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Integrated primary care services have grown in popularity in recent years and demonstrated significant benefits to the patient experience, patient health, and health care operations. However, broader systems-level factors for health care organizations, such as utilization, access, and cost, have been understudied. The current study reviews the results of quality improvement project conducted by the U.S. Air Force, which has practiced integrated primary care behavioral health for over 20 years. This study focuses on exploring how shifting the access point for behavioral from specialty mental health clinics to primary care, along with the use of technicians in patient care, can improve a range of health outcomes. Retrospective data analysis was conducted on an internal Air Force quality improvement project implemented at three military treatment facilities from October 2014 to September 2015. Positive preliminary support for these innovations was seen in the form of expanded patient populations, decreased time to first appointment, increased patient encounters, and decreased purchased community care compared with non-participating sites. Incorporation of behavioral health technicians further increased number of patient encounters while maintaining high levels of patient satisfaction across diverse clinical settings; in fact, patients preferred appointments with both technicians and behavioral health providers, compared with appointments with behavioral health providers only. These findings encourage further systematic review of systems-level factors in primary care behavioral health and adoption of the use of provider extenders in primary care behavioral health clinics.

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INTRODUCTION: Much of behavioral health care takes place within primary care settings rather than in specialty mental health settings. Access to specialty mental health care can be difficult due to limited access to mental health providers and wait times to receive mental health care. The purpose of this study is to determine patient satisfaction with behavioral health consultation visits that take place within the context of the primary care behavioral health consultation model. Patient likelihood to seek out specialty mental health care services if behavioral health consultation services were not provided was also examined. METHOD: Two primary care clinic systems were examined in this study. The first was a primary care clinic predominately serving low-income patients: 100 individuals participated. The second was primary care in the context of military treatment centers: 539 individuals participated. RESULTS: Results show that 61% of the patients in the low-income primary care clinic would not attend a specialty mental health appointment versus 30% in the military population. DISCUSSION: This study suggests that primary care behavioral health is a patient-centered approach to care and reaches populations that otherwise may not receive behavioral health services. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

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Through fine-tuning of reagent and base structure, sulfonyl fluorides can efficiently fluorinate diverse classes of alcohols. We show that machine learning can map the intricate reaction landscape and enable accurate prediction of high-yielding conditions for untested substrates.

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We report a redox-neutral formylation of aryl chlorides that proceeds through selective 2-functionalization of 1,3-dioxolane through nickel and photoredox catalysis. This scalable benchtop approach provides a distinct advantage over traditional reductive carbonylation in that no carbon monoxide, pressurized gas, or stoichiometric reductant is employed. The mild conditions give unprecedented scope from abundant and complex aryl chloride starting materials.

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BACKGROUND: Integrated primary care behavioral health (PCBH) is a growing trend in health care delivery, particularly in the Department of Defense and the Department of Veterans Affairs. This consultative model has been applied within the U.S. Air Force for over 15 years and has demonstrated positive health impacts and patient satisfaction. With extended conflicts and engagements, including Operation Enduring Freedom and Operation Iraqi Freedom, deployment behavioral health care has expanded and positively received, but there is less empirical support of particular models of care in a deployed environment. Brief, solution-focused strategies commonly utilized in PCBH are likely to be particularly good candidates for the deployed environment. One key feature the Air Force's PCBH program is the collaborative team-based approach to care centered around a patient and driven by a primary care manager. This study expands the evaluation of the Air Force's PCBH program to include its novel application in a combat setting. METHOD: A retrospective review of 516 archival patient satisfaction surveys across Air Force military treatment facilities utilizing a PCBH program compared patient satisfaction surveys collected in a deployed environment at a large combat support hospital to noncombat facilities. FINDINGS: Results indicated that patient satisfaction in theater was comparable to satisfaction at Air Force military treatment facilities in noncombat environments, with one exception; patients seen in garrison rated higher satisfaction with the treatment plan than those seen in a deployed setting, F(509) = 5.36, p < 0.01, consistent with limited resources available in theater. DISCUSSION: Given patient satisfaction across settings was found to be relatively equivalent, results suggests that the PCBH consultation model may be an appropriate model of care to meet a majority of the population's needs for a deployed environment. This pilot study has implications not only for military combat environments, but other austere settings, including civilian rural mental health settings. These findings inform provision of care in a deployed environment by demonstrating the benefits of the primary care behavioral model. Additionally, the Department of Veterans Affairs and other federal health care agencies will benefit from reviewing the structured and standardized PCBH model employed by the U.S. Air Force for nearly two decades as they expand care in rural mental health settings across the country.

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BACKGROUND: Research has shown significant contribution of integrated behavioural health care; however, less is known about the perceptions of primary care providers towards behavioural health professionals. OBJECTIVE: The current study examined barriers to care and satisfaction with integrated behavioural health care from the perspective of primary care team members. DESIGN: This study utilized archival data from 42 treatment facilities as part of ongoing program evaluation of the Air Force Medical Service's Behavioral Health Optimization Program. SETTING: This study was conducted in a large managed health care organization for active duty military and their families, with specific clinic settings that varied considerably in regards to geographic location, population diversity and size of patient empanelment. STUDY PARTICIPANTS: De-identified archival data on 534 primary care team members were examined. RESULTS: Team members at larger facilities rated access and acuity concerns as greater barriers than those from smaller facilities (t(533) = 2.57, P < 0.05). Primary Care Managers (PCMs) not only identified more barriers to integrated care (ß = -0.07, P < 0.01) but also found services more helpful to the primary care team (t(362.52) = 1.97, P = 0.05). Barriers to care negatively impacted perceived helpfulness of integrated care services for patients (ß = -0.12, P < 0.01) and team members, particularly among non-PCMs (ß = -0.11, P < 0.01). CONCLUSIONS: Findings highlight the potential benefits of targeted training that differs in facilities of larger empanelment and is mindful of team members' individual roles in a Patient Centered Medical Home. In particular, although generally few barriers were perceived, given the impact these barriers have on perception of care, efforts should be made to decrease perceived barriers to integrated behavioural health care among non-PCM team members.

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The expansion of integrated, collaborative, behavioral health services in primary care requires a trained behavioral health workforce with specific competencies to deliver effective, evidence-informed, team-based care. Most behavioral health providers do not have training or experience working as primary care behavioral health consultants (BHCs), and require structured training to function effectively in this role. This article discusses one such training program developed to meet the needs of a large healthcare system initiating widespread implementation of the primary care behavioral health model of service delivery. It details the Department of Defense's experience in developing its extensive BHC training program, including challenges of addressing personnel selection and hiring issues, selecting a model for training, developing and implementing a phased training curriculum, and improving the training over time to address identified gaps. Future directions for training improvements and lessons learned in a large healthcare system are discussed.

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The copper-catalyzed H-F insertion into α-diazocarbonyl compounds is described using potassium fluoride (KF) and hexafluoroisopropanol. Access to complex α-fluorocarbonyl derivatives is achieved under mild conditions, and the method is readily adapted to radiofluorination with [(18)F]KF. This late-stage strategy provides an attractive route to (18)F-labeled biomolecules.

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We report an inexpensive, thermally stable deoxyfluorination reagent that fluorinates a broad range of alcohols without substantial formation of elimination side products. This combination of selectivity, safety, and economic viability enables deoxyfluorination on preparatory scale. We employ the [(18)F]-labeled reagent in the first example of a no-carrier-added deoxy-radiofluorination.

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