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Table 2 Descriptions of Integrated Primary Care System

From: Understanding collaborative care implementation in the Department of Veterans Affairs: core functions and implementation challenges

Theme CM Site EMBED Site
Same Day Access “And then we also have NPs, psychiatric NPs available, 2 or 3, depending on our staffing levels, who see walk-in patients with medication needs, and they also refer to care management” [Primary Care Psychologist]
“In the VA system I’m in, they have a behavioral health counselor…if I feel they need to be seen in Psychiatry, I filter through her. And it’s actually fabulous. She is right in the same building as me. I can say, “Hey, BHC. Can you do me a favor? This guy, I’m afraid if we send him home right now, he’s going not follow up,” and she says, ‘I’ll get that at two o’clock. I’ve got a one o’clock. Tell him whatever.’ Fabulous - she works him in.” [Primary Care Provider]
“We actually have a mental health nurse practitioner… within our primary care clinic and they are available to see patients who really need, you know, mental health evaluation or intervention that day.” [Physician’s Assistant]
“…a primary care patient…gets screened by the LPN when they come in…they asked the generic questions of depression screening…if they trigger positive then they let us know as the providers….if they seem like they need to be referred or if they seem like they are at risk immediately, then we have the luxury…of having a nurse practitioner and a mental health team available in our primary care area. So we can…evaluate that patient the same day.” [Nurse Practitioner]
Support for Primary Care Providers around mental health assessments, referrals, treatment planning, and psychiatric medications “…[referring to an embedded psychologist] then she assesses, ‘Hey, [PCP], I think maybe you were overestimating,’ or ‘Yeah, I think you’re accurate. This person needs Psychiatry, this person needs SATP [Substance Abuse Treatment Program], this person should be treated at the PTSD clinic.” [Primary Care Doctor]
“So I’m an embedded or co-located MH provider in PC, and so each one of our PC [providers] …has one behavioral health provider embedded, and so we all would refer to the care management program.” [Primary Care Psychologist]
“…so if the primary care provider can’t or doesn’t feel comfortable managing the depression…then they would contact the primary care mental health nurse practitioner.” [Physician’s Assistant]
“So, if the provider, the primary care provider, is, you know, after they assess the patient and if they’ve determined that this is something that can be managed, that they’re comfortable managing in primary care, that’s one route that they’ll go. And so, you know, they would prescribe the med and then set up a follow-up, typically phone with their PACT nurse” [Physician’s Assistant]
  1. Note. BHC behavioral health counselor, PCP primary care provider, MH mental health, PACT patient aligned care team