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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
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1 to 25 of 71 Research Studies Displayed
Wright JH, Owen J, Eells TD
Effect of computer-assisted cognitive behavior therapy vs usual care on depression among adults in primary care: a randomized clinical trial.
Computer-assisted cognitive behavior therapy (CCBT) has been proposed as a method for improving access to effective psychotherapy, reducing cost, and increasing the convenience and efficiency of treatment for depression. The purpose of this study was to evaluate whether clinician-supported CCBT is more effective than treatment as usual (TAU) in primary care patients with depression and to examine the feasibility and implementation of CCBT in a primary care population with substantial numbers of patients with low income, limited internet access, and low levels of educational attainment.
AHRQ-funded; HS024047.
Citation:
Wright JH, Owen J, Eells TD .
Effect of computer-assisted cognitive behavior therapy vs usual care on depression among adults in primary care: a randomized clinical trial.
JAMA Netw Open 2022 Feb;5(2):e2146716. doi: 10.1001/jamanetworkopen.2021.46716..
Keywords:
Depression, Behavioral Health, Primary Care, Treatments, Comparative Effectiveness
Zittleman L, Curcija K, Nease DE
Increasing capacity for treatment of opioid use disorder in rural primary care practices.
Evidence supports treatment for opioid use disorder (OUD) with buprenorphine in primary care practices (PCPs). Barriers that slow implementation of this treatment include inadequately trained staff. This study aimed to increase the number of rural PCPs providing OUD treatment with buprenorphine. This evaluation described the impact of a practice team training on the implementation and delivery of OUD treatment with buprenorphine in PCPs of rural Colorado.
AHRQ-funded; HS025065.
Citation:
Zittleman L, Curcija K, Nease DE .
Increasing capacity for treatment of opioid use disorder in rural primary care practices.
Ann Fam Med 2022 Jan-Feb;20(1):18-23. doi: 10.1370/afm.2757..
Keywords:
Opioids, Rural Health, Primary Care, Substance Abuse, Behavioral Health, Training, Implementation, Medication
Tobin JN, Cassells A, Weiss E
Integrating cancer screening and mental health services in primary care: protocol and baseline results of a patient-centered outcomes intervention study.
AHRQ-funded; HS021667.
Citation:
Tobin JN, Cassells A, Weiss E .
Integrating cancer screening and mental health services in primary care: protocol and baseline results of a patient-centered outcomes intervention study.
J Health Care Poor Underserved 2021;32(4):1907-34. doi: 10.1353/hpu.2021.0173..
Keywords:
Patient-Centered Healthcare, Cancer, Behavioral Health, Primary Care, Depression, Women, Screening
Jonas DE, Barclay C, Grammer D
The STUN (STop UNhealthy) Alcohol Use Now trial: study protocol for an adaptive randomized trial on dissemination and implementation of screening and management of unhealthy alcohol use in primary care.
This paper describes a randomized, controlled trial to evaluate the effect of primary care practice facilitation and telehealth services on evidence-based screening, counseling, and pharmacotherapy for unhealthy alcohol use in primary care practices in North Carolina with 10 or fewer providers. The study will produce important evidence about the effect of practice facilitation on uptake of evidence-based screening, counseling, and pharmacotherapy for unhealthy alcohol use when delivered on a large scale to small and medium-sized practices. The results of this rigorously conducted evaluation are expected to have a positive impact by accelerating the dissemination and implementation of evidence related to unhealthy alcohol use into primary care practices.
AHRQ-funded; HS027078.
Citation:
Jonas DE, Barclay C, Grammer D .
The STUN (STop UNhealthy) Alcohol Use Now trial: study protocol for an adaptive randomized trial on dissemination and implementation of screening and management of unhealthy alcohol use in primary care.
Trials 2021 Nov 16;22(1):810. doi: 10.1186/s13063-021-05641-7..
Keywords:
Alcohol Use, Substance Abuse, Behavioral Health, Primary Care, Screening, Implementation
Sussman AL, Crawford JN, Brakey HR
Use of a benchmark tracking assessment to support expansion of buprenorphine for treatment of opioid use disorder in primary care.
