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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.

          Most cited references51

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          Collaborative care for patients with depression and diabetes mellitus: a systematic review and meta-analysis

          Background Diabetic patients with depression are often inadequately treated within primary care. These comorbid conditions are associated with poor outcomes. The aim of this systematic review was to examine whether collaborative care can improve depression and diabetes outcomes in patients with both depression and diabetes. Methods Medline, Embase, Cochrane library and PsyINFO were systematically searched to identify relevant publications. All randomized controlled trials of collaborative care for diabetic patients with depression of all ages who were reported by depression treatment response, depression remission, hemoglobin A1c (HbA1c) values, adherence to antidepressant medication and/or oral hypoglycemic agent were included. Two authors independently screened search results and extracted data from eligible studies. Dichotomous and continuous measures of outcomes were combined using risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) either by fixed or random-effects models. Results Eight studies containing 2,238 patients met the inclusion criteria. Collaborative care showed a significant improvement in depression treatment response (RR = 1.33, 95% CI = 1.05-1.68), depression remission (adjusted RR = 1.53, 95% CI =1.11-2.12), higher rates of adherence to antidepressant medication (RR = 1.79, 95% CI = 1.19-2.69) and oral hypoglycemic agent (RR = 2.18, 95% CI = 1.61-2.96), but indicated a non-significant reduction in HbA1c values (MD = -0.13, 95% CI = -0.46-0.19). Conclusions Improving depression care in diabetic patients is very necessary and important. Comparing with usual care, collaborative care was associated with significantly better depressive outcomes and adherence in patients with depression and diabetes. These findings emphasize the implications for collaborative care of diabetic patients with depression in the future.
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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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              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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                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
                [1] 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
                6eb226ff-9234-4f8c-954c-70982e003984
                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/.

                History
                : 7 April 2015
                : 17 April 2015
                Categories
                Evidence-Based Review

                General medicine,Medicine,Geriatric medicine,Occupational & Environmental medicine,Internal medicine,Health & Social care
                health care service delivery,Patient-centered medical home,behavioral health integration,mental health,chronic disease management,integrated primary care

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