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The United States is facing a social isolation and loneliness crisis. In response, the US Surgeon General issued an advisory in May 2023 recommending actions that health care, community programs, and social services can take to collaboratively improve social connection. Primary care has a critical role to play in implementing the Surgeon General's recommendations. We present social isolation and loneliness as medical issues and highlight next steps for the primary care sector to combat this epidemic. https://doi.org/10.1370/afm.3102, Annals Early Access article INTRODUCTION The Social Isolation and Loneliness Epidemic Social isolation and loneliness have gained significant attention in recent years and are increasingly recognized as urgent health issues [...]

Integrating behavioral health into primary care can improve access to behavioral health and patient health outcomes. We used 2017-2021 American Board of Family Medicine continuing certificate examination registration questionnaire responses to determine the characteristics of family physicians who work collaboratively with behavioral health professionals. With a 100% response rate, 38.8% of 25,222 family physicians reported working collaboratively with behavioral health professionals, with those working in independently owned practices and in the South having substantially lower rates. Future research exploring these differences could help develop strategies to support family physicians implement integrated behavioral health to improve care for patients in these communities. Key words: behavioral medicine; integration of care; mental health services; primary health care https://doi.org/10.1370/afm.2947, INTRODUCTION The complexity of patients presenting in primary care continues to grow with an estimated 1 in 3 adults in the United States presenting with multiple chronic conditions. (1) The [...]

Introduction: Integrating behavioral health in primary care improves quality of care and outcomes for patients with comorbid conditions. Shortage of a trained behavioral health workforce limits adoption. Professional psychology training programs contribute to recruitment, retention, and development of skilled providers, who value and deliver behavioral health services in primary care. This study interviewed a cohort of established psychology training programs in real-world, state-wide clinical primary care settings and identified their strategies and challenges with teaching practices and program resources that impact the robust quality of training. Method: Between December 2020 and March 2021, we conducted semistructured interviews with 12 licensed psychologists who oversaw nine integrated primary care psychology training programs at the internship and postdoctoral levels across Washington State. Data were analyzed using a thematic approach. Results: Programs taught psychology trainees about integrated primary care via extensive onboarding, modeling and shadowing, structured learning environment, interprofessional education opportunities, flexible and cross-disciplinary supervision, and a psychologically safe space. Teaching challenges included balancing scheduled and curbside supervision, pivoting to telehealth, and aligning trainee expectations and program requirements. Training programs were funded through different and multiple sources, but most lacked a stable funding mechanism, compounded by barriers for psychology trainees to bill for services, a lack of control over organization's budgeting decisions, and instability in funding renewal. Conclusion: Synergistic support from program, organization, and system/policy levels are needed to align teaching activities with clinical practice environments and invest in the growth and sustainability of psychology training programs on integrated primary care. Keywords: behavioral health, integrated primary care, interprofessional education, psychology, workforce, Integrated primary care, in which teams of medical providers and their behavioral health counterparts work closely together to address population health needs, has emerged in response to calls for a [...]

Context: Digital therapeutics may be uniquely positioned to address challenges reported by providers in chronic pain (CP) management. Previous studies have shown patient-provider discordance in priorities for CP management, which can be addressed in digital therapeutics development to encourage implementation and use. Objective: To assess primary care providers' and patients' perceptions of CP treatment goals and motivators for use of a digital therapeutic delivering CP related behavioral interventions. Study Design: Quantitative surveys. Setting: Participants were recruited from four primary care clinics in Washington and Colorado, two patient support groups, and one research community stakeholder group. Population Studied: The sample included 31 patients and 39 providers. Most patients identified as male (61.3%), non-Hispanic White (96.8%) and had experienced pain for one year or longer (90.3%). A mix of provider roles were included: primary care providers (46.2%), behavioral health providers (41.0%), clinical pharmacists (5.1%), and nurses (5.1%). All providers had experience treating patients with CP. Outcomes: Participants rated 10 CP treatment goals (e.g., quality of life, self-management skills) and 11 motivators for use (e.g., coaching, insurance payment coverage) of digital therapeutics on a 5-point Likert-scale. Descriptive statistics and Chi- Square tests were computed. Results: Patients and providers differed in their perceptions of importance across all treatment goals. Patients' ratings of treatment goals ranged from least to very important, whereas providers uniformly rated all treatment goals as very or extremely important (p < .05), and provider ratings of importance were consistently higher than patients (p < .05). Patients and providers on average did not rate motivators for use very high and they differed in their perceptions across six specific motivators. Providers rated friend recommendations and coaching features as more likely to motivate use than patients did (p < .05). Providers tended to rate more uniformly than patients on motivators related to insurance covering most of the cost, it being recommended by a provider or friend, and if the program was personalized with coaching (p < .05). Conclusions: Incorporating digital therapeutics in routine primary care may help improve CP management by providing customizable features that address diverse treatment goals, and bridge differing perspectives between providers and patients., Presenters Kari Stephens, PhD, Kris (Pui Kwan) Ma, PhD, Ying Zhang, MD, MPH, Maria Prado, MPH, Margaret Au, Rachel Geyer, MPH, Brenda Mollis, MA, MPA, MPH, Susan Zbikowski, PhD, Deanna [...]

