F V deGruy

University of Colorado at Boulder, Boulder, Colorado, United States

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Publications (38)252.51 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: As the US health care delivery system undergoes rapid transformation, there is an urgent need to define a comprehensive, evidence-based role for the family physician. A Role Definition Group made up of members of seven family medicine organizations developed a statement defining the family physician's role in meeting the needs of individuals, the health care system, and the country. The Role Definition Group surveyed more than 50 years of foundational manuscripts including published works from the Future of Family Medicine project and Keystone III conference, external reviews, and a recent Accreditation Council on Graduate Medical Education Family Medicine Milestones definition. They developed candidate definitions and a "foil" definition of what family medicine could become without change. The following definition was selected: "Family physicians are personal doctors for people of all ages and health conditions. They are a reliable first contact for health concerns and directly address most health care needs. Through enduring partnerships, family physicians help patients prevent, understand, and manage illness, navigate the health system and set health goals. Family physicians and their staff adapt their care to the unique needs of their patients and communities. They use data to monitor and manage their patient population, and use best science to prioritize services most likely to benefit health. They are ideal leaders of health care systems and partners for public health." This definition will guide the second Future of Family Medicine project and provide direction as family physicians, academicians, clinical networks, and policy-makers negotiate roles in the evolving health system.
    The Annals of Family Medicine 05/2014; 12(3):250-5. DOI:10.1370/afm.1651 · 4.57 Impact Factor
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    Susan H McDaniel, Frank V Degruy
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    ABSTRACT: The health care system in the United States has been less effective and more expensive than it needs to be, but the organizational and political will to address these shortcomings is beginning to emerge. These changes are particularly noticeable in primary care, at the heart of an improved health care system. The value of primary care turns on its comprehensiveness, which means that behavioral health care-health behavior change, mental health care, management of psychological symptoms and psychosocial distress, and attention to substance abuse-must be woven into the fabric of primary care practice. This integration is beginning to happen as psychologists and other behavioral health clinicians are incorporated as essential team members in the patient-centered medical home and other emerging models of primary care. This article introduces psychologists to the fundamental changes taking place in primary care and to the various roles that psychologists can play in the new health care system. We describe the extensive breadth and diversity of primary care by age, sex, setting, and type of clinical problem and the implications of this variety for the psychologist's role. This description is not simply a clinical exercise: Transformation of the primary care system also has policy, educational, and research dimensions. We describe how psychologists are essential to these functions as well. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
    American Psychologist 05/2014; 69(4):325-31. DOI:10.1037/a0036222 · 6.87 Impact Factor
  • C J Peek, Deborah J Cohen, Frank V Degruy
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    ABSTRACT: Across the United States, primary care practices are engaged in demonstration projects and quality improvement efforts aimed at integrating behavioral health and primary care. Efforts to make sustainable changes at the frontline of care have identified new research and evaluation needs. These efforts enable clinics and larger health care communities to learn from demonstration projects regarding what works and what does not when integrating mental health, substance use, and primary care under realistic circumstances. To do this, implementers need to measure their successes and failures to inform local improvement processes, including the efforts of those working on integration in separate but similar settings. We review how new research approaches, beyond the contributions of traditional controlled trials, are needed to inform integrated behavioral health. Illustrating with research examples from the field, we describe how research traditions can be extended to meet these new research and learning needs of frontline implementers. We further suggest that a shared language and set of definitions for the field (not just for a particular study) are critical for the aggregation of knowledge and learning across practices and for policymaking and business modeling. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
    American Psychologist 05/2014; 69(4):430-42. DOI:10.1037/a0036223 · 6.87 Impact Factor
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    ABSTRACT: Special patient populations can present unique opportunities and challenges to integrating primary care and behavioral health services. This article focuses on four special populations: children with special needs, persons with severe and persistent mental illness, refugees, and deaf people who communicate via sign language. The current state of primary care and behavioral health collaboration regarding each of these four populations is examined via Doherty, McDaniel, and Baird's (1996) five-level collaboration model. The section on children with special needs offers contrasting case studies that highlight the consequences of effective versus ineffective service integration. The challenges and potential benefits of service integration for the severely mentally ill are examined via description of PRICARe (Promoting Resources for Integrated Care and Recovery), a model program in Colorado. The discussion regarding a refugee population focuses on service integration needs and emerging collaborative models as well as ways in which refugee mental health research can be improved. The section on deaf individuals examines how sign language users are typically marginalized in health care settings and offers suggestions for improving the health care experiences and outcomes of deaf persons. A well-integrated model program for deaf persons in Austria is described. All four of these special populations will benefit from further integration of primary care and mental health services. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
    American Psychologist 05/2014; 69(4):377-87. DOI:10.1037/a0036220 · 6.87 Impact Factor
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    ABSTRACT: Because a high percentage of primary care patients have behavioral problems, patient-centered medical homes (PCMHs) that wish to attain true comprehensive whole-person care will find ways to integrate behavioral health services into their structure. Yet in today's health care environment, the incorporation of behavioral services into primary care is exceptional rather than usual practice. In this article, we discuss the components considered necessary to provide sustainable, value-added integrated behavioral health care in the PCMH. These components are to: (1) combine medical and behavioral benefits into one payment pool; (2) target complex patients for priority behavioral health care; (3) use proactive onsite behavioral "teams;" (4) match behavioral professional expertise to the need for treatment escalation inherent in stepped care; (5) define, measure, and systematically pursue desired outcomes; (6) apply evidence-based behavioral treatments; and (7) use cross-disciplinary care managers in assisting the most complicated and vulnerable. By adopting these 7 components, PCHMs will augment their ability to achieve improved health in their patients at lower cost in a setting that enhances ease of access to commonly needed services.
