ABOUT THIS COLLECTION

The mission of the Center for Integrated Primary Care (CIPC) at UMass Chan Medical School is to develop, synthesize, and disseminate knowledge and skills for evidence-based approaches to integrated primary care and behavioral health services through work force development and practice based research. This collection showcases journal articles and other publications authored by CIPC faculty and researchers.

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Recently Published

  • Patient screening for integrated behavioral health in adult primary care: A rapid review of effective procedures

    Martin, Matthew P.; McEntee, Mindy L.; Mullin, Daniel J.; Suri, Yash; van Eeghen, Constance (2022-06-02)
    PURPOSE: Although many primary care clinics screen for behavioral health (BH) conditions using validated tools, it is not clear whether adult BH screening leads to better patient outcomes. Our objective was to determine the evidence base by reviewing effectiveness research for multiple strategies of BH screening in adult primary care identified in the Practice Integration Profile. METHOD: We conducted five rapid reviews of effectiveness research supporting BH screening strategies cited in the Practice Integration Profile. Each rapid review was conducted using an adapted REAL (Rapid Evidence Assessment of the Literature) methodology and a standardized search tailored for each screening strategy to identify evidence related to BH screening in primary care. RESULTS: The database search yielded 931 references. Following eligibility review and extraction, we evaluated data from 20 references examining five screening strategies. Results demonstrated limited support for all five strategies and high risk of bias within most studies. Outcomes associated with various BH screening strategies were rarely the focus of study. CONCLUSIONS: There is an absence of robust, well-structured evidence supporting many of the BH screening strategies advocated for in primary care. Stakeholders may wish to understand how to ensure value when developing a robust screening program that will improve patient health outcomes. Future research should advance the science of BH screen selection, timing, and implementation by answering new questions about screening strategies.
  • Our Whole Lives for Hypertension and Cardiac Risk Factors-Combining a Teaching Kitchen Group Visit With a Web-Based Platform: Feasibility Trial

    Gardiner, Paula; McGonigal, Lisa; Villa, Ariel; Kovell, Lara C.; Rohela, Pallavi; Cauley, Andrew; Rinker, Diana; Olendzki, Barbara C. (2022-05-16)
    BACKGROUND: Hypertension (HTN) affects millions of Americans. Our Whole Lives: an eHealth toolkit for Hypertension and Cardiac Risk Factors (OWL-H) is an eHealth platform that teaches evidence-based lifestyle strategies, such mindfulness and cooking skills, to improve self-management of HTN. OBJECTIVE: The primary goal of this pilot study was to evaluate the feasibility of OWL-H combined with teaching kitchen medical group visits (TKMGVs) in a low-income population of participants with HTN. METHODS: We conducted a pre-post 8-week study to assess the feasibility of a hybrid program (a web-based 9-module self-management program, which includes mindfulness and Mediterranean and Dietary Approaches to Stop Hypertension diet) accompanied by 3 in-person TKMGVs among patients with HTN. Data including demographics, platform use, and satisfaction after using OWL-H were examined. Outcome data collected at baseline and 8 weeks included the Mediterranean Diet Questionnaire, Hypertension Self-Care Profile Self-Efficacy Instrument, Blood Pressure Knowledge Questionnaire, and the number of self-reported blood pressure readings. For the statistical analysis, we used descriptive statistics, paired sample t tests (1-tailed), and qualitative methods. RESULTS: Of the 25 enrolled participants, 22 (88%) participants completed the study. Participants' average age was 57 (SD 12.1) years, and 46% (11/24) of them reported a household income < US $30,000 per year. Among the 22 participants who logged in to OWL-H, the average number of mindfulness practices completed was 7 and the average number of module sessions accessed was 4. In all, 73% (16/22) of participants reported that they were "very satisfied" with using OWL-H to help manage their HTN. Participants' blood pressure knowledge significantly increased from baseline (mean 5.58, SD 1.44) to follow-up (mean 6.13, SD 1.23; P=.03). Participants significantly increased their adherence to a Mediterranean diet from baseline (mean 7.65, SD 2.19) to follow-up (mean 9, SD 1.68; P=.004). Participants' self-efficacy in applying heart-healthy habits, as measured by the Hypertension Self-Care Profile Self-Efficacy Instrument, increased from baseline (mean 63.67, SD 9.06) to follow-up (mean 65.54, SD 7.56; P=.14). At the 8-week follow-up, 82% (18/22) of the participants had self-reported their blood pressure on the OWL-H platform at least once during the 8 weeks. CONCLUSIONS: The eHealth platform for HTN self-management, OWL-H, and accompanying in-person TKMGVs have the potential to effectively improve lifestyle management of HTN. TRIAL REGISTRATION: ClinicalTrials.gov NCT03974334; https://clinicaltrials.gov/ct2/show/NCT03974334.
  • Prevention of psychological trauma among health care providers during the COVID-19 pandemic

