Journal of General Internal Medicine

, Volume 29, Supplement 4, pp 904–912 | Cite as

Outcomes of a Partnered Facilitation Strategy to Implement Primary Care–Mental Health

  • JoAnn E. Kirchner
  • Mona J. Ritchie
  • Jeffery A. Pitcock
  • Louise E. Parker
  • Geoffrey M. Curran
  • John C. Fortney
Original Research

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 (β=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.

KEY WORDS

implementation research primary care mental health health policy 

Notes

Acknowledgements

The authors thank Carrie Edlund, MS for assistance with editing and manuscript preparation.

This material is based on work supported by the U.S. Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Service and the VA Quality Enhancement Research Initiative (QUERI) (grant SDP 08–316).

Disclaimer

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs.

Conflicts of Interest

The authors declare that they do not have a conflict of interest.

Supplementary material

11606_2014_3027_MOESM1_ESM.docx (26 kb)
ESM 1(DOCX 25 kb)

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Copyright information

© Society of General Internal Medicine 2014

Authors and Affiliations

  • JoAnn E. Kirchner
    • 1
    • 2
    • 3
  • Mona J. Ritchie
    • 1
    • 2
    • 3
  • Jeffery A. Pitcock
    • 1
  • Louise E. Parker
    • 1
    • 4
  • Geoffrey M. Curran
    • 1
    • 2
    • 3
  • John C. Fortney
    • 2
    • 3
    • 5
  1. 1.VA Mental Health Quality Enhancement Research InitiativeNorth Little RockUSA
  2. 2.Department of PsychiatryUniversity of Arkansas for Medical SciencesLittle RockUSA
  3. 3.VA Center for Mental Healthcare & Outcomes ResearchCentral Arkansas Veterans Healthcare SystemNorth Little RockUSA
  4. 4.Department of Management and MarketingUniversity of MassachusettsBostonUSA
  5. 5.VA South Central Mental Illness Research Education and Clinical CenterNorth Little RockUSA

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