Improving Patient Engagement through Whole Health: Veteran Perspectives on a Values Assessment Tool

Amidst rising rates of costly chronic diseases, a growing emphasis for integrated primary care settings is offering proactive, person-centered, and whole-person care. Through its Whole Health approach, the Veterans Health Administration (VA) is a leading force in this movement. VA’s Whole Health focuses on delivering patient-centered care that engages and empowers Veterans to improve health outcomes. The Personal Health Inventory (PHI) is a brief, whole-person focused, values assessment of what matters most that can lead to personalized health planning. Using a concurrent triangulation (convergent) mixed methods design, we examined the perspectives of 25 post-9/11 Veterans using semi-structured telephone interviews. Qualitative and quantitative questions covered independent PHI completion including acceptability, preferred methods to enhance feasibility (including feedback on a brief introductory overview), and potential impact on healthcare experience. Matrix analysis informed by rapid qualitative analysis was used to analyze responses, and quantitative data were integrated using a joint display. We found that average ratings of acceptability were high across domains for the PHI and independent PHI completion was feasible. The PHI was helpful for prompting reflection and possible action, and highly relevant to what Veterans value in healthcare. Strategies that were identified to improve feasibility and acceptability of independent PHI completion included using the introductory overview piloted with this sample and discussing a completed PHI with the healthcare team. The PHI could help support patient/provider communication and understanding, increase self-awareness and motivation, and help tailor/plan treatment options. Overall, Veterans perceive completion of the PHI as acceptable, feasible, and beneficial. Future directions for research include implementation of the PHI, evaluations of applied use for discussions of what matters most to patients as supported by various members of the integrated primary care team, and expansion to non-VA integrated primary care settings

An Exploration of Self-Reported Training Needs for Anxiety Interventions Among Primary Care Behavioral Health Consultants

Introduction: Despite the need for greater training in evidence-based interventions for the treatment of anxiety in primary care behavioral health (PCBH), there are limited data on which interventions are desired by behavioral healthcare consultants (BHCs). The objective of this study was to identify which interventions BHCs desired more training in when treating anxiety in PCBH practice, and to examine if this preference was associated with theoretical orientation. Method: We conducted an online survey of PCBH providers regarding their training preferences for treatment of anxiety symptoms. The final sample comprised 291 BHCs recruited from e-mail listservs of national professional organizations. Providers reported their primary theoretical orientation as well as the top three interventions they wanted more training in from a list of 17 interventions. Results: BHCs most frequently endorsed training needs for Acceptance and Commitment Therapy (ACT; 63%), mindfulness (43%) and exposure (31%) interventions. Results were independent of theoretical orientation. Discussion: Clear training needs emerged for ACT, mindfulness, and exposure interventions in PCBH. Based on these results, further training should be given to implement these interventions in real world settings. Novel research strategies should also focus on implementing more complex CBT interventions in real-world PCBH settings. These results suggest implications for clinical training, intervention design, and future implementation efforts

Case Report of a Brief Modular Anxiety Intervention for Integrated Primary Care: Addressing Clinician Feasibility Concerns and Barriers to Using Manualized Treatments

Individuals with anxiety symptoms commonly present in primary care settings and prefer behavioral health (versus pharmacotherapy) treatment, but behavioral health interventions are underutilized. Primary care behavioral health (PCBH) models, in which embedded behavioral health providers deliver behavioral treatment in primary care, may help address the gap in provision of anxiety treatment. However, evidence-based anxiety treatment options feasible for delivery in primary care are limited, and clinicians often report concerns about using manualized interventions. Recent recommendations by the U.S. Preventative Services Task Force to increase anxiety screening among adults in primary care may result in increased identification of individuals with anxiety symptoms who may benefit from behavioral anxiety treatment. However, clinicians may be unable to meet the need for behavioral anxiety treatment due to lack of brief, manualized anxiety interventions. This article presents a case report from a pilot randomized controlled trial of an evidence-based, modular anxiety intervention designed for primary care settings. Session-by-session intervention content is described along with patient outcome data. We discuss the course of treatment in relation to commonly cited concerns about using manualized treatments, particularly within the brief treatment format required for efficient PCBH practice. We offer concrete strategies along with illustrative session dialogue to demonstrate successful delivery of an evidence-based, manualized anxiety intervention in primary care and facilitate utilization of this and similar interventions by behavioral health providers

