Researchers identify several barriers to integration of behavioral health in primary care
Physicians face cultural, informational and financial barriers to integrating behavioral health services into their primary care practices in the United States, according to a qualitative analysis published in Annals of Internal Medicine.
“There is high-quality evidence to suggest that behavioral health integration improves patient outcomes, and there have been important national health policy changes over the past decade to increase behavioral health integration,” Peggy Chen, MD, MSc, MPH, physician policy researcher at the RAND Corporation and a board-certified pediatrician, told Healio Primary Care. “We wanted to understand why, given these factors, most physician medical practices have yet to successfully adopt behavioral health integration.”
Researchers conducted semi-structured telephone interviews with 72 participants — including 47 leaders and clinicians from medical practices that implemented behavioral health integration; 20 experts in clinical care, research or health policy related to behavioral health integration; and 5 vendors that provide behavioral telehealth services or technical integration assistance to medical practices.
Chen and colleagues said the physician practices were their primary focus in the analysis, and they questioned leaders and clinicians about their approach to integrating behavioral health, its cost and barriers to its implementation. The experts and vendors provided additional nuance and context for the study.
Four themes materialized from these discussions, according to the researchers:
- Reasons for integrating behavioral health included boosting access to behavioral health services, improving other clinicians' abilities to react to patients' behavioral health needs and enhancing practice reputation.
- Practices tailored their implementation of behavioral health integration to local resources, financial incentives and patient populations.
- Barriers to behavioral health integration included cultural differences and incomplete information flow between behavioral and nonbehavioral health clinicians on patients’ electronic health records as well asbilling difficulties.
- Practices described the advantages and disadvantages of fee-for-service and alternative payment models, and few reported positive financial returns.
Chen said that to overcome cultural differences between behavioral and nonbehavioral clinicians, practices should offer interprofessional training with both behavioral and nonbehavioral clinicians. training.
In addition, “EHR limitations can be addressed by ensuring that regulatory requirements are appropriately interpreted to allow for efficient information flow between behavioral and nonbehavioral health clinicians,” she continued. “Also, larger practices were sometimes able to dedicate financial and human resources to ensuring that the EHR system was well suited capturing care provided using a behavioral health integration approach. This was also beneficial to information sharing.”
Clinicians who participate in fee-for-service models should ensure that the logistics and workflow of the practice can handle additional steps that would allow effective use of behavioral health integration codes, according to Chen. Clinicians who use alternative payment models should make sure that staff and resources are available for any reporting requirements that might be needed, she said.
Chen added that clinicians should “consider the context of their practice and the resources available to them to ensure they identify the model of behavioral health integration that is optimal for their practice.”
The findings provide compelling evidence to enhance the well-being of patients, according to Sue Bornstein, MD, executive director of the Texas Medical Home Initiative in Dallas. She wrote in related editorial that Chen and colleagues’ paper “provides excellent insights to continue our sacred work to improve care of the whole person.”
- Bornstein S. Ann Intern Med. 2020;doi:10.7326/M20-2887.
- Malâtre-Lansac A, et al. Ann Intern Med. 2020;doi:https://doi.org/10.7326/M20-0132.