    The Annals of Family Medicine 03/2014; 12(2):172-5. DOI:10.1370/afm.1619 · 4.57 Impact Factor
  • Frank Verloin DeGruy, Rebecca S Etz
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    ABSTRACT: The foundation of the U.S. healthcare system is faulty, and the consequences have become inescapable (Committee of Quality of Health Care in America, 2001). We are first among nations in spending on healthcare, whether measured in absolute dollars, per capita expenditures, or proportion of our national budget. Yet our citizens are the least healthy in the developed world. (Anderson & Hussey, 2001) Our nation's healthcare system is simply not a high-quality system. This shortfall is serious enough to cause tens of thousands of unnecessary deaths each year and to compromise our capacity for further economic growth (Anderson & Hussey, 2001; Anderson, Frogner, Johns, & Reinhardt, 2006; Macinko, Starfield, & Shi, 2003), yet it ramifies into so many of our political, financial, and social institutions that change is difficult and fraught with serious unintended consequences.
    Families Systems & Health 12/2010; 28(4):298-307. DOI:10.1037/a0022049 · 1.04 Impact Factor
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    ABSTRACT: A tool kit was developed to help primary care physicians overcome some of the barriers to recognition and management of depression. Tools were collected from a variety of sources, categorized by function, and evaluated on the basis of previously established criteria, with the best tools selected for inclusion in the tool kit. New tools were developed when an adequate tool for a desired function was not available. The tool kit was reviewed and then revised based on the feedback from eleven experts on depression in primary care, five medical directors from health care systems or managed care companies, and eighteen primary care physicians. All eighteen primary care physicians completed a questionnaire after reviewing the tool kit as part of the evaluation process. Only five of the eighteen physicians were using any kind of tool for depression prior to reviewing the tool kit. All eighteen physicians indicated that they were likely to use one or more of the components of the tool kit. On average, physicians indicated they were likely to use 6.5 of the ten types of tools included in the kit. A depression tool kit containing screening, diagnostic, management planning, and outcomes assessment questionnaires as well as treatment and counseling guidelines, information tables, flow charts, and patient education materials is likely to be well received by primary care physicians. However, its effectiveness may have as much to do with how its use is organized and implemented as it does with the intrinsic value of its components.
    The International Journal of Psychiatry in Medicine 02/2000; 30(2):99-110. · 0.81 Impact Factor
  • Frank V. Degruy
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    ABSTRACT: To take advantage of the services of mental health professionals, primary care physicians must improve their flexibility, communication, and teamwork. All parties must be willing to surrender a measure of autonomy and control, but the result is worth the effort.