Barriers to the expansion of opioid use disorder (OUD) treatment in primary care using buprenorphine are well documented. Providers require support along a continuum. A systematic tracking framework to enhance provider progress along this continuum is lacking. The investigators developed a benchmark tracking assessment (BTA) as part of data collection in a 5-year study to examine the impact of provider participation in an online intervention to support expansion of buprenorphine treatment for OUD in rural primary care.
AHRQ-funded; HS025345.
Citation:
Sussman AL, Crawford JN, Brakey HR .
Use of a benchmark tracking assessment to support expansion of buprenorphine for treatment of opioid use disorder in primary care.
J Am Board Fam Med 2021 Nov-Dec;34(6):1216-20. doi: 10.3122/jabfm.2021.06.210111..
Keywords:
Opioids, Primary Care, Medication, Substance Abuse, Behavioral Health
Luo Z, Gritz M, Connelly L
A survey of primary care practices on their use of the intensive behavioral therapy for obese Medicare patients.
The objective of this study was to fill the gap in knowledge on systematic differences between primary care practices (PCP) that do or do not provide intensive behavioral therapy (IBT) for obese Medicare patients. The investigators concluded that although the Centers for Medicare and Medicaid Services established payment codes for PCPs to deliver IBT for obesity in 2011, very few providers submitted fee-for-service claims for these services after almost 10 years.
AHRQ-funded; HS024843.
Citation:
Luo Z, Gritz M, Connelly L .
A survey of primary care practices on their use of the intensive behavioral therapy for obese Medicare patients.
J Gen Intern Med 2021 Sep;36(9):2700-08. doi: 10.1007/s11606-021-06596-w..
Keywords:
Primary Care, Obesity, Behavioral Health, Medicare, Elderly
Chen H, Upadhyay N, Lyu N
Association of primary and behavioral health integrated care upon pediatric mental disorder treatment.
This study’s objective was to examine whether linkage with mental health (MH) treatment differed across 3 different integrated care agreements (ICAs) following diagnosis for Attention Deficit Hyperactive Disorder (ADHD) or Major Depressive Disorder (MDD) given by primary care providers (PCPs) in the pediatric setting. The ICAs were categorized as PCPs who practiced alone (non-co-located); PCPs practiced with specialist outside the practice but co-located at the practice site; and employed specialists who were co-located. A total of 4203 incident ADHD and 298 incident MDD diagnoses were identified, of which 74% of ADHD cases and 67% of MDD cases received treatment within 90 days of diagnosis. Children with ADHD were twice as likely to receive treatment if they were diagnosed by non-co-located or co-affiliated PCPs than those diagnosed by non-co-located PCPs. Those treated children were also 2 times more likely to receive guideline recommended psychotherapy and treated at the diagnosing site versus elsewhere.
AHRQ-funded; HS025251.
Citation:
Chen H, Upadhyay N, Lyu N .
Association of primary and behavioral health integrated care upon pediatric mental disorder treatment.
Acad Pediatr 2021 Sep-Oct;21(7):1187-94. doi: 10.1016/j.acap.2021.05.021..
Keywords:
Children/Adolescents, Behavioral Health, Patient-Centered Healthcare, Primary Care, Healthcare Delivery, Depression
Parish MB, Gonzalez A, Hilty D
Asynchronous telepsychiatry interviewer training recommendations: a model for interdisciplinary, integrated behavioral health care.
Asynchronous telepsychiatry (ATP) is an integrative model of behavioral health service delivery that is applicable in a variety of settings and populations, particularly consultation in primary care. This article outlined the development of a training model for ATP clinician skills. The training needs for ATP clinicians were assessed on a limited convenience sample of experts and clinicians. The authors suggested that more rigorous studies of training for ATP and other technology-focused, behavioral health services are needed.
AHRQ-funded; HS021477.
Citation:
Parish MB, Gonzalez A, Hilty D .
Asynchronous telepsychiatry interviewer training recommendations: a model for interdisciplinary, integrated behavioral health care.
Telemed J E Health 2021 Sep;27(9):982-88. doi: 10.1089/tmj.2020.0076..
Keywords:
Telehealth, Health Information Technology (HIT), Behavioral Health, Primary Care, Patient-Centered Healthcare, Training
Simon CB, Klein JW, Bradley KA
Primary care patients with opioid use disorder have a high prevalence of pain and mental health and other substance use disorders.
