Doctor of Nursing Practice Program

• Committee Chair Name & Credentials:
  Michele Martens, DNP, RN
• Committee Member Name & Credentials:
  Abby Parish, DNP, AGPCNP-BC, GNP-BC, FNAP

DNP Project Abstract

Implementation of Standardized Communication: An Intervention for the Integration of Behavioral Health at a Patient-Centered Medical Home

Purpose
The aim of this project was to further improve the integration of behavioral health at a patient centered-medical home (PCMH) through increasing the frequency of electronic communications and warm handoffs from primary care providers (PCPs) to behavioral health providers with a decision-making tool.

Methods
Validated survey data was collected from 15 out of 18 (83.33%) PCPs pertaining to practice data, utilization of depression treatment tools, and self-efficacy when delivering mental health care. One educational session was held to disseminate and discuss how to use the decision tool. The tool assists PCPs with determining treatment steps, utilizing electronic consultations with behavioral health, and arranging referrals for ongoing treatment. Data was queried regarding the number of collaborative contacts between primary care and behavioral health. Six individual feedback interviews were held with PCPs.

Results
All of providers surveyed (100%) utilized rating scales including the PHQ-9 and GAD-7 in their practice to screen and monitor symptoms. Notably, a low level of confidence was expressed with conversing with a psychiatric specialist regarding the management of bipolar affective disorder (x̅=6.8 out of 10), acute suicidality (x̅=5.533 out of 10), and the diagnosing (x̅=4.867 out of 10) and management of bipolar disorder (x̅=3.267 out of 10). In the two months following the intervention, the frequency of collaborative contacts increased from 2.09 to 4.87 times weekly. A content analysis for the feedback sessions revealed the benefits of e-consults and warm handoffs for improving treatment guidance and increasing provider confidence.

Implications for Practice
This project showed the feasibility of increasing the frequency of electronic communications and coordination between primary care and behavioral health providers through the implementation of a decision-making tool. This project exhibited clear evidence for future initiatives to improve collaboration between primary care and behavioral health at the PCMH and other integrated sites.