    New Directions for Mental Health Services 02/1999; DOI:10.1002/yd.23319998106
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    ABSTRACT: To determine the association between severity of sexual abuse and psychiatric or medical problems in a sample of female patients from primary care medical settings and to assess the relationship between sexual abuse severity and health-related quality of life before and after controlling for the effects of a current psychiatric or medical diagnosis. Structured interview and self-report questionnaire. Three family practice outpatient clinics. A total of 252 women selected by somatization status using a screen for unexplained physical symptoms. Patient assessment after administering the Medical Outcomes Study 36-item Short-Form Health Survey and self-report medical problems questionnaire; the quality-of-life scale developed by Andrews and Withey; Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, diagnoses and symptom counts from the Diagnostic Interview Schedule; the Dissociative Experiences Scale; and the modified Dissociative Disorders Interview Schedule. A history of sexual abuse is associated with substantial impairment in health-related quality of life and a greater number of somatized symptoms (P < .001), medical problems (P < .01), and psychiatric symptoms and diagnoses (P < .001). In regression analyses, sexual abuse severity was a significant predictor of high scores on 6 of the 8 subscales of the Medical Outcomes Study Short-Form Health Survey (P < .05) and all of the quality-of-life subscales developed by Andrews and Withey (P < .01), with average decrements of up to 0.41 SDs for moderately abused women and 0.56 SDs for severely abused women. Furthermore, sexual abuse severity remained a significant predictor of high scores on the subscales mental health (P < .05), social functioning (P < .05), and quality of life (P < .05), even after adjusting for the presence of several common psychiatric diagnoses. Female primary care patients with a history of sexual abuse have more physical and psychiatric symptoms and lower health-related quality of life than those without previous abuse. In addition, a linear relationship exists between the severity of sexual abuse and impairment in health-related quality of life, both before and after controlling for the effects of a current psychiatric diagnosis.
    Archives of Family Medicine 01/1999; 8(1):35-43. DOI:10.1001/archfami.8.1.35
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    ABSTRACT: To determine if there is a core subset of depressive symptoms that could be used to efficiently diagnose depression after administering the 2-item PRIME-MD a screening questionnaire for depression. One thousand patients selected randomly and by convenience from 4 primary care clinics were assessed by PRIME-MD and completed a questionnaire measuring the following validation variables: functional status and well-being, disability days, somatic symptoms, depression severity, suicidal thoughts, health care utilization, and the physician-patient relationship. Four symptoms (sleep disturbance, anhedonia, low self-esteem, and decreased appetite) accounted for virtually all the depression symptom-related variance in functional status and well-being, with 8.3% of patients having 2 of these symptoms and 8.2% having 3 or 4 of these symptoms. There was excellent agreement between diagnosis based on core symptoms and major depression (K= 0.77; overall accuracy rate, 94%). There were significant differences (P<.001) among patients with negative depression screen, 0 to 1, 2, and 3 to 4 core symptoms with scores on each of the validation variables getting progressively worse in these 4 groups. A cutoff point of 2 core symptoms identified all but 3 patients with major depression and an additional 5% of the entire sample without major depression who were significantly (P<.05) worse than patients without depression on each of the validation variables. A strategy that includes the use of a 2-item depression screener followed by the evaluation of 4 core depressive symptoms is an efficient and effective way of identifying and classifying primary care patients with depression in need of clinical attention.
    Archives of Internal Medicine 12/1998; 158(22):2469-75. DOI:10.1001/archinte.158.22.2469 · 13.25 Impact Factor
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    ABSTRACT: Sexual abuse is a common problem among female primary care medical patients. There is a wide spectrum of long-term sequelae, ranging from mild to the complex symptom profiles consistent with the theories of a posttraumatic sense of identity. Generally, the latter occurs in the context of severe, chronic abuse, beginning in childhood and often compounded by the presence of violence, criminal behavior, and substance abuse in the family of origin. In this study we search for empirical evidence for the existence of a complex posttraumatic stress syndrome in 99 women patients at 3 family practice outpatient clinics who report a history of sexual abuse. A structured interview was administered by trained female interviewers to gather data on family history and psychiatric symptoms and diagnoses. Empirical evidence from cluster analysis of the data supports the theory of a complex posttraumatic syndrome. The severity gradient based on symptoms roughly parallels the severity gradient based on childhood abuse and sociopathic behavior and violence in the family of origin, with the most severely abused subjects characterized by symptom patterns that fit the description of a complex posttraumatic stress syndrome.
    General Hospital Psychiatry 08/1998; 20(4):214-24. DOI:10.1016/S0163-8343(98)00021-8 · 2.90 Impact Factor
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    ABSTRACT: Current DSM-IV somatoform diagnoses may inadequately capture many somatizing patients in primary care. By using data from two studies (1,000 and 258 patients, respectively), the authors determined 1) the optimal threshold on a checklist of 15 physical symptoms to screen for a recently proposed somatoform diagnosis, multisomatoform disorder (MSD), and 2) the concordance between MSD and somatization disorder. The optimal threshold for pursuing a diagnosis of MSD was seven or more physical symptoms. The majority (88%) of the patients who met criteria for MSD had either full or abridged somatization disorder. MSD was intermediate between abridged and full somatization disorder in terms of its association with functional impairment, psychiatric comorbidity, family dysfunction, and health care utilization and charges.