    Mullin, Daniel J.; Pearson, Sarah; Eisdorfer, Ethan; Mullarkey, Jenna; Dykhouse, Elizabeth C. (2021-09-01)
    The COVID-19 pandemic presented unique biological, psychological, and social threats to health care providers. The failure of local macrosystems placed providers at elevated risk of psychological and physical harm. To reduce the immediate risk of trauma to our local physician workforce, our team initiated a program of proactive psychological first aid in which physicians were regularly contacted by behavioral health colleagues to assess safety conditions and physician's well-being. When threats to the physician's safety were identified, these concerns were escalated to leadership and addressed when possible. When threats to well-being were identified, behavioral health team members provided supportive listening, and, if indicated, provided referral information for appropriate treatment resources. This paper reviews the rationale for this program, addresses ethical concerns, and proposes future directions for responding to threats to safety during events such as the COVID-19 pandemic.
  • An Innovative Electronic Health Toolkit (Our Whole Lives for Chronic Pain) to Reduce Chronic Pain in Patients With Health Disparities: Open Clinical Trial

    Gardiner, Paula; D'Amico, Salvatore; Luo, Man; Haas, Niina (2020-03-30)
    BACKGROUND: Chronic pain affects millions of Americans. Our Whole Lives, an electronic health (eHealth) toolkit for Chronic Pain (Our Whole Lives for Chronic Pain [OWLCP]), is a mind-body chronic pain management platform that teaches self-management strategies to reduce pain impact and pain medication use. OBJECTIVE: The primary goal of this study was to evaluate the feasibility of OWLCP in reducing pain impact and pain-related outcomes. METHODS: We conducted a pre-post clinical study (2 cohorts) to assess the feasibility of OWLCP usage among low-income patients with chronic pain. Outcome data, collected at baseline and 9 weeks, included Patient-Reported Outcomes Measurement Information System (PROMIS-29), pain self-efficacy, and pain medication use. In the statistical analysis, we used descriptive statistics, logistic regression, linear regression, and qualitative methods. RESULTS: Among the enrolled 43 participants, the average age was 50 years, (39/43) 91% were female, (16/43) 37% were black, and (7/43) 16% were Hispanic. From baseline to follow-up, the PROMIS measures showed a reduction in depression (P=.02), pain interference (P=.003), and average pain impact score (P=.007). Pain self-efficacy increased ((P < .001), whereas opioid use had a 13% reduction (P=.03). CONCLUSIONS: The eHealth chronic pain management platform, OWLCP, is a potential tool to reduce the impact of chronic pain for low-income racially diverse populations.
  • Getting It Off the Ground: Key Factors Associated With Implementation of Wellness Programs

