A Qualitative Study on Primary Care Integration into an Asian Immigrant-specific Behavioural Health Setting in the United States

Kris Pui Kwan Ma; Anne Saw

doi:10.5334/ijic.3719

Figures & Tables

Table 1

Provider Characteristics.

	n (%)	or mean (SD)
Gender
Male	1	(20%)
Female	4	(80%)
Ethnicities
Chinese	3	(60%)
Cambodian	1	(20%)
Vietnamese	1	(20%)
Years of professional service	10.6	(8.9)
Roles
Primary care	1	Primary care physician
Behavioural health	1	Program director/clinical supervisor
	1	Program coordinator/clinical supervisor
	1	Wellness coordinator/clinician
	1	Data specialist/peer navigator

Table 2

Patient Characteristics.

	n (%)	or mean (SD)
Gender
Male	12	(29.3%)
Female	27	(65.9%)
Age	52.1	(10.6)
Ethnicities
Chinese	7	(17.1%)
Cambodian	14	(34.2%)
Filipino	1	(2.4%)
Korean	2	(4.9%)
Mien	7	(17.1%)
Vietnamese	6	(14.6%)
Thai	1	(2.4%)

[i] Note: There were 2 missing cases for gender and age, and 3 missing cases for ethnicity.

Table 3

Themes and Examples from Patients and Providers/administrators.

Themes	Sample quotes from patients	Sample quotes from providers/administrators
Limited preconditions at the system level	“I feel bad that inside the church when the clinicians always supplement the food they gave us and cooking by a lot. My clinician spends a lot her own personal money on it outside of it.”	“For some practitioners, it’s just been difficult, and that’s because not fully understanding the benefits of integration, benefits of understanding the whole person, and working as a team not working individually”, (behavioural health project coordinator)
Cross-organisation dynamics		“I have to say when I look back, I felt like we could do more team building and also role clarification…I hope there will be more time [for behavioural health and primary care providers] finding the common ground, finding the vision, and kind of scale back what they need to do in order to get to that point [integrate both sides’ services].” (behavioural health project coordinator)
Changes in organisational culture and system		“I have to say our care managers they are more willing [to] see the importance of bringing the client to their primary care providers appointments more than before.” (behavioural health project coordinator)
Improved patient-provider and provider- provider communication	“He had a gout, which he didn’t know what it was, and he was really thankful that his case manager was there to bring it up to have the discussion with the primary care doctor so he had a better understanding of his physical health.”	“I can recommend walking but who’s going to follow up? The case manager is taking them out for a walk…those are the kind of things I see…Or at least it would be reported back to me that they were doing this.” (primary care physician)
Increased patient involvement	“I volunteer in the exercise, yoga group, in Zumba whenever the instructors are out…1 just memorize the instructor’s combinations, and do the combinations more or less, and they’re just following along, the group members…. It makes me feel proud to be able to do anything good. I’m helping myself and I’m helping others at the same time.”	“The client is part of the team… [In] the past, even though the treatment person or the treatment team decide what’s best for the client. But now, we are incorporating the client to be a part of it. They have a sense of that… Because they know what’s been working for them, what they are willing to do.” (behavioural health clinician)

Table 4

Recommendations for future implementation of integrated care.

Major activities in this primary care integration program		Future recommendations
1.	Co-locate services Primary care providers embedded in behavioural health setting	Provide training to future providers and staff on integrated care prior to implementation Consider organisational culture and top-down involvement in planning for integrated care
2.	Create an interdisciplinary team Recruit primary care physicians, psychiatrists, bilingual care managers, behavioural health clinicians and administrative staff	Invest time and resources in team building and defining shared vision of integration Develop shared protocols and clarify responsibilities with expected outcomes
3.	Develop channels for greater interprofessional communication Regular case conferences Informal check-ins and referral procedures Bilingual behavioural care managers attend primary care appointments with patients	Evaluate reimbursement, billing and funding systems Management commitment to protect time and resources for integrated care activities and training Develop financial and technical capacity in using and maintaining an information sharing system
4.	Set up an electronic health record system For e-prescription, obtaining lab results and coordinating patients’ appointments	Allow different existing electronic health record systems to be compatible with one another Develop culturally responsive treatment plans and wellness activities for patients and their families
5.	Engage patients and family in treatment and wellness activities	Share decision making process with patients through involving bilingual care managers
6.	Enlist peers to be part of the workforce and provide training and leadership opportunities	Create positions, define roles and provide training, incentives and supervision for peer leaders