    Psychosomatics 05/1998; 39(3):263-72. DOI:10.1016/S0033-3182(98)71343-X · 1.67 Impact Factor
  • Frank Verloin deGruy
    General Hospital Psychiatry 12/1997; 19(6):391-4. DOI:10.1016/S0163-8343(97)00069-8 · 2.90 Impact Factor
  • E G Holland, F V Degruy
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    ABSTRACT: Recent estimates suggest that each year more than 1 million patients are injured while in the hospital and approximately 180,000 die because of these injuries. Furthermore, drug-related morbidity and mortality are common and are estimated to cost more than $136 billion a year. The most common type of drug-induced disorder is dose-dependent and predictable. Many adverse drug events occur as a result of drug-drug, drug-disease or drug-food interactions and, therefore, are preventable. Clinicians' awareness of the agents that commonly cause drug-induced disorders and recognition of compromised organ function can significantly decrease the likelihood that an adverse event will occur. Patient assessment should include a thorough medication history, including an analysis of all prescribed and over-the-counter medications, vitamins, herbs and "health-food" products to identify drug-induced problems and potentially reversible conditions. An increased awareness among clinicians of drug-induced disorders should maximize their recognition and minimize their incidence.
    American family physician 12/1997; 56(7):1781-8, 1791-2. · 1.82 Impact Factor
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    ABSTRACT: For clinical or research use in primary care, the DSM-IV diagnostic criteria for somatization disorder are too restrictive, while the criteria for undifferentiated somatoform disorder are overly inclusive. In this article, we examine the validity of multisomatoform disorder, defined as 3 or more medically unexplained, currently bothersome physical symptoms plus a long (> or = 2 years) history of somatization. Data from the Primary Care Evaluation of Mental Disorders Study of 1000 patients from 4 primary care sites were analyzed. The outcomes assessed were 6 domains of health-related quality of life, using the 20-item Short-Form General Health Survey; self-reported disability days and health care use; satisfaction with care; and physician-rated difficulty of the encounter. Multisomatoform disorder was diagnosed in 82 (8.2%) of the 1000 patients who were enrolled in the Primary Care Evaluation of Mental Disorders Study. Compared with mood and anxiety disorders, multisomatoform disorder was associated with comparable impairment in health-related quality of life, more self-reported disability days and clinic visits, and greater clinician-perceived patient difficulty. Multisomatoform disorder may be a valid diagnosis and potentially more useful than the DSM-IV diagnosis of undifferentiated somatoform disorder. Also, because multisomatoform disorder has a large and independent effect on impairment, its diagnosis should not be precluded simply because of a coexisting mood or anxiety disorder.
    Archives of General Psychiatry 05/1997; 54(4):352-8. · 13.75 Impact Factor
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    ABSTRACT: This paper reviews recent developments in assessing and treating major depression in primary care practice and proposes needed research directions for the coming years. Topics warranting attention include the predictive validity of psychiatric nomenclatures specific to general medical settings; the impact of patient, clinician, and system factors on the physician's assessment of major depression; the relationship between diagnostic and treatment decisions; and the course of this disorder when treated in primary care facilities by generalists or specialists.