One potential challenge of treating OUD in primary care is comorbidity. Mental health and substance use disorders and chronic pain are common in patients with Opioid Use Disorders (OUDs) in specialty OUD treatment settings and on confidential surveys, but the prevalence of such comorbidity in primary care patients with OUD has not been confirmed. This brief report addressed that gap.
AHRQ-funded; HS023173.
Citation:
Simon CB, Klein JW, Bradley KA .
Primary care patients with opioid use disorder have a high prevalence of pain and mental health and other substance use disorders.
J Gen Intern Med 2021 Jun;36(6):1799-801. doi: 10.1007/s11606-020-05820-3..
Keywords:
Opioids, Medication, Substance Abuse, Behavioral Health, Primary Care
Grove LR, Gertner AK, Swietek KE
Effect of enhanced primary care for people with serious mental illness on service use and screening.
This retrospective cohort study compared healthcare use and screening receipt of people with serious mental illness (SMI) newly receiving enhanced primary care to people with SMI newly receiving usual primary care. Outcome measures included outpatient visits, emergency department (ED) visits, inpatient stays and dates, and recommended screenings 18 months after the initial visit. Enhanced primary care was associated with an increase of 1.2 primary care visits in the 18 months after the initial visit and decreases of 0.33 non-psychiatric inpatient days and 3.0 non-psychiatric inpatient days. There was no significant effect on psychiatric service and ED visits. Enhanced primary care increased the probability of preventive screenings such as glucose and HIV, decreased the probability of lipid screening, and had no effect on hemoglobin A1c and colorectal cancer screening.
AHRQ-funded; HS000032.
Citation:
Grove LR, Gertner AK, Swietek KE .
Effect of enhanced primary care for people with serious mental illness on service use and screening.
J Gen Intern Med 2021 Apr;36(4):970-77. doi: 10.1007/s11606-020-06429-2..
Keywords:
Behavioral Health, Primary Care: Models of Care, Primary Care, Patient-Centered Healthcare, Screening, Healthcare Utilization, Healthcare Delivery
Tsui JI, Akosile MA, Lapham GT
Prevalence and medication treatment of opioid use disorder among primary care patients with hepatitis C and HIV.
Hepatitis C and HIV are associated with opioid use disorders (OUD) and injection drug use. Medications for OUD can prevent the spread of HCV and HIV. The objective of this retrospective observational cohort study was to describe the prevalence of documented OUD, as well as receipt of office-based medication treatment, among primary care patients with HCV or HIV.
AHRQ-funded; HS026369.
Citation:
Tsui JI, Akosile MA, Lapham GT .
Prevalence and medication treatment of opioid use disorder among primary care patients with hepatitis C and HIV.
J Gen Intern Med 2021 Apr;36(4):930-37. doi: 10.1007/s11606-020-06389-7..
Keywords:
Opioids, Medication, Substance Abuse, Behavioral Health, Hepatitis, Human Immunodeficiency Virus (HIV), Primary Care
Salvador JG, Bhatt SR, Jacobsohn VC
Feasibility and acceptability of an online ECHO intervention to expand access to medications for treatment of opioid use disorder, psychosocial treatments and supports.
This study examined acceptability and feasibility of an online Extensions for Community Healthcare Outcomes (ECHO) model intervention developed to support rural primary care clinics to expand treatment and is part of a larger study tracking the impact of participation in this ECHO on expansion of medications for opioid use disorder (MOUD) in rural primary care. Using qualitative interviews and post-session questionnaires across 27 rural clinics in New Mexico, findings suggested evidence of feasibility and acceptability of MOUD ECHO to support expansion of this treatment.
AHRQ-funded; HS025345.
Citation:
Salvador JG, Bhatt SR, Jacobsohn VC .
Feasibility and acceptability of an online ECHO intervention to expand access to medications for treatment of opioid use disorder, psychosocial treatments and supports.
Subst Abus 2021;42(4):610-17. doi: 10.1080/08897077.2020.1806184..
Keywords:
Opioids, Substance Abuse, Behavioral Health, Medication, Access to Care, Rural Health, Primary Care, Patient-Centered Healthcare
Yeung K, Richards J, Goemer E
Costs of using evidence-based implementation strategies for behavioral health integration in a large primary care system.