    Penwell-Waines, Lauren; Cronholm, Peter F.; Brennan, Julie; Romain, Amy; Runyan, Christine; Buck, Katherine; Fazio, Lindsay; Grace, Aaron; Ricker, Mari; Ross, Valerie; et al. (2020-03-01)
    BACKGROUND AND OBJECTIVES: Many residency programs are developing resident wellness curricula to improve resident well-being and to meet Accreditation Council for Graduate Medical Education guidelines. However, there is limited guidance on preferred curricular components and implementation. We sought to identify how specific driving factors (eg, having an identified wellness champion with a budget and protected time to develop wellness programs) impact implementation of essential elements of a resident wellness curriculum. METHODS: We surveyed 608 family medicine residency program directors (PDs) in 2018-2019 on available resources for wellness programs, essential wellness elements being implemented, and satisfaction with wellness programming; 251 PDs provided complete responses (42.5% response rate). Linear and logistic regressions were conducted for main analyses. RESULTS: Having an identified wellness champion, protected time, and dedicated budget for wellness were associated with greater implementation of wellness programs and PD satisfaction with wellness programming; of these, funding had the strongest association. Larger programs were implementing more wellness program components. Program setting had no association with implementation. CONCLUSIONS: PDs in programs allocating money and/or faculty time can expect more wellness programming and greater satisfaction with how resident well-being is addressed.
  • Burnout among behavioral health providers in integrated care settings

    Zubatsky, Max; Runyan, Christine; Gulotta, Samantha; Knight, Jeanna R.; Pettinelli, J. Douglas (2019-12-02)
    INTRODUCTION: Burnout in health care, especially among physicians, is a growing concern. It is now well accepted that physician burnout leads to increased depersonalization of patients, lower personal accomplishment, employee turnover, and worse patient outcomes. What is not known, however, is to what extent behavioral health providers (BHPs) in medical settings experience burnout and its associated sequela. METHOD: Participants (n = 230) from a variety of practice settings and levels of integrated care completed practice and burnout questions via an online survey. Practice-related questions and a modified version of the Maslach Burnout Inventory was administered to BHPs who work in different levels of collaboration with other medical providers. RESULTS: Overall, BHPs who work primarily in fully integrated care settings reported higher rates of personal accomplishment in their everyday job (B = 1.49; 95% confidence interval [CI] = 0.40, 2.58). Additionally, those who have worked more than 10 years in these types of settings reported both higher personal accomplishment (B = 1.58; 95% CI = 0.68, 2.49) and lower rates of depersonalization (B = -1.32; 95% CI = -2.28, -0.36). DISCUSSION: In contrast to high rates of burnout among many clinicians in the United States, this is the first study to document relatively low rates of reported burnout among integrated care BHPs. The relationships between lower burnout, working in a fully integrated care practice, and experience as a BHP is important to understand when creating and sustaining team-based primary care jobs.
  • Natural Health Product-Drug Interaction Causality Assessment in Pediatric Adverse Event Reports Associated with Attention-Deficit/Hyperactivity Disorder Medication

    Mazhar, Hajra; Foster, Brian C.; Necyk, Candace; Gardiner, Paula M.; Harris, Cory S.; Robaey, Philippe (2019-11-22)
    Background: Some pediatric patients with attention-deficit/hyperactivity disorder (ADHD) use natural health products (NHPs) such as herbal remedies. Although herbal remedies are generally considered to be safe when they are used appropriately, they may contain active components that can interact with medications being used concurrently, with potential for NHP-drug interactions leading to adverse events. Objectives: The objectives of this study were (1) to identify adverse event reports (AERs) involving commonly used herbal remedies and ADHD prescription medicines in children and adolescents; (2) to evaluate the quality of collected AERs; and (3) to assess whether NHP-drug interactions can be causally linked to reported adverse events. Methods: We systematically searched the FDAble database (FDAble.com) for herbal remedies commonly used by patients (4-18 years old) also taking ADHD drugs from 1997 to 2015. We assessed the completeness of the AERs and used three causality assessment tools modified for NHPs (Naranjo Adverse Drug Reaction Probability Scale, HORN Drug Interaction Probability Scale, and World Health Organization Uppsala Monitoring Centre Scale). Results: Of the 23 identified AERs involving both an herbal remedy and an ADHD prescription medication, most involved multiple (>3) substances with inadequate detail to assess multiple potential interactions. Following data extraction and evaluation of completeness, five AERs involving only one herbal remedy and one ADHD medication were evaluated for causality. An NHP-drug interaction was assessed to be probable in one case and to be possible in another. Both these reports involved a methylphenidate formulation and St. John's wort. Conclusions: Eighteen of the 23 identified AERs involving both an herbal remedy and an ADHD drug also involved other multiple ingredient products. The reporting quality was poor for the five AERs examined. Further research is needed to study the interaction between St. John's wort and methylphenidate.
  • Blood Lead Levels of Children Using Traditional Indian Medicine and Cosmetics: A Feasibility Study

