Repaving the Road: Addressing the Challenges of Conducting Outcome Research

in Primary Care

Stacy Ogbeide, PsyD, MSDavid Bauman, PsyDBridget Beachy, PsyD

Collaborative Family Healthcare Association 16th Annual ConferenceOctober 16-18, 2014 Washington, DC U.S.A.

Session #G5bSaturday, October 18, 2014

Faculty Disclosure

• We have not had any relevant financial relationships during the past 12 months.

Learning Objectives

• 1) At the end of the presentation, participants will understand the importance to conducting and disseminating research in primary care settings;

• 2) At the end of the presentation, participants will understand the challenges that occur with conducting research in primary care as well as ways to address the barriers associated with the research process; and

• 3) At the end of the presentation, participants will gain knowledge in the types of research designs that can be appropriate for primary care

References• Davis, M., Balasubramanian, B. A., Waller, E., Miller, B. F., Green, L. A., & Coben, D. J. (2013).

Integrating behavioral and physical health care in the real world: Early lessons from advancing care together. Journal of the American Board of Family Medicine, 26(5), 588-602.

• Goodie, J. L., Kanzler, K. E., Hunter, C. L., Glotfelter, M. A., & Bodart, J. J. (2013). Ethical and effectiveness considerations with primary care behavioral health research in the medical home. Families, Systems, & Health, 31(1), 86-95. doi: 10.1037/a0031852

• Peek, C. J., Cohen, D. J., deGruy, F. V. (2014). Research and evaluation in the transformation of primary care. American Psychologist, 69(4), 430-442. doi: 10.1037/a0036223

• Ray-Sannerud, B. N., Dolan, D. C., Morrow, C. E., Corso, K. E., Kanzler, K. E., Corso, M. L. ... Bryan, C. J., (2012). Longitudinal outcomes after brief behavioral health intervention in an integrated primary care clinic. Families, Systems, & Health, 30(1), 60-71. doi: 10.1037/a0027029

• Sarris, J., Glick, R., Hoenders, R., Duffy, J., & Lake, J. (2013). Integrative mental healthcare White Paper: Establishing a new paradigm through research, education, and clinical guidelines. Advances in Integrative Medicine, 1-8.

Learning Assessment

• A question and answer period will be conducted at the end of this presentation.

Presentation Objectives

• Introduction• Barriers and challenges• Current strategies and recommendations• Creating flexible research protocols• Disseminating research

Introduction

Cartoon from www.stus.com

Introduction

• Data on integrated primary care behavioral health (PCBH) models– There is research!

• Clinical Indicators– E.g., UDS

• High acuity patients• One important aspect of BHC in PCBH model –

impact on patient’s overall functioning

Ray-Sannerud et al., 2012

Introduction

• Time!• Who will help?• Manpower?• Buy-in?• What research needs to be done?

Goodie, Kanzler, Hunter, Glotfelter, & Bodart, 2013

• Outcome research– Anxiety – Weight management – HTN– Protocols for integrating BHCs

• Integration is intuitive. That alone does not equate with improved patient outcomes

Our experience in integrated research

Barriers and Challenges• Confounds

– Use of medications concurrently with behavioral strategies– Comorbid pathologies – mental and physical

• External vs internal validity– Real world settings

• Recruitment– Organizational buy-in

• Number of visits– Protocol 1-3 visits, mode patient visit is 1 – What about the participants coming to 1 visit?

• Short term vs long term outcomes• How to randomize while still staying true to model?• Rigidity vs flexibility

– If rigid, how it is feasible? If flexible, fidelity?

Davis et al., 2013

An impossible task?

• Biomedical approach vs contextual approach– “Cause and effect” in physical world vs

psychological• “Broken, needs fixed” vs learning to be aware and

accepting of pain that comes in life while engaging in value-congruent behavior

– Measures, how to quantify?• Weight loss, less anxiety, more energy = success?• AAQ?

Robinson, Gould, & Strosahl, 2010; Sarris et al., 2013

Training/Teaching Holistic Health

Clinical Interventions

Assisting PCPs

“Trident” Approach to Integrated Research

Recommended strategies

• Have EMRs? USE IT!– Standardizing quality of life measure and tracking in EMR

• Ability to measure long-term impact

• Measures– Brief– Concern specific AND quality of life– Process measures (may be most important)

• Need buy in from organization – Takes a tribe to complete research in PC– Clear workflow for PCPs, MAs, office administration, etc.

• As close to regular workflow as possible

• All three prongs of the Trident

Flexible research protocols

• Uniqueness of operating in integrated context– Focus on specific concern (e.g., HTN) with goal of improving overall

functioning• Psychoeducation important

– Components vs. standard procedures• Adapting SMH evidence based protocols• Flexible in approach while maintaining philosophy

– Need for process measures

– Transdiagnostic• MI, ACT, 5 A’s

– If we cannot apply the protocol to other concerns, what is the point?

– 15 – 30 minute visits• Keep track of time spent, GREAT DATA

– Change the way we evaluate success

Disseminating Your Work

• Sustainability!• Organizations outside of psychology

– American Academy of Family Physicians– Society of Teachers of Family Medicine– State/County Organizations

• Practice-Based Research Network (PBRN)– Collaborative Care Research Network (CCRN)– Regional Networks as well

Peek, Cohen, & deGruy, 2014

Disseminating Your Work

http://pbrn.ahrq.gov/funding-opportunities/ahrq-pbrn-centers-primary-care-practice-based-research-and-learning

Questions?

Contact:Stacy Ogbeide: stacy.ogbeide@gmail.comDavid Bauman: davidbauman4@gmail.comBridget Beachy: bridget.beachy@gmail.com

Session Evaluation

Please complete and return theevaluation form to the classroom monitor

before leaving this session.

Thank you!