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Behavioral health primary care integration

Health Factors: Quality of Care
Decision Makers: Healthcare Professionals & Advocates
Evidence Rating: Scientifically Supported
Population Reach: 100% of WI's population
Impact on Disparities: Likely to decrease disparities

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Description

Integrating behavioral health into primary care practice brings mental health and/or substance abuse screenings and treatments into a primary care setting. These efforts can include coordination between primary care providers, case managers or behavioral health consultants, and mental health specialists (e.g., psychiatrists), and often, require training and redefinition or realignment of staff roles (SAMHSA-HRSA Integrate, CG-Mental health). Mental health conditions and substance abuse issues often occur with other chronic medical conditions; patients with severe conditions are referred to specialty care (SAMHSA-HRSA Integrate).

Expected Beneficial Outcomes

Improved mental health
Increased adherence to treatment
Improved quality of life
Increased patient engagement
Reduced drug and alcohol use

Evidence of Effectiveness

There is strong evidence that integrating behavioral health into primary care practice improves mental health (ICER-Tice 2015, Cochrane-Bower 2011), especially depression symptoms (ICER-Tice 2015, CG-Mental health, Butler 2011, Gilbody 2006a). Integrating care also increases patients’ adherence to treatment, improves their quality of life (Thota 2012), and increases satisfaction (ICER-Tice 2015) and engagement with health care providers (Wissow 2013).

Integrating depression screening and treatment into primary care has been shown to improve depression symptoms for adolescent, adult, and elderly patients (CG-Mental health, Butler 2008). Such care appears effective in various settings, including practices with limited resources and practices in rural and urban areas (CG-Mental health, Berger-Jenkins 2012, Serrano 2011).

Collaborative care approaches  that use case managers to organize and integrate behavioral and primary care improve response to treatment, increase remission and recovery from symptoms, and increase satisfaction with care among patients with depression in the short- and long-term (CG-Mental health, Gilbody 2006a). Coordination which includes regular and planned psychiatrist supervision of case managers has been shown to be more effective than efforts with unplanned supervision (Gilbody 2006a). For patients suffering from chronic pain and substance abuse disorders in addition to depression, multiple interventions in primary care settings (e.g., motivational interviewing and cognitive behavioral therapy) may more effectively improve mental health and reduce drug and alcohol use than a single intervention (Haibach 2014).

Universal mental health screening during pediatric appointments can increase parent, youth, and primary care provider willingness to discuss mental health concerns. Framing screening as universal, confidential, and designed to improve communication may further support patient and family engagement (Wissow 2013).

Economic studies indicate that integrating behavioral health and primary care to treat depression is associated with greater costs and better health outcomes than traditional care models. Overall, studies have shown integrated care to be cost effective in terms of quality adjusted life years (QALYs) saved (CG-Mental health).

Implementation

United States

There are several models to integrate behavioral health into primary care practice. The AIMS center at the University of Washington and the DIAMOND program in Minnesota are two examples. AIMS’ Collaborative Care model to treat depression and anxiety is based on five core principles: patient-centered team care, population-based care, measurement-based treatment to target, evidence-based care, and accountable care (AIMS-Collaborative care). This model utilizes a core team of primary care providers, behavior health providers or case managers, and psychiatrist consultants (Raney 2015, ICER-Tice 2015). The DIAMOND program uses these same components for patients with depression, changing both how care is delivered and how it is paid for (ICSI-DIAMOND).

Wisconsin

The Wisconsin Initiative to Promote Healthy Lifestyles supports integration of behavioral screening and intervention services in primary care settings across the state to address substance use, depression, or obesity concerns. All patients are systematically screened and patients with moderate concerns receive brief interventions from health educators; those with more serious conditions are referred to more intensive treatments (WIPHL).

