Integrating Behavioral Health Care into HIV/AIDS Care Clinics in Puerto Rico
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Publicado
Dec 22, 2017
Resumen
People living with HIV/AIDS (PLWHA) are more likely to have mental health needs than the general population. Integrating behavioral health services in the primary care scenario has the potential to improve the physical and psychological well-being of PLWHA. However, this integration requires addressing fundamental issues, such as clinicians training, the development of new administrative processes, and addressing infrastructure issues. We describe the Primary Care Psychology Program (PCPP) in Puerto Rico created to address the mental health needs of PLWHA. PCPP provides care in a multidisciplinary and collaborative manner that focuses on HIV, uses behavioral measures to drive clinical decisions, and provides evidence-based treatments. In addition, the article presents preliminary findings from a retrospective chart review that evidenced improvements of CD4 counts, viral load, and depressive symptoms among PLWHA. We conclude that the primary care behavioral health model has the potential to address the complexities in HIV-care and improve the quality of life among PLWHA in Puerto Rico.
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References
References
Agerwala, S. M., & McCance-Katz, E. F. (2013). Integrating screening, brief intervention, and referral to treatment (SBIRT) into clinical practice settings: a brief review. Journal of Psychoactive Drugs, 44(4), 307–17. http://doi.org/10.1080/02791072.2012.720169
Barrett, K., & Chang, Y.-P. (2016). Behavioral Interventions Targeting Chronic Pain, Depression, and Substance Use Disorder in Primary Care. Journal of Nursing Scholarship, 48(4), 345–353. https://doi.org/10.1111/jnu.12213
Blount, A. (2003). Integrated Primary Care: Organizing the Evidence. Families, Systems, & Health, 21(2), 121–133. https://doi.org/10.1037/1091-7527.21.2.121
Blount, A., Schoenbaum, M., Kathol, R., Rollman, B. L., Thomas, M., O’Donohue, W., & Peek, C. J. (2007). The economics of behavioral health services in medical settings: A summary of the evidence. Professional Psychology: Research and Practice, 38(3), 290–297. https://doi.org/10.1037/0735-7028.38.3.290
Butler, M., Kane, R. L., McAlpine, D., Kathol, R., Fu, S. S., Hagedorn, H., & Wilt, T. (2011). Does Integrated Care Improve Treatment for Depression? Journal of Ambulatory Care Management, 34(2), 113–125. https://doi.org/10.1097/JAC.0b013e31820ef605
Collins, C., Levis Hewson, D., Munger, R., & Wade, T. (2010). Evolving Models of Behavioral Health. https://doi.org/10.1599/EvolvingCare2010
Di Benedetto, M., Lindner, H., Aucote, H., Churcher, J., McKenzie, S., Croning, N., & Jenkins, E. (2014). Co-morbid depression and chronic illness related to coping and physical and mental health status. Psychology, Health & Medicine, 19(3), 253–62. https://doi.org/10.1080/13548506.2013.803135
Dobbins, M. I., Thomas, S. A., Melton, S. L. S., & Lee, S. (2016). Integrated Care and the Evolution of the Multidisciplinary Team. Primary Care, 43(2), 177–90. https://doi.org/10.1016/j.pop.2016.01.003
Ede, V., Okafor, M., Kinuthia, R., Belay, Z., Tewolde, T., Alema-Mensah, E., & Satcher, D. (2015). An Examination of Perceptions in Integrated Care Practice. Community Mental Health Journal, 51(8), 949–961. https://doi.org/10.1007/s10597-015-9837-9
Farber, E. W., Shahane, A. A., Brown, J. L., & Campos, P. E. (2014). Perceived stigma reductions following participation in mental health services integrated within community-based HIV primary care. AIDS Care, 26(6), 750–753. https://doi.org/10.1080/09540121.2013.845285
Fisher, L., & Dickinson, W. P. (2014). Psychology and primary care: New collaborations for providing effective care for adults with chronic health conditions. The American Psychologist, 69(4), 355–63. https://doi.org/10.1037/a0036101
Gatchel, R. J., & Oordt, M. S. (2003). Clinical health psychology and primary care: Practical advice and clinical guidance for successful collaboration. Washington: American Psychological Association. https://doi.org/10.1037/10592-000
