Moving behavioral medicine to the front line: A model for the integration of behavioral and medical sciences in primary care.

Abstract

Psychologists have an unprecedented opportunity to influence primary medical care systems where chronic conditions, somatic symptoms, and health-threatening behaviors are prevalent. The authors developed a new model to incorporate behavioral medicine expertise into existing primary care practice with the purpose of delivering integrated, comprehensive, and efficient health care through physician training and direct patient care services. This model moves psychologists from isolated referral settings to the front line of medical care, where a broader impact on the outcomes and costs of health care can be achieved.In today's era of reform and managed care, the primary care clinic is emerging as the dominant context for health care delivery. Declining referrals to specialty clinics pressure primary care physicians to manage more patients and an expanding spectrum of patient problems. Because of these changes in health care, an unprecedented window of opportunity exists for psychologists with behavioral medicine expertise to influence primary care services. There is an opening for psychologists to expand their roles to fit the current trends in health care.Most of the problems presenting in primary care clinics cannot adequately be addressed from an exclusively biomedical framework. Chronic illnesses, somatic symptoms, and healththreatening behaviors are common and indicate the need for a more comprehensive approach to care. For example, an estimated 68% of middle-aged adults and 88% of elderly persons SHEW D. PRUITT received her PhD from the University of New Mexico in 1990.

General practice, primary care, and health service psychology: Concepts, competencies, and the Combined‐Integrated model

“…Because an estimated "25% of all primary care visits are for psychosocial-psychiatric needs that compromise health status" (Twilling, Sockell, & Sommers, 2000, p. 685), intervention strategies often include behavioral and psychoeducational approaches, which focus on skill building and lifestyle/habit modification (Siegel, 1993). Psychological interventions in primary care address health compromising behaviors as well as problems associated with chronic conditions and somatic symptoms (Pruitt et al, 1998). Clinical services that impact health status via pathways other than mental health include intervention for pain management, adherence to medical regimens, development of healthy habits, and management of stressful medical procedures (McDaniel et al, 2002).…”

“…As primary care clinics emerge as the dominant context for the delivery of health care services, primary care physicians are often managing patients with an expanding spectrum of problems, which often are not adequately addressed by an exclusively biomedical approach (Pruitt et al, 1998). That is, the biomedical focus of medical education has not fully prepared primary care physicians to address the more complex behavioral issues underlying many somatic complaints, chronic conditions, and health-threatening behaviors (Longlett & Kruse, 1992).…”

“…Psychologists, on the other hand, are trained to assess the behavioral, mental, and emotional status and needs of patients as well as the behavioral-management difficulties experienced with patient care. Additionally, professional psychologists are trained to provide a variety of clinical services, from individual treatment with patients to consultation and training of interdisciplinary team members (Pruitt et al, 1998).…”

The patient-centered medical home: Unprecedented workforce growth potential for professional psychology.

“…Behavioral health professionals must be prepared to incorporate myriad interventions routinely to address behavioral medicine issues, including chronic illness management, modification of disease risk through health behavior change, and adherence to prescribed medical and behavioral regimens (Beacham, Hoodin, Sieber, Ponkshe, & Goodie, 2008;Blount, 2003;Hoodin, Beacham, Alschuler, & Bierenbaum, 2008;Pruitt, Klapow, Epping-Jordan, & Dresselhaus, 1998).…”

Behavioral Pain Management for Pediatric Headache in Primary Care

“…pressure from managed care, providing behavioral health services in primary-care environments is needed to provide a coordinated continuum of health care (Haley et al, 1998;Pruitt et al, 1998).…”