Behavioral health integration and specialty medical care: Opportunities for applying knowledge from primary care integration.

While education and advocacy regarding behavioral health (BH) integration in primary care have been in full force at the state and national level for many years, specialty care BH integration has not received the same attention in terms of practice transformation, workforce development, and payment reform. Models of BH care have been tested in primary care and can be easily adapted to improve specialty patient care. There are many opportunities for using the knowledge base gained from integrated primary care to help move integration forward in the specialty medical setting. The timing for this is rife, as the benefits of integrated BH for patient health outcomes are well established. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Update on Office-Based Strategies for the Management of Obesity.

Obesity is a common condition that is associated with numerous medical problems such as cardiovascular disease, pulmonary disease, and diabetes mellitus. Primary care physicians have an important role in helping patients develop a successful weight loss plan to improve their overall health. Dietary strategies emphasizing reduced caloric intake, regardless of the nutrient composition, are important for weight loss. Behavioral interventions such as motivational interviewing and encouraging physical activity lead to additional weight loss when combined with dietary changes. Medication regimens for concomitant medical problems should take into account the effect of specific agents on the patient's weight. Persons with a body mass index of 30 kg per m2 or greater or 27 kg per m2 or greater with comorbidities who do not succeed in losing weight with diet and activity modifications may consider medication to assist with weight loss. Medications approved for long-term treatment of obesity include orlistat, lorcaserin, liraglutide, phentermine/topiramate, and naltrexone/bupropion. Physicians should consider referring patients for bariatric surgery if they have a body mass index of 40 kg per m2 or greater. For those with obesity-related comorbid conditions, patients should be considered for adjustable gastric banding or other bariatric surgical approaches if they have a body mass index of 30 to 39.9 kg per m2. The most commonly performed procedures for weight loss are Roux-en-Y gastric bypass, sleeve gastrectomy, and adjustable gastric banding. Bariatric surgery is the most effective intervention for weight loss in obese patients, and it leads to improvement in multiple obesity-related conditions, including remission of diabetes.

Righting wrongs and reforming rights.

Discusses issues faced by LGBT people, such as a lack of equal civil rights and the need for extra legal and financial protection for families because partners cannot be married. The author notes that, in our society, it is no longer acceptable to be racist, but it is still okay to be homophobic. The many campaigns against gay marriage and efforts in the legislature to prevent change toward equal civil rights and protections are prime examples. In our current political climate, two things are very clear: (a) homophobia is freely tolerated and (b) the times are changing as we inch closer to equal rights every day. We are "righting wrongs and reforming rights."

Working toward financial sustainability of integrated behavioral health services in a public health care system.

The need, benefit, and desirability of behavioral health integration in primary care is generally accepted and has acquired widespread positive regard. However, in many health care settings the economics, business aspects, and financial sustainability of practice in integrated care settings remains an unsolved puzzle. Organizational administrators may be reluctant to expand behavioral health services without evidence that such programs offer clear financial benefits and financial sustainability. The tendency among mental health professionals is to consider positive clinical outcomes (e.g., reduced depression) as being globally valued indicators of program success. Although such outcomes may be highly valued by primary care providers and patients, administrative decision makers may require demonstration of more tangible financial outcomes. These differing views require program developers and evaluators to consider multiple outcome domains including clinical/psychological symptom reduction, potential cost benefit, and cost offset. The authors describe a process by which a pilot demonstration project is being implemented to demonstrate programmatic outcomes with a focus on the following: 1) clinician efficiency, 2) improved health outcomes, and 3) direct revenue generation associated with the inclusion of integrated primary care in a public health care system. The authors subsequently offer specific future directions and commentary regarding financial evaluation in each of these domains.