Gwadz, M., Cleland, C. M., Applegate, E., Belkin, M., Gandhi, M., Salomon, N., … Heart to Heart Collaborative Research Team. (2015). Behavioral intervention improves treatment outcomes among HIV-infected individuals who have delayed, declined, or discontinued antiretroviral therapy: a randomized controlled trial of a novel intervention. AIDS and Behavior, 19(10), 1801–17. https://doi.org/10.1007/s10461-015-1054-6
Hill, J. M. (2015). Behavioral health integration: Transforming patient care, medical resident education, and physician effectiveness. International Journal of Psychiatry in Medicine, 50(1). https://doi.org/10.1177/0091217415592357
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Kalichman, S. C., Cherry, C., Kalichman, M. O., Amaral, C. M., White, D., Pope, H., … Cain, D. (2011). Integrated Behavioral Intervention to Improve HIV/AIDS Treatment Adherence and Reduce HIV Transmission. American Journal of Public Health, 101(3), 531–538. https://doi.org/10.2105/AJPH.2010.197608
Leff, J. A., Hernández, D., Teixeira, P. A., Castellón, P. C., Feaster, D. J., Rodriguez, A. E., … Schackman, B. R. (2017). The structural and health policy environment for delivering integrated HIV and substance use disorder treatments in Puerto Rico. BMC Health Services Research, 17(1), 232. https://doi.org/10.1186/s12913-017-2174-7
Linardakis, M., Papadaki, A., Smpokos, E., Micheli, K., Vozikaki, M., & Philalithis, A. (2015). Association of Behavioral Risk Factors for Chronic Diseases With Physical and Mental Health in European Adults Aged 50 Years or Older, 2004-2005. Preventing Chronic Disease, 12, E149. https://doi.org/10.5888/pcd12.150134
Martínez-González, N. A., Berchtold, P., Ullman, K., Busato, A., & Egger, M. (2014). Integrated care programmes for adults with chronic conditions: a meta-review. International Journal for Quality in Health Care : Journal of the International Society for Quality in Health Care, 26(5), 561–70. https://doi.org/10.1093/intqhc/mzu071
Miller-Matero, L. R., Dykuis, K. E., Albujoq, K., Martens, K., Fuller, B. S., Robinson, V., & Willens, D. E. (2016). Benefits of integrated behavioral health services: The physician perspective. Families, Systems, & Health, 34(1), 51–55. https://doi.org/10.1037/fsh0000182
Pappin, M., Wouters, E., & Booysen, F. L. R. (2012). Anxiety and depression amongst patients enrolled in a public sector antiretroviral treatment programme in South Africa: a cross-sectional study. BMC Public Health, 12(1), 244. Retrieved from http://www.biomedcentral.com/1471-2458/12/244
Peek, C. J. (2013). Integrated Behavioral Health and Primary Care: A Common Language. In Integrated Behavioral Health in Primary Care (pp. 9–31). New York, NY: Springer New York. https://doi.org/10.1007/978-1-4614-6889-9_2
Puerto Rico Department of Health (2016). Puerto Rico HIV / AIDS Surveillance Summary Cumulative HIV / AIDS Cases Diagnosed. Retrieved from http://www.salud.gov.pr/Estadisticas-Registros-y-Publicaciones/Estadisticas VIH/Estadísticas Generales/2016/Agosto 2016/Puerto Rico HIVAIDS Surveillance Summary.pdf
Safren, S. A., Bedoya, C. A., O’Cleirigh, C., Biello, K. B., Pinkston, M. M., Stein, M. D., … Mayer, K. H. (2016). Cognitive behavioural therapy for adherence and depression in patients with HIV: a three-arm randomised controlled trial. The Lancet HIV, 3(11), e529–e538. https://doi.org/10.1016/S2352-3018(16)30053-4
Sawyer, A., Ayers, S., & Field, A. P. (2010). Posttraumatic growth and adjustment among individuals with cancer or HIV/AIDS: A meta-analysis. Clinical Psychology Review, 30(4), 436–447. Retrieved from http://dx.doi.org/10.1016/j.cpr.2010.02.004
Substance Abuse and Mental Health Services Administration and Health Resources and Services Administration. (2016). The Case for Behavioral Health Screening in HIV Care Settings, 17. Retrieved from http://store.samhsa.gov/shin/content/SMA16-4999/SMA16-4999.pdf
