Dataset Information

Outcomes of a partnered facilitation strategy to implement primary care-mental health.

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 (?=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.

SUBMITTER: Kirchner JE

PROVIDER: S-EPMC4239280 | biostudies-literature | 2014 Dec

REPOSITORIES: biostudies-literature

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Publications

Outcomes of a partnered facilitation strategy to implement primary care-mental health.

Kirchner JoAnn E JE Ritchie Mona J MJ Pitcock Jeffery A JA Parker Louise E LE Curran Geoffrey M GM Fortney John C JC

Journal of general internal medicine 20141201

<h4>Background</h4>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.<h4>Objective</h4>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).<h4>Design</h4>This was a quasi-experimental, Hybrid Typ ...[more]

PMID: 25355087

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Project description:This study compares the mental health of single parents relative to partnered parents and assesses the contribution of the social and demographic factors to this difference, examining the gender difference in it.We analyzed 12,024 single and partnered subjects, aged 30-59 years, living with children, aged 0-19 years, drawn from the 4th, 5th, and 6th Korea National Health and Nutrition Examination Survey (KNHANES) dataset in South Korea conducted from 2007-2013. Mental health was evaluated by self-reported questionnaires including depressive mood for recent two weeks, presence of suicidal ideation, and the Korean version of the Alcohol Use Disorder Identification Test. Covariates included age, physical illness, socioeconomic status (family income, recipient of national basic livelihood guarantees, educational level, house ownership, job, and residential area), family structure, and support (co-residence of another adult). Multiple logistic regression was carried out and the explained fractions of each covariate was calculated.Single parents had significantly poorer mental health than their partnered counterparts, with odds ratio (OR) of 2.02 (95% confidence interval (CI) 1.56-2.63) for depressive symptoms, 1.69 (95% CI 1.27-2.25) for suicidal ideation, and 1.74 (95% CI 1.38-2.20) for any of the three mental health statuses (suspicious depression, suicidal ideation, and alcohol dependence) after controlling for the covariates. The odds of depressive symptoms (OR = 3.13, 95% CI 2.50-3.93) and suicidal ideation (OR = 2.50, 95% CI 1.97-3.17) among both single fathers and mothers were higher than partnered parents. However, the odds of alcohol dependence were 3.6 times higher among single mothers than partnered mothers (OR = 3.58, 95% CI 1.81-7.08) and were 1.4 times greater among single fathers than partnered fathers (OR = 1.35, 95% CI 0.81-2.25). Socio-economic status explained more than 50% (except for substance use disorders) of the poorer mental health in single parents. These results were more remarkable for single fathers than for single mothers except for alcohol dependence. However, physical illness, family structure, and support made only minor contributions to single parents' mental health.This study demonstrates that single parents have poorer mental health than partnered parents. Although lower SES is an important factor explaining poorer mental health in single parents, there are other factors we cannot explain about their poor mental health. Therefore, we should pay proper regard to identifying other factors affecting mental health and to establishing policies to support single parents.

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Dataset Information

Outcomes of a partnered facilitation strategy to implement primary care-mental health.

Background

Objective

Design

Participants

Intervention

Main measures

Key results

Conclusion

Publications

Outcomes of a partnered facilitation strategy to implement primary care-mental health.

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