The purpose of this study was to describe the cost of using evidence-based implementation strategies for sustained behavioral health integration (BHI) involving population-based screening, assessment, and identification at 25 primary care sites of Kaiser Permanente Washington (2015-2018). The investigators concluded that when spread across patients screened in a single year, BHI implementation costs were well within the range for commonly used diagnostic assessments in primary care (eg, laboratory tests).
AHRQ-funded; HS023173.
Citation:
Yeung K, Richards J, Goemer E .
Costs of using evidence-based implementation strategies for behavioral health integration in a large primary care system.
Health Serv Res 2020 Dec;55(6):913-23. doi: 10.1111/1475-6773.13592..
Keywords:
Healthcare Costs, Evidence-Based Practice, Implementation, Behavioral Health, Primary Care: Models of Care, Primary Care, Patient-Centered Healthcare
Radovic A, Odenthal K, Flores AT
Prescribing technology to increase uptake of depression treatment in primary care: a pre-implementation focus group study of SOVA (Supporting Our Valued Adolescents).
Supporting Our Valued Adolescents (SOVA) is a web-based technology intervention designed to increase depression and anxiety treatment uptake by adolescents in the context of an anonymous peer community with an accompanying website for parents. With a goal of informing the design of a hybrid effectiveness-implementation randomized controlled trial, we conducted a pre-implementation study in two primary care practices to guide implementation strategy development. We conducted focus groups with primary care providers (PCPs) at three different timepoints with PCPs (14 total) from two community practices.
AHRQ-funded; HS022989.
Citation:
Radovic A, Odenthal K, Flores AT .
Prescribing technology to increase uptake of depression treatment in primary care: a pre-implementation focus group study of SOVA (Supporting Our Valued Adolescents).
J Clin Psychol Med Settings 2020 Dec;27(4):766-82. doi: 10.1007/s10880-019-09669-5.
.
.
Keywords:
Children/Adolescents, Depression, Anxiety, Behavioral Health, Primary Care, Health Information Technology (HIT), Implementation
Carter E, Monane R, Peccoralo L
Missed opportunities to engage patients in collaborative care challenge program sustainability: a qualitative study.
The authors examined barriers and accompanying strategies to patient engagement in the context of collaborative care sustainability. They concluded that their research signals the need for improved patient engagement at the time of diagnosis and referral, and they suggested innovative areas for quality improvement in primary care settings, including e-handoffs, culturally-tailored preference-driven treatment, collaborative care vs. psychiatry referral algorithms, and community-based paraprofessionals.
AHRQ-funded; HS025198.
Citation:
Carter E, Monane R, Peccoralo L .
Missed opportunities to engage patients in collaborative care challenge program sustainability: a qualitative study.
Gen Hosp Psychiatry 2020 Nov-Dec;67:158-59. doi: 10.1016/j.genhosppsych.2020.05.007..
Keywords:
Patient and Family Engagement, Primary Care: Models of Care, Primary Care, Behavioral Health, Patient-Centered Healthcare, Innovations and Emerging Issues
Callejo-Black A, Wagner DV, Ramanujam K
A systematic review of external validity in pediatric integrated primary care trials.
This study used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to conduct a systematic review of external validity reporting in integrated primary care (IPC) interventions for mental health concerns. A literature search was conducted to identify relevant literature from 1998 to 2018 reporting on open, randomized or quasi-randomized trials of IPC interventions that targeted child (ages 0-18 years) psychological symptoms. The authors included 39 publications describing 25 studies in the review. Publications rarely reported indicators of external validity, including the representatives of participants (12%), rate of adoption clinics or providers (16%), cost of implementation (8%), or evidence of maintenance (16%). Few studies also included key pragmatic factors such as cost or organizational change processes related to implementation and maintenance.
AHRQ-funded; HS022981.
Citation:
Callejo-Black A, Wagner DV, Ramanujam K .
A systematic review of external validity in pediatric integrated primary care trials.
J Pediatr Psychol 2020 Oct 1;45(9):1039-52. doi: 10.1093/jpepsy/jsaa068..
Keywords:
Children/Adolescents, Primary Care, Behavioral Health, Healthcare Delivery, Evidence-Based Practice, Health Services Research (HSR), Research Methodologies
McClellan C, Maclean JC, Saloner B
Integrated care models and behavioral health care utilization: quasi-experimental evidence from Medicaid health homes.
