Integrated Behavioral Health Care in Viet Nam: Examples from the Hanoi Bach Mai Hospital of Patients with Hypertension

Adimika Smith,Bui Minh Thu,Christina M Clarke,Do Van Thanh,Jennifer Rolfes,Nguyen Thi Huong Giang,Nguyen Thi Lan Anh,Pham Thi Thu Hien,Pham Thi Thu Huong,Ronald R Odonnell,Shiyou Wu

doi:10.15419/ajhs.v8i1.499

Abstract

Objectives: Behavioral conditions contribute to poor clinical outcomes and are not routinely addressed in medical settings in Viet Nam. Few studies focus on the level of integrated care in clinics, the provider ratings of the prevalence of behavioral conditions, the need for a behavioral health consultant (BHC), and patient health risk assessments (HRAs) in Viet Nam. To fill these research gaps, this study aims to explore the level of behavioral health integration in primary care clinics, the provider perceived prevalence of behavioral problems, the need for an expert behavioral health consultant on the primary care team, and the health risks for patients in Viet Nam. Methodology: This study collected first-hand survey data from two healthcare sites, 41 service providers, and 199 patients in Hanoi, Viet Nam. Regression analyses were conducted to examine the relationship between HRA behavioral conditions and each of the biometric health risk factors. Results: The healthcare site and provider survey results showed low levels of integrated health services, provider perceptions of the moderate prevalence of common behavioral conditions, and the need for a BHC to assist in care. In addition, the patient’s HRA results showed an elevated risk of sleep apnea, fruit and vegetable intake, tobacco, alcohol use for men, and poor health literacy. Conclusion: The level of integrated care services is low in Viet Nam, the need for the providers to have a BHC to assist in treatment is moderate, and the patients reported elevated health risks in several areas. The findings demonstrated a pressing need for the development of integrated behavioral health care services in Viet Nam.

Highlights

Non-communicable diseases (NCDs) are increasing globally and account for 82% of NCD-related deaths in low- and middle-income countries 1
To fill these research gaps, this study aims to explore the level of behavioral health integration in primary care clinics, the provider perceived prevalence of behavioral problems, the need for an expert behavioral health consultant on the primary care team, and the health risks for patients in Viet Nam
This review shows that behavioral factors such as poor nutrition, a lack of physical activity, tobacco smoking, alcohol abuse, untreated co-morbid psychiatric disorders, and poor medication adherence largely account for the increase of hypertension in Viet Nam

Summary

Introduction

Non-communicable diseases (NCDs) are increasing globally and account for 82% of NCD-related deaths in low- and middle-income countries 1. Economic transitions in Asia have led to a change from low-calorie, high fiber foods to processed foods that are high in fat, salt, and sugar 3,4. Changes in the workforce have led to more sedentary time and workplace technological changes contribute to decreasing physical activity levels 5–7. Integrated behavioral health, the teambased systemic treatment of NCD, lifestyle, and behavioral (psychiatric and substance use disorder) conditions in medical settings such as primary care clinics, is viewed as an urgent need in Asia 8. Integrated behavioral health interventions are associated with reduced hospital admissions and readmissions, a decreased hospital length of stay, lowered healthcare costs, enhanced adherence to treatment recommendations, and clinical and quality outcomes 9,10. There is no feasible and standardized approach to defining and measuring integrated healthcare in practice 11, resulting in a lack of consensus among stakeholders on the implementation and funding of integrated care globally 12

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Results