Regular Research ArticlesInterdisciplinary Team Perspectives on Mental Health Care in VA Home-Based Primary Care: A Qualitative Study
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INTRODUCTION
In 1972, the U.S. Department of Veteran's Affairs (VA) established the Home-Based Primary Care (HBPC) Program to provide in-home interdisciplinary, comprehensive, longitudinal primary care for frail, chronically ill or disabled Veterans with complex medical, social and behavioral conditions.1 The goal of HBPC is to allow Veterans to achieve the highest practicable function while minimizing institutionalization and maintaining quality of life.2 Veterans enrolled in HBPC are predominantly older
Sample: Site Selection
This study is part of a multi-phase VA Health Services Research and Development (HSR&D) funded study, “Factors Associated with Institutional use by Veterans in Home-Based Primary Care.” In Fall 2015, HBPC program directors representing 395 HBPC sites across the US were invited to complete a survey on their site's Background, Structures, and Processes (BSP Survey).17 We received 236 completed surveys from HBPC sites (response rate 60%). As part of that survey, directors identified members of
RESULTS
The analysis revealed four themes related to provision of care for Veterans with mental health needs from HBPC teams. These included: 1) HBPC Veterans have not only complex physical needs but also co-occurring mental health needs; 2) the multi-faceted role of psychologists on HBPC teams that includes providing care for Veterans and support for colleagues; 3) collaboration between medical and mental health providers as a means of caring for HBPC Veterans with mental health needs; and 4) gaps in
DISCUSSION
The VA has been a pioneer in the advancement of high quality HBPC. The experiences of VA HBPC teams in integration of home-based mental health care furthers this tradition by informing the work of other practices and systems. This is the first qualitative study of VA HBPC team member insights on mental health care. The themes identify important features of mental health care in HBPC with policy implications beyond VA programs and underscore what many health systems that assume responsibility
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Funding: This work was supported by a Veterans Affairs Health Science Research & Development grant. HSR5-011-13S, Project ID 1193873, VACO No. IIR12-152-3.