Improving the Quality of Veteran Health Care by Optimizing VA Integrated Primary Care: 20 Years and Beyond of the Center for Integrated Healthcare

Primary care patients often present with mental and behavioral health concerns, such as depression or insomnia, leaving medical teams scrambling. To help fill this gap and increase access to care while aligning with patient preferences, a new service delivery model of integrated care, characterized by embedding behavioral health providers within medical teams, was embraced in a grassroots effort, with the VA being one of the first healthcare systems to implement it throughout all primary care settings. A common challenge to grassroot efforts is the lack of research establishing effectiveness and identifying ways to optimize the innovation’s impact. Innovative VA leaders and Congress recognized integrated care’s promise but also realized the importance of and need for research, training, and implementation support to optimize its success resulting in the creation of the VA Center for Integrated Healthcare (CIH) in 2004. To assist in overcoming the known lengthy timeline of translating research into practice and vice versa, CIH integrated research with training and implementation support through a purposeful and highly collaborative approach impacting both the CIH structure and processes, which contributed to a high level of productivity over the past 20 years helping to optimize evidence-based mental and behavioral health care for Veterans. This article will describe CIH’s successes in bringing evidence-based integrated care practices to over 450,000 Veterans annually and how this novel approach contributed. Exemplars are provided on how internal synergies created more empirical evidence for integrated care and greater utilization of evidence-based practices within integrated care settings

Prospective Receptivity and Acceptability of Brief Alcohol Interventions Among Women and Racial/Ethnic Minority Veterans in Primary Care

Brief alcohol interventions (BAIs) are an evidence-based practice for addressing hazardous drinking among primary care patients, yet implementation of BAIs in practice has been difficult and disparities have been identified regarding implementing BAIs with women and racial/ethnic minority patients. Further, patient engagement is a commonly identified barrier to BAI implementation. This mixed methods study aimed to assess acceptability of BAIs among women and racial/ethnic minority primary care patients and to identify factors that may impact their receptivity to engaging in a BAI. Qualitative interviews were conducted with 17 patients who had screened positive for hazardous alcohol use. Patients reported neutral to positive acceptability ratings regarding BAIs, and qualitative responses yielded 4 main themes for factors that may impact receptivity to BAIs including: (1) delivery of the BAI, (2) patient-centeredness, (3) personal relevance, and (4) relationship with the provider. Results have potential implications for implementation of BAIs in primary care settings

Building Research and Evaluation Into the Collaborative Family Healthcare Association With Intention

In 2013, a bunch of us ran around collecting paper surveys off chairs after a plenary address at the Collaborative Family Healthcare Association\u27s (CFHA) annual conference. From 150 responses, we found that less than a quarter would take the time to attend a workshop about research and evaluation. Fast forward 5 years: The organization showed robust attendance at research and evaluation training sessions, and interest in a preconference had risen to 77%. What prompted this shift? In response to survey findings, the Research and Evaluation Committee (REC), supported by the CFHA, engaged a data-informed and stakeholder-responsive approach to cultivating empiricism within the CFHA. The activities led by the REC demonstrate the need for creativity and leadership in this area and the CFHA\u27s strong. organizational values around such efforts. As past and present leaders in the CFHA\u27s REC initiatives, we write this editorial to make explicit the value of research to the organization and the value of the organization to the evidence base. In addition, we document some key institutional history in this area and, with input from the CFHA\u27s current chief executive officer, Neftali Serrano, and REC chair, Will Lusenhop, forecast a vision for the future. (PsycInfo Database Record (c) 2022 APA, all rights reserved)