    Keosaian, Julia; Venkatesh, Thuppil; D'Amico, Salvatore; Gardiner, Paula; Saper, Robert (2019-08-22)
    Background: Traditional Indian cosmetics and Ayurvedic medicines may contain lead. Previous studies have shown a relationship between eye cosmetic use (kohl) in children and elevated blood lead levels (BLLs) > 10 microg/dL. However, an association between Ayurvedic use and elevated BLLs in children is unknown and understudied. Methods: We assessed the feasibility of collecting BLLs in children attending Ayurvedic outpatient settings in India. Our pilot study took place over 3 days in the summer of 2010 at a large public Ayurveda hospital and a small pediatric clinic in southern India. Using a trained interpreter, we administered a standardized questionnaire in Malayalam, assessing sociodemographics, Ayurvedic medicine use, kohl use, and other potential risk factors for lead exposure, to parents of pediatric outpatients. We also analyzed BLLs using a portable lead analyzer. Results: The study enrolled 29 children (mean age, 3.8 years). The mean BLL was 6.7 microg/dL (SD = 3.5; range, 3.5-20.2). Seventy-two percent of the children used Ayurvedic medicine in the past 2 years and 55% reported kohl use. Mean BLL of Ayurvedic users and nonusers was 6.2 microg/dL and 8.5 microg/dL, respectively (P = .08). Kohl users had a statistically significant higher BLL than nonusers (8.0 microg/dL vs 5.3 microg/dL, P = .03). Conclusions: It is feasible to collect BLLs in pediatric Ayurvedic outpatient clinics in southern India. Collaborative relationships with community members and hospital staff were essential. Further research is needed to investigate Ayurveda and kohl use as risk factors for elevated lead burden among Indian children.
  • Feasibility and Acceptability of Mindfulness-Based Group Visits for Smoking Cessation in Low-Socioeconomic Status and Minority Smokers with Cancer

    Charlot, Marjory; D'Amico, Salvatore; Luo, Man; Gemei, Ahmed; Kathuria, Hasmeena; Gardiner, Paula (2019-07-16)
    Objective: Smoking cessation studies tailored for low-income and racial/ethnic minority cancer patients are limited. African American and low-socioeconomic status (SES) smokers have higher cancer mortality rates and are less likely to use evidence-based smoking cessation treatments compared with white and higher SES counterparts. Mindfulness training is a promising approach to address racial and SES disparities in smoking cessation. The authors assessed the feasibility and acceptability of a mindfulness-based smoking cessation (MBSC) medical group visit for low-income and racially diverse smokers with cancer. Design and intervention: The authors adapted the integrative medical group visit model used for chronic pain and included the You Can Quit smoking cessation curriculum used at the study site, Tobacco Treatment Center. The program was conducted in eight weekly 2-h visits. The authors then tested the feasibility and acceptability of this intervention for actively smoking cancer patients and cancer survivors in two pilot groups (N = 18) using a pre-post design. Setting/Location: This study took place at Boston Medical Center, a large urban safety net academic teaching hospital. Outcome measures: The authors used a medical group visit intake form to collect data on weekly cigarette intake and home practice. They also gathered additional qualitative data from focus groups and in-depth interviews. Results: Over 50% of participants (n = 10) self-identified as black and 56% reported an annual income of $20,000 or less. Over two-thirds of the participants attended four or more of the eight group visits. There was a significant decrease in weekly cigarette intake from 75.1 cigarettes at baseline to 44.3 at 3 months (p = 0.039). None of the participants quit smoking. Participants were satisfied with the program and reported positive lifestyle changes. Conclusion: MBSC group visits are feasible and acceptable among racially diverse and low-SES smokers with cancer and should be further studied in a larger cohort.
  • Improving Access, Integration, and Sustainability: A Reflective Overview of the Special Issue on Innovation in Group-Delivered Services

