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      Patient-centered medical home and integrated care in the United States: An opportunity to maximize delivery of primary care

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          Abstract

          The reciprocal relationship between mental and physical health is well established. Undiagnosed, untreated, and poorly managed mental health conditions are associated with numerous physical health complications, poor treatment adherence, and decreased quality of life. Despite growing evidence regarding the importance of effectively addressing these conditions in primary care, the rates of identification remain low and follow-up and management by primary care providers has been criticized. The objective of this review was to demonstrate the role of Patient-Centered Medical Home (PCMH) and mental health integration in addressing comprehensive health care needs in primary care patients, and to describe common barriers and facilitators to the implementation of these types of programs.

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          Most cited references 51

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          Severity of mental health impairment and trajectories of improvement in an integrated primary care clinic.

          To model typical trajectories for improvement among patients treated in an integrated primary care behavioral health service, multilevel models were used to explore the relationship between baseline mental health impairment level and eventual mental health functioning across follow-up appointments.
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            Mental health care treatment initiation when mental health services are incorporated into primary care practice.

            Most primary care patients with mental health issues are identified or treated in primary care rather than the specialty mental health system. Primary care physicians report that their patients do not have access to needed mental health care. When referrals are made to the specialty behavioral or mental health care system, rates of patients who initiate treatment are low. Collaborative care models, with mental health clinicians as part of the primary care medical staff, have been suggested as an alternative. The aim of this study is to examine rates of treatment startup in 2 collaborative care settings: a rural family medicine office and a suburban internal medicine office. In both practices referrals for mental health services are made within the practice.
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              Collaborative Care for Depression in Primary Care: How Psychiatry Could “Troubleshoot” Current Treatments and Practices

              The bulk of mental health services for people with depression are provided in primary care settings. Primary care providers prescribe 79 percent of antidepressant medications and see 60 percent of people being treated for depression in the United States, and they do that with little support from specialist services. Depression is not effectively managed in the primary care setting. Collaborative care based on a team approach, a population health perspective, and measurement-based care has been proven to treat depression more effectively than care as usual in a variety of settings and for different populations, and it increases people’s access to medications and behavioral therapies. Psychiatry has the responsibility of supporting the primary care sector in delivering mental health services by disseminating collaborative care approaches under recent initiatives and opportunities made possible by the Affordable Care Act (ACA).
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                Author and article information

                Journal
                FMCH
                Family Medicine and Community Health
                FMCH
                Family Medicine and Community Health & American Chinese Medical Education Association (USA )
                xxx-xxx
                2305-6983
                June 2015
                July 2015
                : 3
                : 2
                : 48-53
                Affiliations
                1Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
                Author notes
                CORRESPONDING AUTHOR: Sandra J. Gonzalez, MSSW, LCSW, Department of Family and Community Medicine, 3701 Kirby Drive, Suite 600, Houston, TX 77098, USA, Tel.: +713-798-3633, E-mail: Sandra.Gonzalez@ 123456bcm.edu
                Article
                fmch20150120
                10.15212/FMCH.2015.0120
                Copyright © 2015 Family Medicine and Community Health

                This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 Unported License (CC BY-NC 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc/4.0/.

                Product
                Self URI (journal page): http://fmch-journal.org/
                Categories
                Evidence-Based Review

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