    General Hospital Psychiatry 12/1996; 18(6-18):395-406. DOI:10.1016/S0163-8343(96)00093-X · 2.90 Impact Factor
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    ABSTRACT: Recently there has been increased interest in the special mental health needs of women. We used data from the PRIME-MD 1000 study to assess gender differences in the frequency of mental disorders in primary care settings, and to explore the potential impact of these differences on health-related quality of life (HRQL). One thousand primary care patients (559 women) were interviewed during the PRIME-MD study, which was conducted at four primary care clinics affiliated with university hospitals throughout the eastern United States. Patients completed a one-page questionnaire in the waiting room prior to being seen by the physician; patients and physicians then completed together a clinician evaluation guide that used DSM-III-R algorithms to diagnose mood, anxiety, somatoform, eating, and alcohol related disorders. Health-related quality of life was assessed with the Medical Outcomes Study SF-20 General Health Survey. Women were more likely than men to have at least one mental disorder (43% versus 33%, P < 0.05). Higher rates were particularly prominent for mood disorders (31% of women versus 19% of men, odds ratio [OR] = 1.9, 95% confidence interval [CI] 1.4 to 2.6), anxiety disorders (22% versus 13%, OR = 1.9, CI = 1.3 to 2.8), and somatoform disorders (18% versus 9%, OR = 2.2, CI = 1.5 to 3.4). Psychiatric comorbidity was also more common in women (26% of women had two or more mental disorders versus 15% of men, P < 0.05). Unadjusted HRQL scores, ranging from 0 to 100, with 100 = best health, were all significantly lower in women than in men (eg, physical function = 67 in women versus 76 in men, P < 0.0001; mental health = 69 in women versus 76 in men, P < 0.0001). Many HRQL differences persisted after controlling for age, education, ethnicity, marital status, and number of physical disorders; however, differences in HRQL were eliminated in 5 of 6 domains after controlling for number of mental disorders. When compared with female patients of male physicians, female patients of female physicians demonstrated similar satisfaction with care, health care utilization, HRQL, and recognition rate of mental disorders. In the 1,000 patients of the PRIME-MD study, mood, anxiety, and somatoform disorders and psychiatric comorbidity were all significantly more common in women than men. The HRQL scores were poorer in women than men, although most of this difference was accounted for by the difference in prevalence of mental disorders. These data suggest that one of the most important aspects of a primary care physician's care of female patients is to screen for and treat common mental disorders.
    The American Journal of Medicine 11/1996; 101(5):526-33. DOI:10.1016/S0002-9343(96)00275-6 · 5.30 Impact Factor
  • JAMA The Journal of the American Medical Association 07/1996; 275(24):1884. · 30.39 Impact Factor
  • Journal of General Internal Medicine 06/1996; 11(7):441-442. DOI:10.1007/BF02600197 · 3.42 Impact Factor
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    ABSTRACT: To determine the proportion of primary care patients who are experienced by their physicians as "difficult," and to assess the association of difficulty with physical and mental disorders, functional impairment, health care utilization, and satisfaction with medical care. Survey. Four primary care clinics. Six-hundred twenty-seven adult patients. Physician perception of difficulty (Difficult Doctor-Patient Relationship Questionnaire), mental disorders and symptoms (Primary Care Evaluation of Mental Disorders, [PRIME-MDI]), functional status (Medical Outcomes Study Short-Form Health Survey [SF-20]), utilization of and satisfaction with medical care by patient self-report. Physicians rated 96 (15%) of their 627 patients as difficult (site range 11-20%). Difficult patients were much more likely than not-difficult patients to have a mental disorder (67% vs 35% [corrected], p < .0001). Six psychiatric disorders had particularly strong associations with difficulty: multisomatoform disorder (odds ratio [OR] = 12.3. 95% confidence interval [CI] = 5.9-26.8), panic disorder (OR = 6.9, 95% CI = 2.6-18.1), dysthymia (OR = 4.2, 95% CI = 2.0-8.7), generalized anxiety (OR = 3.4, 95% CI = 1.7-7.1), major depressive disorder (OR = 3.0, 95% CI = 1.8-5.3), and probable alcohol abuse or dependence (OR = 2.6, 95% CI = 1.01-6.7). Compared with not-difficult patients, difficult patients had more functional impairment, higher health care utilization, and lower satisfaction with care, whereas demographic characteristics and physical illnesses were not associated with difficulty. The presence of mental disorders accounted for a substantial proportion of the excess functional impairment and dissatisfaction in difficult patients. Difficult patients are prevalent in primary care settings and have more psychiatric disorders, functional impairment, health care utilization, and dissatisfaction with care. Future studies are needed to determine whether improved diagnosis and management of mental disorders in difficult patients could diminish their excess disability, health care costs, and dissatisfaction with medical care, as well as the physicians experience of difficulty.
    Journal of General Internal Medicine 02/1996; 11(1):1-8. DOI:10.1007/BF02603477 · 3.42 Impact Factor

Publication Stats

3k Citations
252.51 Total Impact Points

Institutions

  • 2014
    • University of Colorado at Boulder
      Boulder, Colorado, United States
  • 2010
    • University of Colorado
      • Department of Family Medicine
      Denver, Colorado, United States
  • 1988–1999
    • University of South Alabama
      • College of Medicine
      Mobile, Alabama, United States
  • 1995
    • Albert Einstein College of Medicine
      New York City, New York, United States