    Gardiner, Paula; Chao, Maria; Burnett, Marena (2019-07-16)
    The theme of appropriate access of care is a major consideration in all efforts toward health care reform. When one considers the appropriate use of integrative health practices and practitioners, the theme of access has particular resonance. Even in areas such as pain management and cancer treatment where a quality evidence base for their use has accrued, insurers rarely cover. Those who cannot pay cash are typically denied what may be their optimal treatment.
  • Making Sense of Family Medicine Resident Wellness Curricula: A Delphi Study of Content Experts

    Penwell-Waines, Lauren; Runyan, Christine; Kolobova, Irina; Grace, Aaron; Brennan, Julie; Buck, Katherine; Ross, Valerie; Schneiderhan, Jill (2019-07-02)
    BACKGROUND AND OBJECTIVES: The Association of Family Medicine Residency Directors (AFMRD) Physician Wellness Task Force released a comprehensive Well-Being Action Plan as a guide to help programs create a culture of wellness. The plan, however, does not offer a recommendation as to which elements may be most important, least resource intensive, or most feasible. This study sought to identify the most essential components of the AFMRD's Well-Being Action Plan, as rated by expert panelists using a modified Delphi technique. METHODS: Sixty-eight selected experts were asked to participate; after three rounds of surveys, the final sample included 27 participants (7% residents, 38% MD faculty, 54% behavioral science faculty). RESULTS: Fourteen elements were rated as essential by at least 80% of the participants. These components included interventions at both the system and individual level. Of those elements ranked in the top five by a majority of the panel, all but one do not mention specific curricular content, but rather discusses the nature of a wellness curriculum. CONCLUSIONS: The expert consensus was that an essential curriculum should begin early, be longitudinal, identify a champion, and provide support for self-disclosure of struggles.
  • Lessons Learned and Strategies for Recruitment of Diverse, Low-income Patients into an Integrative Medical Group Visit Clinical Trial

    Gardiner, Paula; Lestoquoy, Anna Sophia; Negash, N. Lily; Luo, Man; Gergen-Barnett, Katherine; Saper, Robert; Penti, Brian; White, Laura F.; Liebschutz, Jane M. (2019-05-06)
    OBJECTIVE: Description of recruitment methods and lessons learned in a randomized controlled trial of underserved patients using an integrative medical group visits intervention. METHODS: Comparison of the demographic characteristics of participants screened and consented to the study as well as description of recruitment methods used. OUTCOME MEASURES: This paper examines the characteristics of patients who were eligible compared to those who were not, characteristics of patients at the different sites, and patient characteristics over time (by comparing various cohorts) based on our experiences recruiting underserved patients. RESULTS: We screened 338 patients, with 205 (60.6%) meeting eligibility criteria and 159 patients randomized and consented. 133 patients were found ineligible, with the most common reasons being low depression scores (n=20), manic symptoms (n=20), and psychotic symptoms (n=19), and alcohol use (n=15). We found demographic differences in patients recruited by different methods and at different sites- patients referred by provider letter were older than those referred by self-referral or provider referral (mean age/SD vs. mean age/SD, p=0.0001). For site-specific differences, patients at DH were older (53 SD=12.3) than those at the Boston Medical Center (49 SD=11.3) and CSHC (p=0.048) in pair-wise comparisons. Patients at DH were also more likely to be white (25%) as compared to BMC (18%) and DH (7%), while those at CSHC were more likely to be black (70%) (p=0.008).
  • Characteristics and Components of Medical Group Visits for Chronic Health Conditions: A Systematic Scoping Review

