Graduation Year

2019

Document Type

Dissertation

Degree

D.P.H.

Degree Name

Doctor of Public Health (Dr.PH.)

Degree Granting Department

Community and Family Health

Major Professor

Bruce Lubotsky Levin, Dr.PH.

Committee Member

Marion A. Becker, Ph.D., R.N.

Committee Member

Donorah Martinez Tyson, Ph.D.

Committee Member

Oliver T. Massey, Ph.D.

Committee Member

Julie A. Baldwin, Ph.D.

Keywords

Behavioral Health, Case Study, Mental Health, System Integration

Abstract

Introduction: The integration of physical and behavioral health services is an innovative method of delivering health care services for persons dual or triply diagnosed with HIV, mental health and/or substance use disorders. Reducing the fragmented delivery of health services by integrating services into one setting is essential to providing holistic patient-centered care and address the complex health needs of this population. Although research shows integrated care improves health outcomes, little is known about the implementation of integrated care in real-world settings because the perspectives and experiences of those delivering and receiving integrated health and social services are underrepresented in the literature.

Objectives: To accomplish the study aims, a mixed-methods case study was used: Aim 1: Describe the degree of integrated care in a community-based organization that provides physical and behavioral health services, as well as social services to people living with HIV in the geographical area. Aim 2: Identify and document the experience and perceptions of staff and service users in a newly integrated care setting. Aim 3: Describe the implementation of Integrated Care using the Consolidated Framework for Implementation Research (CFIR) as a lens to organize and integrate the survey and interview data.

Setting: This study took place in a community-based non-profit organization in West Central Florida that recently integrated HIV medical care, primary care, and psychiatric medication management, and on-site pharmacy services for their service users.

Design: Using a mixed-methods case study design, this research was completed in two phases. In phase 1, the organization’s staff completed a survey aimed to understand at what level of service integration they achieved. Staff (n = 17) and service users (n = 48) completed a survey to document their perspectives and experiences. In phase 2, semi-structured interviews with staff (n = 10) and service users (n = 13) were used to complement and expand the phase 1 data, describe and compare staff and service users’ experiences, and explore the complex issues associated with integrated care health service delivery for people living with HIV. Using template analysis, interview data were analyzed deductively, using the consolidated framework for implementation research, and inductively, allowing themes to emerge from the data.

Results: The key findings of this study show that overall, the organization was functioning at level four of the six levels of integration. The Level of Integration Measures (LIM) and interview data showed that staff and service users shared similar perspectives about the level of integrated care provided, with both groups perceiving a high level of service integration. Staff and service users valued the advantages of providing and receiving health and social services in one setting. Findings suggest service users were satisfied with the quality of services and the competency of providers in their healthcare setting. Facilitators of integrated care included structural characteristics such as proximity of provider offices within the community-based organization’s locations and specific services offered, such as transportation for service users to and from clinical appointments. Challenges to higher levels of integration included lack of staff education and training in interdisciplinary care and lack of a centralized electronic health system for recording and sharing service user data. Additional research is needed to explore levels of integration and their association with health outcomes and quality of life for people living with HIV.

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