Skip to main content

Main menu

  • Home
  • Current Issue
  • Content
    • Current Issue
    • Early Access
    • Multimedia
    • Podcast
    • Collections
    • Past Issues
    • Articles by Subject
    • Articles by Type
    • Supplements
    • Plain Language Summaries
    • Calls for Papers
  • Info for
    • Authors
    • Reviewers
    • Job Seekers
    • Media
  • About
    • Annals of Family Medicine
    • Editorial Staff & Boards
    • Sponsoring Organizations
    • Copyrights & Permissions
    • Announcements
  • Engage
    • Engage
    • e-Letters (Comments)
    • Subscribe
    • Podcast
    • E-mail Alerts
    • Journal Club
    • RSS
    • Annals Forum (Archive)
  • Contact
    • Contact Us
  • Careers

User menu

  • My alerts

Search

  • Advanced search
Annals of Family Medicine
  • My alerts
Annals of Family Medicine

Advanced Search

  • Home
  • Current Issue
  • Content
    • Current Issue
    • Early Access
    • Multimedia
    • Podcast
    • Collections
    • Past Issues
    • Articles by Subject
    • Articles by Type
    • Supplements
    • Plain Language Summaries
    • Calls for Papers
  • Info for
    • Authors
    • Reviewers
    • Job Seekers
    • Media
  • About
    • Annals of Family Medicine
    • Editorial Staff & Boards
    • Sponsoring Organizations
    • Copyrights & Permissions
    • Announcements
  • Engage
    • Engage
    • e-Letters (Comments)
    • Subscribe
    • Podcast
    • E-mail Alerts
    • Journal Club
    • RSS
    • Annals Forum (Archive)
  • Contact
    • Contact Us
  • Careers
  • Follow annalsfm on Twitter
  • Visit annalsfm on Facebook
Article CommentaryDepartments

A Randomized Trial of a Practice-Level Intervention for Integrated Primary and Behavioral Health Care

Andrew S. Detty and Michael E. Johansen
The Annals of Family Medicine November 2023, 21 (6) 567; DOI: https://doi.org/10.1370/afm.3065
Andrew S. Detty
Grant Family Medicine
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Michael E. Johansen
Grant Family Medicine
MD, MS
Roles: Associate Editor
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • eLetters
  • Info & Metrics
  • PDF
Loading

The Annals of Family Medicine encourages readers to develop a learning community to improve health and health care through enhanced primary care. With the Annals Journal Club, we encourage diverse participants—particularly among students, trainees, residents, and interns—to think critically about and discuss important issues affecting primary care, and even consider how their discussions might inform their practice.

HOW IT WORKS

The Annals provides discussion tips and questions related to one original research article in each issue. We welcome you to post a summary of your conversation to our eLetters section, a forum for readers to share their responses to Annals articles. Further information and links to previous Annals Journal Club features can be found on our website.

CURRENT SELECTION

Littenberg B, Clifton J, Crocker AM, et al. A cluster randomized trial of primary care practice redesign to integrate behavioral health for those who need it most: patients with multiple chronic conditions. Ann Fam Med 2023;21:483-495. 10.1370/afm.3027

Discussion Tips

Many Americans with chronic medical conditions also have behavioral health conditions, including mental illness and substance use disorders. Even the distinction between medical and behavioral health conditions reflects historically siloed systems of care. Integrating behavioral health care into primary care practices allows health care teams to meet the physical and behavioral health needs of patients in 1 setting. The study authors evaluate the effectiveness of a toolkit designed to enhance behavioral health integration in primary care, in a pragmatic, cluster randomized control trial including 42 primary care practices. Their primary outcomes were self-reported physical, mental, and social function and well-being among patients with chronic conditions.

Discussion Questions

  • What question is asked by this study and why does it matter?

  • How does this study advance beyond previous research and clinical practice on this topic?

  • What is a cluster randomized controlled trial (RCT)? Why do we see these often in the primary care literature?

  • What is a pragmatic trial? How strong is the study design for answering the question?

  • Based on the inclusion criteria and patient characteristics, how comparable is the study sample to similar patients in your practice or region? What is your judgment about the transportability of the findings?

  • What is the Patient-Reported Outcomes Measurement Information System (PROMIS-29)?

    • ◦ How would you determine the validity of this and other instruments whose scores were used as outcome measures?

  • What are the main study findings?

  • To what degree can the findings be accounted for by:

    1. Meaningful differences, if any, between intervention and control practices or patients (see Tables 1 and 2)

    2. The duration of the intervention

    3. The COVID-19 pandemic

    4. The inclusion criteria for patients and practices in the study

    5. The recruitment process for participating practices and patients

  • What is a Bonferroni correction? Why are these used in statistical analyses? Did these adjustments impact the outcomes of the study?

  • How do you interpret exploratory analyses?

  • How might this study change your practice? Policy? Education? Research?

  • Who are the constituencies for the findings, and how might they be engaged in interpreting or using the findings?

  • What are the next steps in interpreting or applying the findings?

  • © 2023 Annals of Family Medicine, Inc.
PreviousNext
Back to top

In this issue

The Annals of Family Medicine: 21 (6)
The Annals of Family Medicine: 21 (6)
Vol. 21, Issue 6
November/December 2023
  • Table of Contents
  • Index by author
  • Plain Language Summaries
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on Annals of Family Medicine.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
A Randomized Trial of a Practice-Level Intervention for Integrated Primary and Behavioral Health Care
(Your Name) has sent you a message from Annals of Family Medicine
(Your Name) thought you would like to see the Annals of Family Medicine web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
4 + 13 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
Citation Tools
A Randomized Trial of a Practice-Level Intervention for Integrated Primary and Behavioral Health Care
Andrew S. Detty, Michael E. Johansen
The Annals of Family Medicine Nov 2023, 21 (6) 567; DOI: 10.1370/afm.3065

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Get Permissions
Share
A Randomized Trial of a Practice-Level Intervention for Integrated Primary and Behavioral Health Care
Andrew S. Detty, Michael E. Johansen
The Annals of Family Medicine Nov 2023, 21 (6) 567; DOI: 10.1370/afm.3065
Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • HOW IT WORKS
    • CURRENT SELECTION
  • eLetters
  • Info & Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

Departments

  • What do Primary Care Patients Want?
  • Support for the WHO Resolution on Social Participation
  • STFM Announces New Point of Care Ultrasound Task Force and Initiative on POCUS Family Medicine Education
Show more Departments

Annals Journal Club

  • What do Primary Care Patients Want?
  • Vocal Recognition of Depression?
  • Treating Depression With Trauma-Informed Care in Chile
Show more Annals Journal Club

Similar Articles

Content

  • Current Issue
  • Past Issues
  • Early Access
  • Plain-Language Summaries
  • Multimedia
  • Podcast
  • Articles by Type
  • Articles by Subject
  • Supplements
  • Calls for Papers

Info for

  • Authors
  • Reviewers
  • Job Seekers
  • Media

Engage

  • E-mail Alerts
  • e-Letters (Comments)
  • RSS
  • Journal Club
  • Submit a Manuscript
  • Subscribe
  • Family Medicine Careers

About

  • About Us
  • Editorial Board & Staff
  • Sponsoring Organizations
  • Copyrights & Permissions
  • Contact Us
  • eLetter/Comments Policy

© 2025 Annals of Family Medicine