This study provided the first population-level evidence on the effects of Medicaid health homes (HH) on behavioral health care service use. As of 2016, 16 states had adopted an HH for enrollees with serious mental illness and/or substance use disorder. Using data from the National Survey on Drug Use and Health, the authors found that HH adoption increased service use among enrollees and enrollee self-reported health improved post-HH.
AHRQ-authored.
Citation:
McClellan C, Maclean JC, Saloner B .
Integrated care models and behavioral health care utilization: quasi-experimental evidence from Medicaid health homes.
Health Econ 2020 Sep;29(9):1086-97. doi: 10.1002/hec.4027..
Keywords:
Behavioral Health, Medicaid, Substance Abuse, Primary Care: Models of Care, Primary Care, Ambulatory Care and Surgery, Patient-Centered Outcomes Research
Riley AR, Walker BL, Hall TA
Development and initial validation of a measure of parents' preferences for behavioral counseling in primary care.
There is a significant need to understand the factors that contribute to parents' consumer preferences for behavioral health services in pediatric primary care; however, no validated measure of such preferences exists. In this article, the investigators discuss the development of the BIPS (Behavioral Information Preferences Scale), a measure of parents' preferences for delivery of behavioral guidance in pediatric primary care and assessed its psychometric properties.
AHRQ-funded; HS022981.
Citation:
Riley AR, Walker BL, Hall TA .
Development and initial validation of a measure of parents' preferences for behavioral counseling in primary care.
Fam Syst Health 2020 Jun;38(2):139-50. doi: 10.1037/fsh0000481..
Keywords:
Children/Adolescents, Behavioral Health, Primary Care, Caregiving
Jonassaint CR, Belnap BH, Huang Y
Racial differences in the effectiveness of Internet-delivered mental health care.
The purpose of this study was to examine race differences in the impact of computerized cognitive behavioral therapy (cCBT) use on mental health outcomes among White and African American primary care patients. Participants were patients aged 18-75 who were referred by their primary care physicians and who met the eligibility criteria. Findings showed that, compared to usual care, cCBT had no effect on quality of life, depression, or anxiety for Whites. However, for African American patients, cCBT was associated with a significant 6-month decrease in depression and anxiety scores; thus, cCBT may be an efficient and scalable first step to eliminating disparities in mental health care.
AHRQ-funded; HS022989.
Citation:
Jonassaint CR, Belnap BH, Huang Y .
Racial differences in the effectiveness of Internet-delivered mental health care.
J Gen Intern Med 2020 Feb;35(2):490-97. doi: 10.1007/s11606-019-05542-1..
Keywords:
Behavioral Health, Telehealth, Racial / Ethnic Minorities, Disparities, Primary Care, Treatments
Golberstein E, Joseph JM, Druss BG
The use of psychiatric econsults in primary care.
This study examined the use of an electronic consultation tool (eConsult) by primary care physicians (PCPs) with psychiatrists. The authors investigated the use of psychiatric eConsults in a large integrated delivery system in Minnesota (Allina Health). The tool was introduced in 22 of its primary care clinics on August 1, 2015. Patients had no fee and psychiatrists received 0.75 work relative value units for each eConsult. Out of 95,105 encounters across 219 PCPs from August 2015 through December 2016 only 256 (0.27%) had a psychiatric eConsult order. Among 37.606 encounters with a primary mental health diagnosis only 138 (0.37%) had an eConsult order. Anxiety and depressive disorders were the most common diagnosis types for PCP visits without an eConsult order as well as bipolar disorder, but schizophrenia and psychotic disorder diagnoses were more common with eConsult orders. Over half of eConsults were for medication-related issues, 33% for a specific mental health diagnosis, and 15% for psychiatry without any details. Most PCPs (63%) never ordered an eConsult but the top ten users of eConsults accounted for 46% of the total orders.
AHRQ-funded; HS025245.
Citation:
Golberstein E, Joseph JM, Druss BG .
The use of psychiatric econsults in primary care.
J Gen Intern Med 2020 Feb;35(2):616-17. doi: 10.1007/s11606-019-05048-w..
Keywords:
Telehealth, Health Information Technology (HIT), Behavioral Health, Primary Care: Models of Care, Primary Care, Healthcare Delivery
Peterson EL, Ndumele CD, Busch SH
National referral and treatment patterns among mental health pediatric primary care visits.
