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Outcomes of a partnered facilitation strategy to implement primary care-mental health
JoAnn E Kirchner1, Mona J Ritchie, Jeffery A Pitcock
1VA Mental Health Quality Enhancement Research Initiative, North Little Rock, AR, USA, joann.kirchner@va.gov.
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.
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