Vera, M., Perez-Pedrogo, C., Huertas, S. E., Reyes-Rabanillo, M. L., Juarbe, D., Huertas, A., … Chaplin, W. (2010). Collaborative care for depressed patients with chronic medical conditions: a randomized trial in Puerto Rico. Psychiatric Services (Washington, D.C.), 61(2), 144–50. https://doi.org/10.1176/ps.2010.61.2.144
Vera, M., Reyes-Rabanillo, M. L., Huertas, S., Juarbe, D., Pérez-Pedrogo, C., Huertas, A., & Peña, M. (2011). Suicide ideation, plans, and attempts among general practice patients with chronic health conditions in Puerto Rico. International Journal of General Medicine, 4, 197–205. https://doi.org/10.2147/IJGM.S17156
Agerwala, S. M., & McCance-Katz, E. F. (2013). Integrating screening, brief intervention, and referral to treatment (SBIRT) into clinical practice settings: a brief review. Journal of Psychoactive Drugs, 44(4), 307–17. http://doi.org/10.1080/02791072.2012.720169
Barrett, K., & Chang, Y.-P. (2016). Behavioral Interventions Targeting Chronic Pain, Depression, and Substance Use Disorder in Primary Care. Journal of Nursing Scholarship, 48(4), 345–353. https://doi.org/10.1111/jnu.12213
Blount, A. (2003). Integrated Primary Care: Organizing the Evidence. Families, Systems, & Health, 21(2), 121–133. https://doi.org/10.1037/1091-7527.21.2.121
Blount, A., Schoenbaum, M., Kathol, R., Rollman, B. L., Thomas, M., O’Donohue, W., & Peek, C. J. (2007). The economics of behavioral health services in medical settings: A summary of the evidence. Professional Psychology: Research and Practice, 38(3), 290–297. https://doi.org/10.1037/0735-7028.38.3.290
Butler, M., Kane, R. L., McAlpine, D., Kathol, R., Fu, S. S., Hagedorn, H., & Wilt, T. (2011). Does Integrated Care Improve Treatment for Depression? Journal of Ambulatory Care Management, 34(2), 113–125. https://doi.org/10.1097/JAC.0b013e31820ef605
Collins, C., Levis Hewson, D., Munger, R., & Wade, T. (2010). Evolving Models of Behavioral Health. https://doi.org/10.1599/EvolvingCare2010
Di Benedetto, M., Lindner, H., Aucote, H., Churcher, J., McKenzie, S., Croning, N., & Jenkins, E. (2014). Co-morbid depression and chronic illness related to coping and physical and mental health status. Psychology, Health & Medicine, 19(3), 253–62. https://doi.org/10.1080/13548506.2013.803135
Dobbins, M. I., Thomas, S. A., Melton, S. L. S., & Lee, S. (2016). Integrated Care and the Evolution of the Multidisciplinary Team. Primary Care, 43(2), 177–90. https://doi.org/10.1016/j.pop.2016.01.003
Ede, V., Okafor, M., Kinuthia, R., Belay, Z., Tewolde, T., Alema-Mensah, E., & Satcher, D. (2015). An Examination of Perceptions in Integrated Care Practice. Community Mental Health Journal, 51(8), 949–961. https://doi.org/10.1007/s10597-015-9837-9
Farber, E. W., Shahane, A. A., Brown, J. L., & Campos, P. E. (2014). Perceived stigma reductions following participation in mental health services integrated within community-based HIV primary care. AIDS Care, 26(6), 750–753. https://doi.org/10.1080/09540121.2013.845285
Fisher, L., & Dickinson, W. P. (2014). Psychology and primary care: New collaborations for providing effective care for adults with chronic health conditions. The American Psychologist, 69(4), 355–63. https://doi.org/10.1037/a0036101
Gatchel, R. J., & Oordt, M. S. (2003). Clinical health psychology and primary care: Practical advice and clinical guidance for successful collaboration. Washington: American Psychological Association. https://doi.org/10.1037/10592-000
Gwadz, M., Cleland, C. M., Applegate, E., Belkin, M., Gandhi, M., Salomon, N., … Heart to Heart Collaborative Research Team. (2015). Behavioral intervention improves treatment outcomes among HIV-infected individuals who have delayed, declined, or discontinued antiretroviral therapy: a randomized controlled trial of a novel intervention. AIDS and Behavior, 19(10), 1801–17. https://doi.org/10.1007/s10461-015-1054-6
Hill, J. M. (2015). Behavioral health integration: Transforming patient care, medical resident education, and physician effectiveness. International Journal of Psychiatry in Medicine, 50(1). https://doi.org/10.1177/0091217415592357
IBM SPSS Statistics for Windows. (2013). Armonk, NY: IBM Corp.