    Parikh, Manasi; Rajendran, Iniya; D'Amico, Salvatore; Luo, Man; Gardiner, Paula (2019-04-04)
    OBJECTIVES: Chronic health conditions are a major challenge to the health care system. Medical Group Visits (MGVs) are a valuable health care delivery model used in a variety of medical settings and patient populations. We conducted a systematic scoping review of MGV research literature for chronic health conditions to summarize the characteristics and individual components of MGVs in the United States of America and Canada. DESIGN: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses scoping review methodology and searched five databases using nine widely used MGV-related terms. SUBJECTS: We included studies conducted in the United States and Canada, whose participants were > 18 years old and attended an MGV conducted in a medical setting by a billable health care provider. We excluded groups related to diabetes, pregnancy, and cancer. RESULTS: Of 3777 studies identified, we found 55 eligible studies of which 9 are randomized controlled trials and 46 are observational studies. The majority of studies were conducted in academic medical centers, were observational in design, and recruited patients using physician referrals. The three most frequently studied groups include a combination of several chronic conditions (n = 12), chronic pain conditions (n = 10), and cardiovascular disease (n = 9). Curriculum components included didactics (n = 55), experiential activities (n = 27), and socializing components (n = 12). Didactic areas include (1) medical topics such as symptoms management (n = 27) of which 14 included pain management, and (2) lifestyle/educational component (n = 33) that comprised of talks on nutrition (n = 29), exercise (n = 20), stress (n = 16), and sleep (n = 10). The top integrative medicine (IM) modalities (n = 13) included: mindfulness techniques (n = 8), meditation (n = 6), and yoga (n = 5). Substantial heterogeneity was observed in the recruitment, implementation, curriculum components, and outcomes reported. CONCLUSION: The MGV is a model of patient-centered care that has captured the attention of researchers. IM modalities are well represented in the curriculum components of MGVs. Further investigation into the components identified by this study, may help in better targeting of group interventions to patients and contexts, where it is most likely to be effective.
  • Measuring the integration of primary care and behavioral health services

    Mullin, Daniel J.; Hargraves, J. Lee; Auxier, Andrea; Brennhofer, Stephanie A; Hitt, Juvena R; Kessler, Rodger S.; Littenberg, Benjamin; Macchi, C. R.; Martin, Matthew; Rose, Gail; et al. (2019-04-01)
    OBJECTIVE: To perform a factor analysis of the Practice Integration Profile (PIP), a 30-item practice-level measure of primary care and behavioral health integration derived from the Agency for Healthcare Research and Quality's Lexicon for Behavioral Health and Primary Care Integration. DATA SOURCES: The PIP was completed by 735 individuals, representing 357 practices across the United States. STUDY DESIGN: The study design was a cross-sectional survey. An exploratory factor analysis and assessment of internal consistency reliability via Cronbach's alpha were performed. DATA COLLECTION METHODS: Participant responses were collected using REDCap, a secure, web-based data capture tool. PRINCIPAL FINDINGS: Five of the PIP's six domains had factor loadings for most items related to each factor representing the PIP of 0.50 or greater. However, one factor had items from two PIP domains that had loadings >0.50. A five-factor model with redistributed items resulted in improved factor loadings for all domains along with greater internal consistency reliability (>0.80). CONCLUSIONS: Five of the PIP's six domains demonstrated excellent internal consistency for measures of health care resources. Although minor improvements to strengthen the PIP are possible, it is a valid and reliable measure of the integration of primary care and behavioral health.
  • Essential Skills for Family Medicine Residents Practicing Integrated Behavioral Health: A Delphi Study

