March 10, 2017
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Integrating behavioral health and primary care beneficial for patients

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Combining primary care and behavioral health services led to better patient experiences and lowered the severity of patients’ depression, according to research published in the Journal of the American Board of Family Medicine.

“Prior research on integrated behavioral health and primary care has focused on efficacy or effectiveness studies conducted under research-driven experimental conditions where homogeneity between practices and tight control are desired,” Bijal A. Balasubramanian, MBBS, PhD, department of epidemiology, human genetics and environmental services, University of Texas School of Public Health, and colleagues wrote. “This study extends our previous research by demonstrating that among community practices implementing integrated care strategies relevant to their local setting and context, depression severity improved and patients perceived tangible benefits of integrated care.”

Researchers used a convergent mixed-methods design, merging findings from a quasi-experimental study involving interviews with 475 patients from five different practices, including three primary care practices and two mental health care centers. Each practice took a different approach in integrating primary care and behavioral health. These practices were also part of Advancing Care Together, a community demonstration project that developed an innovation incubator for practices implementing evidence-based integration strategies. The patients all had scores of 10 or greater on the Patient Health Questionnaire-9 at baseline. The patients spent an average of 6 to 9 months in the cohort, and averaged between 2.3 to 3.6 visits.

Balasubramanian and colleagues observed statistically significant reductions in mean scores in all practices, ranging from 2.72 to 6.46 points. Clinically, 50% of patients had a 5 or greater point reduction in their score and 32% had a reduction of 50% or greater.

“This finding was corroborated by patient interviews that demonstrated positive experiences with behavioral health clinicians and acquiring new skills to cope with adverse situations at work and home,” they wrote. They said these situations included managing relationships, anger and grief, finding solutions to manage everyday events and knowing when to reach out for additional help from the behavioral health clinician.

Researchers also indicated that the three primary care practices devoted their attention to providing care for the whole person; patients at these locations had lower questionnaire scores. The two community medical health centers focused mainly on patients with ongoing, serious mental illness, as well as combining substance and medical use care.

“Integration is a worthwhile investment; clinical leaders, policymakers, and payers should support integration in their communities,” Balasubramanian and colleagues concluded.

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“Findings from this study, together with a robust body of evidence from randomized controlled trials, makes a compelling case for practices to adopt integrated care and for payers to make this model feasible through finance reform.”

Previous research has suggested that changing management strategies and using targeted data collections are just some of the important items that need to be addressed when combining primary care with behavioral health. – by Janel Miller


Disclosure: The researchers report no relevant financial disclosures.