ABSTRACT
Though integrated behavioral health programs often encourage primary care physicians to refer patients by means of a personal introduction (warm handoff), data are limited regarding the benefits of warm handoffs. We conducted a retrospective study of adult primary care patients referred to behavioral health clinicians in an urban, safety-net hospital to investigate the association between warm handoffs and attendance rates at subsequent initial behavioral health appointments. In multivariable analyses, patients referred via warm handoffs were not more likely to attend initial appointments (OR = 0.96; 95% CI, 0.79-1.18; P = .71). A prospective study is necessary to confirm the role of warm handoffs.
Subject(s)
Delivery of Health Care, Integrated/statistics & numerical data , Mental Disorders/therapy , Patient Handoff , Referral and Consultation/statistics & numerical data , Adolescent , Adult , Aged , Boston , Delivery of Health Care, Integrated/standards , Female , Humans , Logistic Models , Male , Middle Aged , Multivariate Analysis , Poverty , Primary Health Care/standards , Primary Health Care/statistics & numerical data , Referral and Consultation/standards , Retrospective Studies , Young AdultABSTRACT
Many people with depression recognize their symptoms as depression, but fail to seek treatment for a number of years. We aimed to explore the reasons for this. Thirty primary care patients who screened positive for depression participated in semistructured, face-to-face interviews. Transcripts were analyzed using grounded thematic analysis. Patients who sought depression treatment emphasized their understanding of depression, their belief that treatment would work, and the negative consequences that would ensue if they did not seek treatment. Patients who did not seek treatment emphasized that treatment would not be effective, thought that depression would not last very long, and believed that depression did not affect their everyday lives. Patients' illness perceptions of depression were represented by and organized using the framework of the Self-Regulation Model of Illness Behavior. This model might be useful for planning patient activation intervention studies to increase the uptake of depression treatment in primary care.
Subject(s)
Depression/psychology , Models, Psychological , Patient Satisfaction , Perception , Primary Health Care , Stress, Psychological , Adaptation, Psychological , Adult , Depression/drug therapy , Depression/therapy , Emotions , Female , Health Knowledge, Attitudes, Practice , Humans , Interpersonal Relations , Interview, Psychological , Male , Middle Aged , Psychometrics , Qualitative Research , Risk Factors , Self-Assessment , Surveys and Questionnaires , Young AdultABSTRACT
Team-based care may address burnout in primary care; few studies have examined the impact of nurse practitioner-physician (NP-MD) teams on provider burnout. This article describes a model of NP-MD care teams in an urban safety-net primary care practice. Average time to third next available appointment with a team provider (either NP or MD) decreased by nearly 20 days after implementation of the model. In total, 79% of MDs reported that the model was very or extremely helpful in reducing the burden of work between visits and 100% of NPs reported that they were very or extremely satisfied with their current job.