Context: Digital therapeutics are growing as a solution to improve access and quality of care. Increasing evidence has shown the efficacy of digital therapeutics in managing pain for patients, but they are underutilized by primary care providers who see over half of the patients with chronic pain. Engaging providers to develop and use digital therapeutics with patients in chronic pain management has become necessary. Objective: This study explored primary care providers' challenges and strategies in chronic pain management to identify needs and practice gaps that inform development of digital therapeutics for chronic pain. Study Design: Qualitative study, using a human-centered design approach. Setting: Eleven providers from four primary care clinics in Washington and Colorado participated in semi-structured interviews between July and October 2021. Population Studied: The sample (N=11) included seven primary care physicians, two behavioral health providers, one physician assistant and one nurse. Most providers worked in clinics affiliated with urban, academic health systems or in federally qualified health centers. Outcomes: Interviews focused on provider goals in chronic pain management, challenges and strategies used, and perceptions of digital therapeutics. Results: Four themes related to provider needs emerged: patient-provider alliance, team-based care, tracking and monitoring, and social determinants of health. Providers desired resources to streamline pain education, counseling, and goal setting with patients. Greater accessibility to multidisciplinary care team consultations and non-pharmacological pain treatments would be beneficial to providers and patients. Infrastructure and systems are needed for providers to systematically track and monitor patients' pain. Providers requested assistance with connecting underserved patients to wraparound social services and addressing healthcare access barriers. Conclusion: Digital therapeutics for chronic pain would benefit from incorporating multimodal features that strengthen patient-provider alliance, increase access to non-pharmacological treatment options, support population health tracking and management, and provide equitable solutions that require lower sophistication of device and Internet access. Leveraging digital therapeutics in healthcare settings requires meeting provider needs at individual care and system levels., Presenters Kris (Pui Kwan) Ma, PhD, Ying Zhang, MD, MPH, Maria Prado, MPH, Rachel Geyer, MPH, Brenda Mollis, MA, MPA, MPH, Susan Zbikowski, PhD, Deanna Waters, MA, Jo Masterson, MBA, [...]

PURPOSE Six key elements of opioid medication management redesign in primary care have been previously identified. Here, we examine the effect of implementing these Six Building Blocks on opioid-prescribing practices. METHODS Six rural-serving organizations with 20 clinic locations received support for 15 months during the period October 2015 to May 2017 to implement the Six Building Blocks. Patients undergoing long-term opioid therapy (LtOT) at these study sites were compared with patients undergoing LtOT enrolled in a regional health plan who did not receive care at the study sites but who resided in the same primary care service areas (control group). Outcomes were monthly trend in the proportion of patients undergoing LtOT prescribed a >100 morphine equivalent dose (MED) of opioids daily and the total number of patients receiving an opioid prescription. An interrupted time series using difference- indifference analysis was used for tests of significance. RESULTS The proportion of patients prescribed a >100 MED of opioids daily decreased 2.2% (11.8% to 9.6%) among patients at the intervention clinics and 1.3% (14.0% to 12.7%) among patients in the control group. The rate of decrease was significantly greater among study patients than among patients in the control group (P = .018). The rate of decrease in the number of patients on LtOT at intervention clinics increased during the intervention period compared with the preintervention period (P CONCLUSIONS Efforts to redesign opioid medication management in primary care resulted in a significant decrease in opioid prescribing. Future research is needed to determine if these results are generalizable to other settings and to assess implications for patient-reported outcomes., INTRODUCTION Use of opioid medication long term for chronic pain has contributed to an epidemic of opioid overdose and addiction. (1) Although rates of opioid prescribing have moderated in recent [...]

This study evaluates the effectiveness of a theoretically based rape prevention intervention with college men who were at high or low risk to perpetrate sexually coercive behavior. Participants (N = 146) are randomly assigned to the intervention or control group. Outcomes include rape myth acceptance, victim empathy, attraction to sexual aggression, sex-related alcohol expectancies, and behavioral indicators, measured across three time points. Positive effects are found for rape myth acceptance, victim empathy, attraction to sexual aggression, and behavioral intentions to rape. Only rape myth acceptance and victim empathy effects sustain at the 5-week follow-up. High-risk men are generally unaffected by the intervention although low-risk men produced larger effects than the entire sample. Results suggest rape prevention studies must assess risk status moderation effects to maximize prevention for high-risk men. More research is needed to develop effective rape prevention with men who are at high risk to rape. Keywords: rape; prevention; sexual aggression; sexual assault; college men

Explanatory models of sexual aggression were examined among mainland Asian American (n = 222), Hawaiian Asian American (n = 127), and European American men (n = 399). The Malamuth et al. (N. M. Malamuth, D. Linz, C. L. Heavey, G. Barnes, & M. Acker, 1995; N. M. Malamuth, R. J. Sockloskie, M. P. Koss, & J. S. Tanaka, 1991) confluence model of sexual aggression, which posits impersonal sex and hostile masculinity as paths to sexual aggression, was consistently supported. Culture-specific moderators of sexual aggression were also identified. Whereas loss of face was a protective factor against sexual aggression in the Asian American samples, it generally was not a protective factor among European Americans. These findings are not a function of actual or perceived minority status. An implication is that theoretical models may need to be augmented with cultural constructs for optimal application in certain ethnic group contexts. Keywords: sexual aggression, confluence model, Asian Americans, loss of face

Despite the growth of campus rape-prevention programs, the role of individual differences in moderating program effects has been largely ignored. We hypothesized that the effects of anti-rape videotape content--typical of such programs--would depend on men's past sexual coerciveness. After watching an anti-rape or control video, coercive (n = 22) and noncoercive (n = 23) men were compared on attitudes toward women, rape-myth acceptance, and sex-related alcohol expectancies. As hypothesized, effects of the videotape were moderated by coerciveness. For the noncoercives, the anti-rape video resulted in lower rape-myth acceptance and sex-related alcohol expectancy scores than the control video. Coercives--who presumably most need to be deterred--exhibited no such effects. We discuss the relevance of these findings for rape-prevention programs.