Does anyone remember the Hostess commercials of
the 1990s that included this important question: where’s the cream filling? Or about how the famous line of Wendy’s commercials that
included this query: where’s the beef?
A similar question arose in my mind as I recently completed a systematic review
of Integrated Primary Care empirical articles for my dissertation: where’s the family?
|As many of you know, Integrated Primary Care (IPC)
can be an effective way for teaming up medical and behavioral health providers
in treating primary care patients who struggle with behavioral health issues
(e.g., depression, anxiety, substance use, treatment adherence). In practice,
there is significant diversity in how IPC is delivered (e.g., psychoeducation,
psychopharmacology, telehealth, psychotherapy) and by whom (e.g., physicians,
nurses, psychiatrists, psychologists, social workers, marriage and family
therapists). There is also growing evidence that IPC is cost-effective
as well. ||Where's the |
But during my review of these IPC articles, I kept wondering
why there was so little
family-oriented IPC research. Out of the 112 articles I reviewed, I only found one study in which researchers
mentioned anything about including family members (Reiss-Brennan, Briot,
Savitz, Cannon, & Staheli, 2010). This was very surprising to me especially
considering the evidence that nearly 75% of all deaths in the US may largely be
attributed to unhealthy lifestyles (Mokdad, Marks, Stroup, & Gerberding,
2004) and a healthy or unhealthy lifestyle is usually developed, maintained, or
changed within the family setting (McDaniel, Campbell, Hepworth, & Lorenz,
2005). Moreover, there is strong evidence that demonstrates a bi-directional relationship
between family relationships and health (Kiecolt-Glaser, 1999; Kiecolt-Glaser
& Newton, 2001). This paucity of
family-oriented care in IPC is especially ironic given that many primary care
sites have names like "Family Medical Center” or "Family Health Center” and
that many primary care providers are family physicians. So, what gives? Why is
there little research being done on family-oriented IPC?
is certainly a push for family-centered care (FCC), albeit not always in primary
care settings. These two hospitals, St. Jude and the Children’s Hospital of
Central California, provide solid models for FCC.
And consider the mission of the Institute for Patient- and
Family-Centered Care which is an organization that offers ideas for implementing
FCC into primary care. See here and here for PDF documents. Also,
the National Alliance for Mental Illness has provided a guide for families who are being treated at
integrated sites (2011). See here for a PDF document. There’s
some great stuff out there for FCC!
of the ideas from IPFCC, NAMI, and the previously mentioned hospitals center on
including family members as advisors and consultants in treatment planning.
Sounds great but why does it seem like there is a disconnect between these
great ideas and the clinical and research worlds of IPC? How can primary care
providers (both medical and behavioral health) push for more family-friendly
integrated care? And how can this more effectively be shared with the
scientific community via research? Reflect on these ideas:
- Medical and behavioral health providers who are trained in
family- and systems- oriented approaches should be actively involved in not
only including family members in treatment but in also publishing their work
through papers and presentations.
- These same providers can, during consultation/collaboration,
purposefully help other professionals to consider the role of family members in
treating a patient.
- It would be very helpful to develop core competencies for
training health professionals to include family members in IPC. Such
competencies can be very helpful for training as well as for standardizing
Kiecolt-Glaser, J. K. (1999). Stress, personal
relationships, and immune function: Health implications. Brain, Behavior, and Immunity, 13, 61-72.
Kiecolt-Glaser, J. K., & Newton, T. L. (2001). Marriage
and health: His and hers. Psychological
Bulletin, 127, 472-503. doi:10.1037/0033-2909.127.4.472
McDaniel, S. H., Campbell, T. L., Hepworth, J., &
Lorenz, A. (2005).Family-oriented primary care. New York:
Mokdad, A. H., Marks, J. S., Stroup, D. F., &
Gerberding, J. L. (2004). Actual causes of death in the united states, 2000.
The Journal of the American Medical Association,291(10), 1238-1245.
National Alliance on Mental Illness (2011). A Family
Guide: Integrating Mental Health and Pediatric Primary Care. Arlington, VA: Retrieved from National
Alliance on Mental Illness website: http://www.nami.org/Content/ContentGroups/CAAC/FG-Integrating.pdf
Reiss-Brennan, B., Briot, P., Savitz, L., Cannon, W., &
Staheli, R. (2010). Cost and quality impact of Intermountain's Mental Health
Integration program. Journal of Healthcare Management, 55(2), 97-113.
Matt Martin is a licensed marriage and family therapist and
is currently working as a post-doctoral fellow with the Chicago Center for
Family Health and the Illinois Masonic Family Practice Residency Program. He
received a master’s degree in MFT from Brigham Young University and just
recently completed requirements for a PhD from East Carolina University. His
interests include integrated primary care, behavioral health, and family
medicine residency education.