Institute of Medicine (US) Committee on the Future of Primary Care. (1994). Defining Primary Care. In Primary Care: America’s Health in a New Era. Washington, D.C.: National Academies Press. https://doi.org/10.17226/9153
Kalichman, S. C., Cherry, C., Kalichman, M. O., Amaral, C. M., White, D., Pope, H., … Cain, D. (2011). Integrated Behavioral Intervention to Improve HIV/AIDS Treatment Adherence and Reduce HIV Transmission. American Journal of Public Health, 101(3), 531–538. https://doi.org/10.2105/AJPH.2010.197608
Leff, J. A., Hernández, D., Teixeira, P. A., Castellón, P. C., Feaster, D. J., Rodriguez, A. E., … Schackman, B. R. (2017). The structural and health policy environment for delivering integrated HIV and substance use disorder treatments in Puerto Rico. BMC Health Services Research, 17(1), 232. https://doi.org/10.1186/s12913-017-2174-7
Linardakis, M., Papadaki, A., Smpokos, E., Micheli, K., Vozikaki, M., & Philalithis, A. (2015). Association of Behavioral Risk Factors for Chronic Diseases With Physical and Mental Health in European Adults Aged 50 Years or Older, 2004-2005. Preventing Chronic Disease, 12, E149. https://doi.org/10.5888/pcd12.150134
Martínez-González, N. A., Berchtold, P., Ullman, K., Busato, A., & Egger, M. (2014). Integrated care programmes for adults with chronic conditions: a meta-review. International Journal for Quality in Health Care : Journal of the International Society for Quality in Health Care, 26(5), 561–70. https://doi.org/10.1093/intqhc/mzu071
Miller-Matero, L. R., Dykuis, K. E., Albujoq, K., Martens, K., Fuller, B. S., Robinson, V., & Willens, D. E. (2016). Benefits of integrated behavioral health services: The physician perspective. Families, Systems, & Health, 34(1), 51–55. https://doi.org/10.1037/fsh0000182
Pappin, M., Wouters, E., & Booysen, F. L. R. (2012). Anxiety and depression amongst patients enrolled in a public sector antiretroviral treatment programme in South Africa: a cross-sectional study. BMC Public Health, 12(1), 244. Retrieved from http://www.biomedcentral.com/1471-2458/12/244
Peek, C. J. (2013). Integrated Behavioral Health and Primary Care: A Common Language. In Integrated Behavioral Health in Primary Care (pp. 9–31). New York, NY: Springer New York. https://doi.org/10.1007/978-1-4614-6889-9_2
Puerto Rico Department of Health (2016). Puerto Rico HIV / AIDS Surveillance Summary Cumulative HIV / AIDS Cases Diagnosed. Retrieved from http://www.salud.gov.pr/Estadisticas-Registros-y-Publicaciones/Estadisticas VIH/Estadísticas Generales/2016/Agosto 2016/Puerto Rico HIVAIDS Surveillance Summary.pdf
Safren, S. A., Bedoya, C. A., O’Cleirigh, C., Biello, K. B., Pinkston, M. M., Stein, M. D., … Mayer, K. H. (2016). Cognitive behavioural therapy for adherence and depression in patients with HIV: a three-arm randomised controlled trial. The Lancet HIV, 3(11), e529–e538. https://doi.org/10.1016/S2352-3018(16)30053-4
Sawyer, A., Ayers, S., & Field, A. P. (2010). Posttraumatic growth and adjustment among individuals with cancer or HIV/AIDS: A meta-analysis. Clinical Psychology Review, 30(4), 436–447. Retrieved from http://dx.doi.org/10.1016/j.cpr.2010.02.004
Substance Abuse and Mental Health Services Administration and Health Resources and Services Administration. (2016). The Case for Behavioral Health Screening in HIV Care Settings, 17. Retrieved from http://store.samhsa.gov/shin/content/SMA16-4999/SMA16-4999.pdf
Vera, M., Perez-Pedrogo, C., Huertas, S. E., Reyes-Rabanillo, M. L., Juarbe, D., Huertas, A., … Chaplin, W. (2010). Collaborative care for depressed patients with chronic medical conditions: a randomized trial in Puerto Rico. Psychiatric Services (Washington, D.C.), 61(2), 144–50. https://doi.org/10.1176/ps.2010.61.2.144
Vera, M., Reyes-Rabanillo, M. L., Huertas, S., Juarbe, D., Pérez-Pedrogo, C., Huertas, A., & Peña, M. (2011). Suicide ideation, plans, and attempts among general practice patients with chronic health conditions in Puerto Rico. International Journal of General Medicine, 4, 197–205. https://doi.org/10.2147/IJGM.S17156
Cómo citar
Integrating Behavioral Health Care into HIV/AIDS Care Clinics in Puerto Rico. (2017). Revista Puertorriqueña De Psicologia, 28(2), 284-293. https://www.repsasppr.net/index.php/reps/article/view/368
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Cómo citar
Integrating Behavioral Health Care into HIV/AIDS Care Clinics in Puerto Rico. (2017). Revista Puertorriqueña De Psicologia, 28(2), 284-293. https://www.repsasppr.net/index.php/reps/article/view/368