Assessing Family Medicine Physicians’ Perceptions of Integrated Behavioral Health in a Primary Care Residency

Abstract

Background and Objectives: Physicians are increasingly confronted with patients’ interrelated psychosocial and physiological issues. To assist physicians in managing the psychosocial needs of patients, integrated behavioral health (IBH) has become increasingly common. This study was completed in a large, Midwestern family medicine residency program where the authors sought to (1) identify physicians’ perceptions of IBH implementation and areas of needed IBH improvement, and (2) recognize educational needs to be addressed when providing behavioral health training to resident physicians. Methods: The authors utilized a pre/post design to measure physician perception of access and quality of an integrated behavioral health program. For quantitative data, we performed standard descriptive statistics, likelihood ratio χ2 tests, independent sample t test, and linear mixed-model analysis. For qualitative data, we completed phenomenological analysis, derived from a focus group. Results: Physician satisfaction with access and quality of behavioral health services significantly improved after the implementation of the IBH (P<.01). Perception of behavioral health management also improved, including the commitment of the residency program to mental health well-being, benefit from consultations with BHPs, and physician ownership of managing patients’ mental health needs. Themes from the focus group indicated a desire for increased communication with BHPs, as well as additional assessment and intervention skills to manage psychiatric disorders. Conclusions: Family physicians value IBH in supporting patients’ behavioral health treatment, and resident physicians hone behavioral health management skills through collaborating with BHPs and completing behavioral health training. Residencies should increase focus on teaching essential skills in behavioral health management.

Integrated Behavioral Health Implementation and Training in Primary Care: A Practice-Based Research Network Study

“…Our findings support prior reports that IBH may improve patient and clinician satisfaction, outcomes, access, and timely treatment for behavioral health concerns. 22,[37][38][39][40][41][42][43] Likewise, the results reinforce documentation of barriers found in prior studies such as inadequate staffing (BHPs and care managers), limited access to psychiatric consultation, organizational and financial barriers, patient insurance challenges, and stigma. 30,[44][45][46][47][48] Our findings have important implications for gaining organizational buy-in and support, which may require increased preparedness with data to justify upfront expenses (like office space or salary) when seeking to hire a BHP or invest in a psychiatrist.…”

The Association Between Depression and Substance Use Among Primary Care Patients With Comorbid Medical and Behavioral Health Conditions

“…These findings suggest that primary care providers might consider any patient at potential risk for substance use problems, regardless of demographic factors. 65,66 Future research might address some of the limitations inherent in the present study. Enhancements would feature a prospectively designed study of primary care patients with depression, substance use, or both disorders; more systematic tracking of mood and substance use symptoms over multiple timepoints; and, measuring outcomes of interventions that target both types of problems among complex chronic patients.…”

“…These findings suggest that primary care providers might consider any patient at potential risk for substance use problems, regardless of demographic factors. 65,66…”

Clinical Efforts Double Disparity for Nonphysician URiM Faculty: Implications for Academic Family Medicine

“…21,22,36,37 Therefore, previously proposed changes to ACGME's requirements on protected time and the definition of core faculty would have reversed the established benefits from the integration of pharmacy, behavioral health, and family physicians. 34,[38][39][40][41][42][43] Importantly, if we are to successfully recruit, retain, and develop URiM academic FM faculty, then we must properly support them, especially with equitable time and compensation for their efforts. The future of our country's health and health care depends on it.…”