The current study explored factors that predict referral from pediatric primary care to mental health specialty care among a nationally representative sample of visits. Results indicated that patient visits that included rarer/serious diagnoses (e.g., bipolar disorder) were more likely to receive a referral in comparison to those with ADHD.
AHRQ-funded; HS017589.
Citation:
Peterson EL, Ndumele CD, Busch SH .
National referral and treatment patterns among mental health pediatric primary care visits.
Adm Policy Ment Health 2020 Jan;47(1):86-93. doi: 10.1007/s10488-019-00972-9..
Keywords:
Children/Adolescents, Behavioral Health, Primary Care, Practice Patterns
Stafford AM, Garbuz T, Etter DJ
The natural course of adolescent depression treatment in the primary care setting.
Little is known about how adolescents receive depression follow-up in primary care. The purpose of this study was to describe the rates of symptom assessment and depression treatment over time in a group of adolescents screening positive for moderate or severe depression in the primary care setting. Retrospective chart reviews were conducted to gather information related to symptom reassessments, antidepressant prescriptions, psychotherapy referrals, and treatment discontinuation.
AHRQ-funded; HS022681.
Citation:
Stafford AM, Garbuz T, Etter DJ .
The natural course of adolescent depression treatment in the primary care setting.
J Pediatr Health Care 2020 Jan-Feb;34(1):38-46. doi: 10.1016/j.pedhc.2019.07.002..
Keywords:
Children/Adolescents, Depression, Behavioral Health, Primary Care
Samples H, Stuart EA, Saloner B
The role of screening in depression diagnosis and treatment in a representative sample of US primary care visits.
This study aimed to examine depression screening patterns and the role of screening in depression diagnosis and treatment in the outpatient primary care setting. The investigators found that physicians appeared to use depression screening selectively based on patients' presenting symptoms. Higher screening rates were associated with higher odds of depression diagnosis and treatment. The investigators suggest that even modest increases in screening rates could meaningfully increase population-level rates of depression identification and treatment in primary care.
AHRQ-funded; HS000029.
Citation:
Samples H, Stuart EA, Saloner B .
The role of screening in depression diagnosis and treatment in a representative sample of US primary care visits.
J Gen Intern Med 2020 Jan;35(1):12-20. doi: 10.1007/s11606-019-05192-3..
Keywords:
Depression, Behavioral Health, Diagnostic Safety and Quality, Primary Care, Screening, Ambulatory Care and Surgery
Riley AR, Walker BL, Wilson AC
Parents' consumer preferences for early childhood behavioral intervention in primary care.
In this study, the investigators sought to better understand parents' preferences for the content and delivery method of behavioral health guidance in pediatric primary care and to determine the relationship of those preferences with demographic characteristics, child behavior problems, and parenting style. The investigators found that most parents were interested in behavioral guidance as part of primary care, but their preferences for the content and delivery of that guidance varied by known socioeconomic, child, and parenting risk factors.
AHRQ-funded; HS022981.
Citation:
Riley AR, Walker BL, Wilson AC .
Parents' consumer preferences for early childhood behavioral intervention in primary care.
J Dev Behav Pediatr 2019 Dec;40(9):669-78. doi: 10.1097/dbp.0000000000000736..
Keywords:
Children/Adolescents, Primary Care, Behavioral Health, Caregiving, Healthcare Delivery
Bierman AS
Preventing and managing multimorbidity by integrating behavioral health and primary care.
People with multimorbidity are especially challenged in navigating fragmented health systems designed to treat diseases rather than people. The harms associated with this fragmentation, such as adverse events resulting from conflicting treatments and increased costs, have been well documented. As a result, there have been renewed calls for more patient-centered care, with a particular emphasis on the importance of the integration of primary care and behavioral health as fundamental for achieving this goal. This paper discusses preventing and managing multimorbidity by integrating behavioral health and primary care.
AHRQ author - Bierman
Citation:
Bierman AS .
Preventing and managing multimorbidity by integrating behavioral health and primary care.
Health Psychol 2019 Sep;38(9):851-54. doi: 10.1037/hea0000787..
Keywords:
Care Coordination, Healthcare Delivery, Behavioral Health, Patient-Centered Healthcare, Primary Care
