations, etc) that operationalize and facilitate successful primary care integration, and illustrates how these elements are applied to population segments with differing needs for behavioral healthcare involvement. Lastly, the article discusses the potential value of primary care integration in promoting quality, accessibility, and provider retention; discusses how new developments in healthcare financing could enhance the sustainability of primary care integration models; and summarizes lessons learned.
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Affiliation(s)
| | - Cori L Takesue
- Department of Psychiatry, University of Hawai'i at Manoa, Honolulu, HI
| | - Jared Hn Medeiros
- Department of Psychiatry, University of Hawai'i at Manoa, Honolulu, HI
| | - Aileen A Duran
- Department of Psychiatry, University of Hawai'i at Manoa, Honolulu, HI
| | - Joseph W Humphry
- Department of Psychiatry, University of Hawai'i at Manoa, Honolulu, HI
| | - Ryan M Lunsford
- Department of Psychiatry, University of Hawai'i at Manoa, Honolulu, HI
| | - Diana V Shaw
- Department of Psychiatry, University of Hawai'i at Manoa, Honolulu, HI
| | - Michael H Fukuda
- Department of Psychiatry, University of Hawai'i at Manoa, Honolulu, HI
| | - Earl S Hishinuma
- Department of Psychiatry, University of Hawai'i at Manoa, Honolulu, HI
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8
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Abstract
There is increasing interest in methods to improve access to behavioral health services for children and adolescents. Children's Community Pediatric Behavioral Health Service (CCPBHS) is an integrated behavioral health service whose method of (a) creating a leadership team with empowered administrative and clinical stakeholders who can act on a commitment to change and (b) having a clear mission statement with integrated administrative and clinical care processes can serve as a model for implementing integration efforts within the medical home. Community Pediatrics Behavioral Health Service (CPBHS) is a sustainable initiative that improved the utilization of physical health and behavioral health systems for youth and improved the utilization of evidence-based interventions for youth served in primary care.
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