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Outcomes of a partnered facilitation strategy to implement primary care-mental health.

Kirchner JE, Ritchie MJ, Pitcock JA, Parker LE, Curran GM, Fortney JC. Outcomes of a partnered facilitation strategy to implement primary care-mental health. Journal of general internal medicine. 2014 Dec 1; 29 Suppl 4:904-12.

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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 ( = 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.

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