A Qualitative Investigation of Characteristics Impacting Clinical Decision-Making in Integrated Behavioral Health Care
To support implementation of integrated behavioral health care (IBHC) models in local settings, providers may benefit from clinical decision-making support. The present analysis examines perspectives on patient characteristics appropriate or inappropriate for, and currently managed within, IBHC at a...
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| Veröffentlicht in: | The journal of behavioral health services & research 2024-10, Vol.51 (4), p.561-587 |
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| container_title | The journal of behavioral health services & research |
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| creator | Smith, Ash M. Prom, Maria C. Ng, Lauren C. |
| description | To support implementation of integrated behavioral health care (IBHC) models in local settings, providers may benefit from clinical decision-making support. The present analysis examines perspectives on patient characteristics appropriate or inappropriate for, and currently managed within, IBHC at a large medical center to inform recommendations for provider decision-making. Twenty-four participants (
n
= 13 primary care providers;
n
= 6 behavioral health providers;
n
= 5 administrators) in an IBHC setting were interviewed. Thematic analysis was conducted with acceptable interrater reliability (κ = 0.75). Responses indicated behavioral health symptom and patient characteristics that impact perceptions of appropriateness for management in IBHC, with high variability between providers. Many patients with characteristics identified as inappropriate for IBHC were nonetheless currently managed in IBHC. Interactions between patient ability to engage in care and provider ability to manage patient needs guided decisions to refer a patient to IBHC or specialty care. A heuristic representing this dimensional approach to clinical decision-making is presented to suggest provider decision-making guidance informed by both patient and provider ability. |
| doi_str_mv | 10.1007/s11414-024-09891-6 |
| format | Article |
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n
= 13 primary care providers;
n
= 6 behavioral health providers;
n
= 5 administrators) in an IBHC setting were interviewed. Thematic analysis was conducted with acceptable interrater reliability (κ = 0.75). Responses indicated behavioral health symptom and patient characteristics that impact perceptions of appropriateness for management in IBHC, with high variability between providers. Many patients with characteristics identified as inappropriate for IBHC were nonetheless currently managed in IBHC. Interactions between patient ability to engage in care and provider ability to manage patient needs guided decisions to refer a patient to IBHC or specialty care. A heuristic representing this dimensional approach to clinical decision-making is presented to suggest provider decision-making guidance informed by both patient and provider ability.</description><identifier>ISSN: 1094-3412</identifier><identifier>ISSN: 1556-3308</identifier><identifier>EISSN: 1556-3308</identifier><identifier>DOI: 10.1007/s11414-024-09891-6</identifier><identifier>PMID: 38982024</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Ability ; Adult ; Clinical Decision-Making ; Community and Environmental Psychology ; Delivery of Health Care, Integrated ; Dimensional approach ; Female ; Health behavior ; Health care ; Health Informatics ; Health Personnel - psychology ; Health Promotion and Disease Prevention ; Health Psychology ; Heuristic ; Humans ; Inappropriateness ; Integrated care ; Interrater reliability ; Male ; Medical personnel ; Medicine ; Medicine & Public Health ; Mental health ; Mental Health Services ; Middle Aged ; Primary care ; Primary Health Care ; Psychiatry ; Public Health ; Qualitative Research</subject><ispartof>The journal of behavioral health services & research, 2024-10, Vol.51 (4), p.561-587</ispartof><rights>The Author(s) 2024</rights><rights>2024. The Author(s).</rights><rights>The Author(s) 2024. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>The Author(s) 2024 2024</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c426t-7e3080231dbf78e5b8cdf906b7bb8afa87396a61b1792ad30119b82121bf54c73</cites><orcidid>0000-0001-5988-008X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11414-024-09891-6$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11414-024-09891-6$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,27901,27902,30976,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38982024$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Smith, Ash M.</creatorcontrib><creatorcontrib>Prom, Maria C.</creatorcontrib><creatorcontrib>Ng, Lauren C.</creatorcontrib><title>A Qualitative Investigation of Characteristics Impacting Clinical Decision-Making in Integrated Behavioral Health Care</title><title>The journal of behavioral health services & research</title><addtitle>J Behav Health Serv Res</addtitle><addtitle>J Behav Health Serv Res</addtitle><description>To support implementation of integrated behavioral health care (IBHC) models in local settings, providers may benefit from clinical decision-making support. The present analysis examines perspectives on patient characteristics appropriate or inappropriate for, and currently managed within, IBHC at a large medical center to inform recommendations for provider decision-making. Twenty-four participants (
n
= 13 primary care providers;
n
= 6 behavioral health providers;
n
