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Where's the Family in Integrated Primary Care?

Posted By Matt Martin, Tuesday, September 4, 2012

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.
Matt Martin
Where's the
cream filling?


Where's the
beef?


Where's the
family?

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?

There 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!

Most 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 family-centered treatment.

References:

Kiecolt-Glaser, J. K. (1999). Stress, personal relationships, and immune function: Health implications. Brain, Behavior, and Immunity, 13, 61-72. doi:10.1006/brbi.1999.0552

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: Springer.

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. doi:10.1001/jama.291.10.1238

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.


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