Health Services Research & Development

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Moye JA, Harris G, Kube E, Hicken B, Adjognon O, Shay K, Sullivan JL. Mental Health Integration in Geriatric Patient Aligned Care Teams in the Department of Veterans Affairs. American Journal of Geriatric Psychiatry. 2018 Sep 13; 1-25.
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Abstract: Objectives: To inform geriatric mental health policy by describing the role of behavioral healthcare providers within Geriatric Patient Aligned Care Teams (Geri-PACT), a Patient Centered Medical Home (PCMH) model of care within the Veterans Health Administration (VHA), serving older Veterans with chronic disease, functional dependency, cognitive decline and psychosocial challenges, and/or who have elder abuse, risk for long term care placement, or impending disability. Design: Mixed methods consisting of a national survey and site visits between July 2016 and February 2017. Setting: Veterans Health Administration outpatient clinics. Participants: 101 GeriPACT teams at 44 sites completed surveys and 24 medical providers were interviewed. Measurements: A standardized survey and semi-structured interview guide was developed based on the program handbook with input from experts in the VHA Office of Geriatrics and Extended (GEC) Care guided by the Consolidated Frameworks for Implementation Science. Results: 42.6% of surveyed GeriPACT teams have a mental health provider on the team, either a psychiatrist 28.7% and/or psychologist 23.8%. Of these, a mean full time employee equivalent was .27 FTEE psychiatrist and .44 FTEE psychologist per team (suggested panel =800 patients). In surveys, teams with behavioral health providers were more likely to manage psychosocial 2=8.87, cognitive 2=8.68, and depressive 2=11.85 conditions in their panel than those who do not. Conclusions: Mental health integration is less than 50% in GeriPACT. Population differences between general primary care and geriatric primary care may require different care approaches and provider competencies and needs further study.