= 5 administrators) in an IBHC setting were interviewed. Thematic analysis was conducted with acceptable interrater reliability (κ = 0.75). Responses indicated behavioral health symptom and patient characteristics that impact perceptions of appropriateness for management in IBHC, with high variability between providers. Many patients with characteristics identified as inappropriate for IBHC were nonetheless currently managed in IBHC. Interactions between patient ability to engage in care and provider ability to manage patient needs guided decisions to refer a patient to IBHC or specialty care. A heuristic representing this dimensional approach to clinical decision-making is presented to suggest provider decision-making guidance informed by both patient and provider ability.</description><subject>Ability</subject><subject>Adult</subject><subject>Clinical Decision-Making</subject><subject>Community and Environmental Psychology</subject><subject>Delivery of Health Care, Integrated</subject><subject>Dimensional approach</subject><subject>Female</subject><subject>Health behavior</subject><subject>Health care</subject><subject>Health Informatics</subject><subject>Health Personnel - psychology</subject><subject>Health Promotion and Disease Prevention</subject><subject>Health Psychology</subject><subject>Heuristic</subject><subject>Humans</subject><subject>Inappropriateness</subject><subject>Integrated care</subject><subject>Interrater reliability</subject><subject>Male</subject><subject>Medical personnel</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mental health</subject><subject>Mental Health Services</subject><subject>Middle Aged</subject><subject>Primary care</subject><subject>Primary Health Care</subject><subject>Psychiatry</subject><subject>Public Health</subject><subject>Qualitative Research</subject><issn>1094-3412</issn><issn>1556-3308</issn><issn>1556-3308</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>7QJ</sourceid><recordid>eNp9kU1v1DAQhiNERUvhD3BAkbhwCfXYTmyfUBs-ulIRQoKzZTtO1iXrLHYSiX_PlC1t4cDBssfzzOsZv0XxAsgbIEScZQAOvCIUl5IKquZRcQJ13VSMEfkYz0TxinGgx8XTnK8JIZwz8aQ4ZlJJinUnxXpeflnMGGYzh9WXm7j6PIcBoymWU1-2W5OMm30KeO1yudntMQxxKNsxxODMWL7zLmTEq0_m-00iRJSZ_ZDM7Lvywm_NGqaE4KU347wtW5P8s-KoN2P2z2_30-Lbh_df28vq6vPHTXt-VTlOm7kSHgchlEFneyF9baXrekUaK6yVpjdSMNWYBiwIRU3HCICykgIF29fcCXZavD3o7he7853zccZO9D6FnUk_9WSC_jsTw1YP06rxa3nNQKHC61uFNP1Y8HP0LmTnx9FEPy1ZMyKEUgCSIPrqH_R6WlLE-TQDAAGNEBwpeqBcmnJOvr_rBoi-8VUffNXoj_7tq26w6OXDOe5K_hiJADsAGVNx8On-7f_I_gJ0Hq9g</recordid><startdate>20241001</startdate><enddate>20241001</enddate><creator>Smith, Ash M.</creator><creator>Prom, Maria C.</creator><creator>Ng, Lauren C.</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QJ</scope><scope>K7.</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-5988-008X</orcidid></search><sort><creationdate>20241001</creationdate><title>A Qualitative Investigation of Characteristics Impacting Clinical Decision-Making in Integrated Behavioral Health Care</title><author>Smith, Ash M. ; Prom, Maria C. ; Ng, Lauren C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c426t-7e3080231dbf78e5b8cdf906b7bb8afa87396a61b1792ad30119b82121bf54c73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Ability</topic><topic>Adult</topic><topic>Clinical Decision-Making</topic><topic>Community and Environmental Psychology</topic><topic>Delivery of Health Care, Integrated</topic><topic>Dimensional approach</topic><topic>Female</topic><topic>Health behavior</topic><topic>Health care</topic><topic>Health Informatics</topic><topic>Health Personnel - psychology</topic><topic>Health Promotion and Disease Prevention</topic><topic>Health Psychology</topic><topic>Heuristic</topic><topic>Humans</topic><topic>Inappropriateness</topic><topic>Integrated care</topic><topic>Interrater reliability</topic><topic>Male</topic><topic>Medical personnel</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Mental health</topic><topic>Mental Health Services</topic><topic>Middle Aged</topic><topic>Primary care</topic><topic>Primary Health Care</topic><topic>Psychiatry</topic><topic>Public Health</topic><topic>Qualitative Research</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Smith, Ash M.</creatorcontrib><creatorcontrib>Prom, Maria C.</creatorcontrib><creatorcontrib>Ng, Lauren C.</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>ProQuest Criminal Justice (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The journal of behavioral health services & research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Smith, Ash M.</au><au>Prom, Maria C.</au><au>Ng, Lauren C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Qualitative Investigation of Characteristics Impacting Clinical Decision-Making in Integrated Behavioral Health Care</atitle><jtitle>The journal of behavioral health services & research</jtitle><stitle>J Behav Health Serv Res</stitle><addtitle>J Behav Health Serv Res</addtitle><date>2024-10-01</date><risdate>2024</risdate><volume>51</volume><issue>4</issue><spage>561</spage><epage>587</epage><pages>561-587</pages><issn>1094-3412</issn><issn>1556-3308</issn><eissn>1556-3308</eissn><abstract>To support implementation of integrated behavioral health care (IBHC) models in local settings, providers may benefit from clinical decision-making support. 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n
= 13 primary care providers;
n
= 6 behavioral health providers;
n
= 5 administrators) in an IBHC setting were interviewed. Thematic analysis was conducted with acceptable interrater reliability (κ = 0.75). Responses indicated behavioral health symptom and patient characteristics that impact perceptions of appropriateness for management in IBHC, with high variability between providers. Many patients with characteristics identified as inappropriate for IBHC were nonetheless currently managed in IBHC. Interactions between patient ability to engage in care and provider ability to manage patient needs guided decisions to refer a patient to IBHC or specialty care. A heuristic representing this dimensional approach to clinical decision-making is presented to suggest provider decision-making guidance informed by both patient and provider ability.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>38982024</pmid><doi>10.1007/s11414-024-09891-6</doi><tpages>27</tpages><orcidid>https://orcid.org/0000-0001-5988-008X</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Ability Adult Clinical Decision-Making Community and Environmental Psychology Delivery of Health Care, Integrated Dimensional approach Female Health behavior Health care Health Informatics Health Personnel - psychology Health Promotion and Disease Prevention Health Psychology Heuristic Humans Inappropriateness Integrated care Interrater reliability Male Medical personnel Medicine Medicine & Public Health Mental health Mental Health Services Middle Aged Primary care Primary Health Care Psychiatry Public Health Qualitative Research |
| title | A Qualitative Investigation of Characteristics Impacting Clinical Decision-Making in Integrated Behavioral Health Care |
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