    Martin, Matt; Allison, Leslie; Banks, Elizabeth; Bauman, David; Harsh, Jennifer; Hewitt, Amber L.; Myerholtz, Linda; Zubatsky, Max; Mauksch, Larry (2019-03-01)
    BACKGROUND AND OBJECTIVES: There are several trends compelling physicians to acquire team-based skills for interprofessional care. One underdeveloped area of team-based skills for physicians is integrated behavioral health (IBH) in primary care. We used a Delphi method to explore what skills were needed for residents to practice integrated behavioral health. METHODS: We conducted a literature review of IBH competencies and found 41 competencies across seven domains unique to physicians. Using a modified Delphi technique, we recruited family medicine educators to rate each competency as "essential," "compatible," or "irrelevant." We also shared findings from the Delphi study with a focus group for additional feedback. RESULTS: Twenty-one participants (12 physicians, nine behavioral health providers) completed all three rounds of the Delphi survey resulting in a list of 21 competencies. The focus group gave additional feedback. CONCLUSIONS: Participants chose skills that required physicians to share responsibilities across the entire care team, were not redundant with standard primary care, and necessitated strong communication ability. Many items were revised to reflect team-based care and a prescribed physician role as a team facilitator. Next steps include determining how these competencies fit with a variety of medical providers and creating effective training programs that develop competency in IBH.
  • Health Disparities in Access to Nonpharmacologic Therapies in an Urban Community

    Cheng, Teresa; D'Amico, Salvatore; Luo, Man; Lestoquoy, Anna Sophia; Yinusa-Nyahkoon, Leanne; Laird, Lance D.; Gardiner, Paula (2019-01-01)
    OBJECTIVE: The overuse of prescription opioids for chronic pain is recognized as a public health crisis. Yet, poor access to nonpharmacologic treatments is the norm in low-income, racially and ethnically diverse patients with chronic pain. The main objective of this study was to understand how chronic pain impacts low-income individuals with chronic pain and their communities from multiple perspectives. DESIGN: This was a qualitative study using a Science Cafe methodology. SETTING: The Science Cafe event was held at an urban community center in Boston, MA. SUBJECTS: Inclusion criteria included the following: having the ability to attend the event, being at least 18 years of age or older, and participating in English. METHODS: Data were collected through self-reported questionnaires and audio or video recordings of two focus groups. Quantitative and qualitative data were analyzed with SAS 9.3 and NVivo 10. RESULTS: Thirty participants attended the Science Cafe event. The average age was 45 years, 77% reported as female, 42% identified as black, and 19% as Hispanic. Participants identified themselves as either patients (46%) or providers (54%) to the chronic pain community. Our forum revealed three major themes: (1) nonpharmacologic options for chronic pain management are warranted, (2) larger sociodemographic and contextual factors influence management of chronic pain, and (3) both patients and providers value the patient-provider relationship and acknowledge the need for better communication for patients with chronic pain. CONCLUSIONS: Future research should consider identifying and addressing disparities in access to nonpharmacologic treatments for chronic pain in relation to underlying social determinants of health, particularly for racially and ethnically diverse patients.
  • Assessing social determinants of health in primary care: Liability or opportunity

    Runyan, Christine (2018-12-01)
    Health care is never boring. It changes rapidly based on political winds, financial models, novel terminology, and biomedical advances. In the past decade, there has been large-scale implementation of integrated health care, routine screening for common behavioral health conditions, and the rollout of alternative payment models in primary care. However, even before these advances have been inculcated as the standard of care, we are now witnessing the implementation of health coaches and recommendations to screen for social determinants of health. Social determinants of health (SDOHs) include nonclinical factors that impact health, such as income, education, and the social the conditions in which people are born, grow, live, work and age. While there is strong evidence that health outcomes are only marginally determined by direct clinical care and largely determined, it is unclear what "system of care" (public health vs. medical care) bears the responsibility of identifying and addressing these issues. Is this really the responsibility and role of primary care? Whether we as a health care system decide that systematically asking about and addressing SDOHs is within our job descriptions remains to be seen. Further research is needed to determine the cost and clinical impact of screening and addressing SDOHs.
  • Integrated primary care could play a starring role in the Amazon-JP Morgan-Buffet health care enterprise

