title: St. Louis Initiative for Integrated Care Excellence (SLI(2)CE): integrated-collaborative care on a large scale model.
abstract: The primary care health setting is in crisis. Increasing demand for services, with dwindling numbers of providers, has resulted in decreased access and decreased satisfaction for both patients and providers. Moreover, the overwhelming majority of primary care visits are for behavioral and mental health concerns rather than issues of a purely medical etiology. Integrated-collaborative models of health care delivery offer possible solutions to this crisis. The purpose of this article is to review the existing data available after 2 years of the St. Louis Initiative for Integrated Care Excellence; an example of integrated-collaborative care on a large scale model within a regional Veterans Affairs Health Care System. There is clear evidence that the SLI(2)CE initiative rather dramatically increased access to health care, and modified primary care practitioners' willingness to address mental health issues within the primary care setting. In addition, data suggests strong fidelity to a model of integrated-collaborative care which has been successful in the past. Integrated-collaborative care offers unique advantages to the traditional view and practice of medical care. Through careful implementation and practice, success is possible on a large scale model.
authors.affiliation: Department of Mental Health, St. Louis VA Medical Center, St Louis, MO, USA. peter.brawer@va.gov
authors.forename: Peter A
authors.initials: PA
authors.lastname: Brawer
authors.forename: Richard
authors.initials: R
authors.lastname: Martielli
authors.forename: Patrice L
authors.initials: PL
authors.lastname: Pye
authors.forename: Jamie
authors.initials: J
authors.lastname: Manwaring
authors.forename: Anna
authors.initials: A
authors.lastname: Tierney
mesh_terms: D003299:Cooperative Behavior; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D006801:Humans; D007318:Inservice Training / Q000458:organization & administration; D001523:Mental Disorders / Q000175:diagnosis / Q000628:therapy*; D008605:Mental Health Services / Q000458:organization & administration*; D008923:Missouri; D011320:Primary Health Care / Q000458:organization & administration*; D012737:Sex Factors; D012959:Socioeconomic Factors; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration