1. Stacy Ogbeide, PsyD, MS David Bauman, PsyD Bridget Beachy, PsyD
Session #G5b
Saturday, October 18, 2014
Repaving the Road: Addressing the Challenges of Conducting Outcome Research in Primary Care
Stacy Ogbeide, PsyD, MS
David Bauman, PsyD
Bridget Beachy, PsyD
Please insert the assigned session number (letter and number), i.e., A2a
Please insert the assigned DAY and DATE of your presentation, i.e., Friday, October 17, 2014
Collaborative Family Healthcare Association 16th Annual Conference
October 16-18, Washington, DC U.S.A.
Collaborative Family Healthcare Association 12th Annual Conference

2. Faculty Disclosure
We have not had any relevant financial relationships during the past 12 months.
CFHA requires that your presentation be FREE FROM COMMERCIAL BIAS. Educational materials that are a part of a continuing education activity such as slides, abstracts and handouts CANNOT contain any advertising or product‐group message.
The content or format of a continuing education activity or its related materials must promote improvements or quality in health care and not a specific propriety business interest of a commercial interest.
Presentations must give a balanced view of therapeutic options. Use of generic names will contribute to this impartiality. If the educational material or content includes trade names, where available trade names for products of multiple commercial entities should be used, not just trade names from a single commercial entity. Faculty must be responsible for the scientific integrity of their presentations. Any information regarding commercial products/services must be based on scientific (evidence‐based) methods generally accepted by the medical community.
Collaborative Family Healthcare Association 12th Annual Conference

3. 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
Include the behavioral learning objectives for this session
Collaborative Family Healthcare Association 12th Annual Conference

4. 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),
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), doi: /a
Peek, C. J., Cohen, D. J., deGruy, F. V. (2014). Research and evaluation in the transformation of primary care. American Psychologist, 69(4), doi: /a
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), doi: /a
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.
Collaborative Family Healthcare Association 12th Annual Conference

5. Learning Assessment
A question and answer period will be conducted at the end of this presentation.
Please incorporate audience interaction through a brief Question & Answer period during or at the conclusion of your presentation.
This component MUST be done in lieu of a written pre- or post-test based on your learning objectives to satisfy accreditation requirements.
Collaborative Family Healthcare Association 12th Annual Conference

6. Presentation Objectives
Introduction
Barriers and challenges
Current strategies and recommendations
Creating flexible research protocols
Disseminating research
Collaborative Family Healthcare Association 12th Annual Conference

7. Introduction Cartoon from www.stus.com
Collaborative Family Healthcare Association 12th Annual Conference

8. 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
Collaborative Family Healthcare Association 12th Annual Conference

9. Introduction Time! Who will help? Manpower? Buy-in?
What research needs to be done?
Goodie, Kanzler, Hunter, Glotfelter, & Bodart, 2013
Collaborative Family Healthcare Association 12th Annual Conference

10. Our experience in integrated research
Outcome research
Anxiety
Weight management
HTN
Protocols for integrating BHCs
Integration is intuitive. That alone does not equate with improved patient outcomes
Unique Obstacles

11. 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?
Comorbid pathologies – mental and physical
- we are working w/htn, but pt has depression, thus they do not “do” behavioral strategies. How do we know if behavioral strategies then work?
Working on depression, but has medical conditions – back surgery, this is a huge confound
External vs internal validity
Generalizable in real world settings; Do these interventions have a direct impact on presenting concern?
Messy
Real world application
Recruitment
Organization buy-in
Patient referrals
Different PCPs referred, PCPs also referred difficult patients, relying on other team members for their end, if we assign participants who are interested – there is bias there too; Organic referral process – PCP determines whether they want a “warm hand off” – BHC is seeing both follow-ups; even if every pt was asked – what if comorbidities agreed, while those with simpler said “no” and were not included in study. Of course it is harder ot get movement on measures when there is co-morbidities.
Davis et al., 2013

12. 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
Collaborative Family Healthcare Association 12th Annual Conference

13. “Trident” Approach to Integrated Research
Clinical Interventions
Training/Teaching Holistic Health
Assisting PCPs
“Trident” approach
Assessing brief clinical interventions
Training and teaching medical providers on mind-body connection (ACT philosophy, ACEs study, panic attacks, etc.)
Assisting overworked PCPs to reduce burden

14. 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
Collaborative Family Healthcare Association 12th Annual Conference

15. 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
Collaborative Family Healthcare Association 12th Annual Conference

16. 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
Collaborative Family Healthcare Association 12th Annual Conference

17. Disseminating Your Work
Collaborative Family Healthcare Association 12th Annual Conference

18. Questions? Contact: Stacy Ogbeide: stacy.ogbeide@gmail.com
David Bauman:
Bridget Beachy:
Collaborative Family Healthcare Association 12th Annual Conference

19. Thank you! Session Evaluation
Please complete and return the evaluation form to the classroom monitor before leaving this session.
Thank you!
This should be the last slide of your presentation
Collaborative Family Healthcare Association 12th Annual Conference