    Runyan, Christine (2018-09-01)
    Earlier this year, Amazon, J. P. Morgan, and Berkshire Hathaway announced plans to launch a joint health care company with more than a million covered lives. Dr. Atul Gawande, the prominent Boston-based surgeon and health care thought leader, will become the first chief executive officer of this health care venture, with a mission to get the best results at the lowest costs and remain free from profit-making incentives and constraints. In this presidential column, the author explores what this has to do with the mission in the Collaborative Family Health care Association (CFHA) and the promulgation of integrated health care.
  • A cross-sectional review of the prevalence of integrative medicine in pediatric pain clinics across the United States

    Bodner, Kristen; D'Amico, Salvatore; Luo, Man; Sommers, Elizabeth; Goldstein, Laura; Neri, Caitlin; Gardiner, Paula (2018-06-01)
    PURPOSE: This project assesses the prevalence of integrative medicine (IM) in pediatric pain clinics (PPCs) across the United States. METHODS: PPCs were identified through the American Pain Society and cross referenced through the International Association for the Study of Pain (IASP). A cross-sectional review using each PPC's website was then utilized for further information. We collected data regarding each program's target population, non-profit status (where non-profits were designated as hospitals that do not operate for-profit purpose, and private as institutions receiving private funding), location, services provided and participating providers. Descriptive statistics were used for data analysis. RESULTS: Of the 53 PPCs identified, 43 (81%) were part of a non-profit healthcare organization, and 10 (19%) were within a private hospital; 85% were located in urban settings, 15% in rural settings; 83% were located in free-standing children's hospitals. Thirty-two (60%) PPCs utilized IM, including acupuncture (38%), mind-body (21%), massage (21%), aromatherapy (19%), nutrition counseling (17%) and/or art/music therapy (11%). The most prevalent providers within PPCs offering IM were yoga instructors (84%), nutritionists (56%) and mind-body specialists (44%). IM was offered in 63% of programs in non-profit organizations and 50% in private hospitals; 58% of urban sites and 75% of rural sites. Within each region, 91% (n=10) of PPCs in the West offer IM, 53% of PPCs in the Midwest (n=10) and Northeast (n=8) offer IM and 50% (n=4) of PPCs in the South offer IM compared to PPCs who do not. CONCLUSIONS: Of 53 current identified PPCs, over half offer IM services. While children in the US are more likely to find a PPC offering IM services, access to do so is more limited in rural and southern regions.
  • Dissolving the dichotomy in health and healthcare

    Runyan, Christine (2018-06-01)
    The New England Journal of Medicine Catalyst recently published an article entitled "It's Time to Treat Physical and Mental Health With Equal Intent" (Compton-Phillips and Mohta, 2018). The article describes a survey of the NEJM Catalyst Insights Council, a qualified group (n=565) of U.S. executives, clinical leaders, and clinicians who are directly involved in health care delivery. Ninety nine percent of council members responded that mental health should not only be integrated into ambulatory medical care settings but also embrace a "shared concept of mutual responsibility" (p. 11). As a long-time clinician, educator, and advocate for integrated care, Runyan was so pleased to see this dogmatic statement in a New England Journal of Medicine publication. Labeling disease as either physical or emotional has never served the individual well and may further exacerbate existing stigma and reluctance to seek the most appropriate services. Runyan argues it is time to use intentional language to avoid deconstructing physical and mental health in our discourse or be complicit when others dichotomize measurement and funding. Runyan challenges leaders and aspiring leaders in the field of integrated care to use language and advocate for measures that blur, if not dissolve, this unhelpful and artificial dichotomy.

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