Behavioral health referrals and treatment initiation rates in integrated primary care: a Collaborative Care Research Network study

Abstract

Although the benefits of integrating behavioral health (BH) services into primary care are well established (World Health Organization and World Organization of Family Doctors, 2012; Chiles et al. in Clin Psychol-Sci Pr 6:204-220, 1999; Cummings 1997; O'Donohue et al. 2003; Olfson et al. in Health Aff 18:79-93, 1999; Katon et al. in Ann Intern Med 124:917-925, 2001; Simon et al. in Arch Gen Psychiatry 52:850-856, 1995; Anderson et al. in Diabetes Care 24:1069-1078, 2001; Ciechanowski et al. in Arch Intern Med 160:3278-3285, 2000; Egede et al. in Diabetes Care 25:464-470, 2002), research has focused primarily on describing the types of interventions behavioral health providers (BHPs) employ rather than on reasons for referral, treatment initiation rates, or the patient characteristics that may impact them. This study presents the results of a multisite card study organized by The Collaborative Care Research Network, a subnetwork of the American Academy of Family Physicians' National Research Network devoted to conducting practice-based research focused on the provision of BH and health behavior services within primary care practices. The goals of the study included: (1) identifying the characteristics of patients referred for BH services; (2) codifying reasons for referral and whether patients were treated for the referral; (3) exploring any differences between patients who initiated BH contact and those who did not; and (4) assessing the types and frequency of BH services provided to patients who attended at least one appointment. Of the 200 patients referred to a BHP, 81 % had an initial contact, 71 % of which occurred on the same day. Men and women were equally likely to engage with a BHP although the time between appointments varied by gender. Depression and anxiety were the primary reasons for referral. Practice-based research is a viable strategy for advancing the knowledge about integrated primary care.

Variations in Mental Health Diagnosis and Prescribing Across Pediatric Primary Care Practices

“…26,28,30,42,43 Previous studies have found that colocation improved access to mental health care 30,44 and engagement with mental health care providers 31,45 and improved patient satisfaction and outcomes. 46,47 We hypothesized that colocation would result in increased diagnosis and prescribing by bringing expertise with these conditions to the practice and potentially drawing additional children needing these services.…”

“…23 Several practice-level characteristics might affect the primary care delivery of mental health services. In response to family difficulties in accessing mental health specialists, 24,25 primary care practices increasingly include colocated mental health providers, [26][27][28][29][30] a model that may improve access, identification, and treatment. 26,31 Second, practices with higher numbers of patients in foster care may manage more mental health care owing to prevalent psychotropic medication use.…”

“…In response to family difficulties in accessing mental health specialists, 24,25 primary care practices increasingly include colocated mental health providers, [26][27][28][29][30] a model that may improve access, identification, and treatment. 26,31 Second, practices with higher numbers of patients in foster care may manage more mental health care owing to prevalent psychotropic medication use. 18,32 Finally, practices located in communities where mental health providers, particularly psychiatrists, are not available may need to fill this gap by providing psychotropic medication management.…”

Newcomers to Al-Anon family groups: Who stays and who drops out?

“…The lack of referral by health care professionals may contribute to long delays between the beginning of COs' difficulties and their seeking help through Al-Anon (Timko et al, in press). Patients with SUDs who receive enhanced referrals to 12-step groups by health care providers participate more in meetings and have better outcomes (Timko, DeBenedetti, & Billow, 2006; Timko, Sutkowi, Cronkite, Makin-Byrd, & Moos, 2011), and individuals referred by health care providers to behavioral health services follow through with referrals at high rates (over 80%) (Auxier et al, 2012; Healey et al, 2013). Overall, individuals are more likely to become engaged in Al-Anon when attendance is recommended by health care professionals.…”

Integrating Behavioral Health in Primary Care Using Lean Workflow Analysis: A Case Study

“…Prior to 2010, state and national leaders began to explore integrated care as a new model for behavioral and primary care services through special tasks forces on workforce, reimbursement, and population-based service needs, some of which included one of the authors. State policy makers and leading local health insurers started to support changes in traditional behavioral health programs at this time, modestly supporting behavioral health interventions in adult primary care, obstetrics, neurology, and gastroenterology 7,21,22 . These changes allowed primary care services to bill directly for behavioral health services using traditional psychotherapy codes and reduced prior approval requirements for these services.…”