Implementation Resources

AHRQ-Integrate - Agency for Healthcare research and Quality (AHRQ). The Academy: Integrating behavioral health and primary care. Accessed on January 26, 2016
AIMS-Collaborative care - Collaborative Care. Advancing Integrated Mental Health Solutions (AIMS). University of Washington. Accessed on March 15, 2016
ICSI-DIAMOND - DIAMOND for depression. Institute for Clinical Systems Improvement (ICSI). Accessed on March 29, 2016
SAMHSA-HRSA Integrate - Integrate behavioral health into primary care. SAMHSA-HRSA Center for Integrated Health Solutions. Accessed on March 15, 2016
WIPHL - Wisconsin Initiative to Promote Healthy Lifestyles (WIPHL). Accessed on January 25, 2016

Citations - Description

CG-Mental health - The Guide to Community Preventive Services (The Community Guide). Mental health. Accessed on December 19, 2016
SAMHSA-HRSA Integrate - Integrate behavioral health into primary care. SAMHSA-HRSA Center for Integrated Health Solutions. Accessed on March 15, 2016

Citations - Evidence

Berger-Jenkins 2012* - Berger-Jenkins E, McCord M, Gallagher T, Olfson M. Effect of routine mental health screening in a low-resource pediatric primary care population. Clinical Pediatrics. 2012;51(4):359-65. Accessed on January 26, 2016
Butler 2008 - Butler M, Kane RL, McAlpine D, et al. Integration of mental health/substance abuse and primary care. Rockville: Agency of Healthcare Research and Quality (AHRQ); 2008. Accessed on January 26, 2016
Butler 2011* - Butler M, Kane RL, McAlpine D, et al. Does integrated care improve treatment for depression: A systematic review. The Journal of Ambulatory Care Management. 2011;34(2):11-25. Accessed on March 15, 2016
CG-Mental health - The Guide to Community Preventive Services (The Community Guide). Mental health. Accessed on December 19, 2016
Cochrane-Bower 2011* - Bower P, Knowles S, Coventry, PA, Rowland N. Counselling for mental health and psychosocial problems in primary care: Review. Cochrane Database of Systematic Reviews. 2011;(9):CD001025. Accessed on March 15, 2016
Gilbody 2006a* - Gilbody S, Bower P, Fletcher J, Richards D, Sutton AJ. Collaborative care for depression: a cumulative meta-analysis and review of longer-term outcomes. Archives of Internal Medicine. 2006;166(21):2314-21. Accessed on January 25, 2016
Haibach 2014* - Haibach JP, Beehler GP, Dollar KM, Finnell DS. Moving toward integrated behavioral intervention for treating multimorbidity among chronic pain, depression, and substance-use disorders in primary care. Medical Care. 2014;52(4):322-27. Accessed on March 15, 2016
ICER-Tice 2015 - Tice JA, Ollendorf DA, Reed SJ, et al. Integrating behavioral health into primary care. Institute for Clinical and Economic Review (ICER); 2015. Accessed on March 7, 2016
Serrano 2011 - Serrano N, Monden K. The effect of behavioral health consultation on the care of depression by primary care clinicians. WMJ. 2011;110(3):113-119. Accessed on January 26, 2016
Thota 2012* - Thota AB, Sipe TA, Byard GJ, et al. Collaborative care to improve the management of depressive disorders: a community guide systematic review and meta-analysis. American Journal of Preventive Medicine. 2012;42(5):525-38. Accessed on March 15, 2016
Wissow 2013 - Wissow LS, Brown J, Fothergill KE, et al. Universal mental health screening in pediatric primary care: A systematic review. Journal of the American Academy of Child and Adolescent Psychiatry. 2013;52(11):1134-1147.e23. Accessed on March 15, 2016

Citations - Implementation

AIMS-Collaborative care - Collaborative Care. Advancing Integrated Mental Health Solutions (AIMS). University of Washington. Accessed on March 15, 2016
ICER-Tice 2015 - Tice JA, Ollendorf DA, Reed SJ, et al. Integrating behavioral health into primary care. Institute for Clinical and Economic Review (ICER); 2015. Accessed on March 7, 2016
ICSI-DIAMOND - DIAMOND for depression. Institute for Clinical Systems Improvement (ICSI). Accessed on March 29, 2016
Raney 2015* - Raney LE. Integrating primary care and behavioral health: The role of the psychiatrist in the collaborative care model. 2015;172(8): 721-728. Accessed on March 7, 2016
WIPHL - Wisconsin Initiative to Promote Healthy Lifestyles (WIPHL). Accessed on January 25, 2016

Page Last Updated

August 28, 2015

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