Primary Care Behavioral Health (PCBH) Model Research: Current State of the Science and a Call to Action

Hunter, Christopher L.; Funderburk, Jennifer S.; Polaha, Jodi; Bauman, David; Goodie, Jeffrey L.; Hunter, Christine M.

doi:10.1007/s10880-017-9512-0

Cited by 99 publications

(92 citation statements)

References 63 publications

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“…Primary care settings are integrating behavioral health providers in greater numbers using a variety of clinical models . One model, Primary Care Behavioral Health (PCBH), calls for a Behavioral Health Consultant (BHC) to be included as a full member of the care team and for the BHC to provide treatment according to a primary care model of brief, focused, high‐volume interventions instead of conducting traditional independent psychotherapy sessions . Behavioral Health Consultants in this model are available for same‐day interventions and educate the rest of the team to improve behavioral health knowledge and skills.…”

Section: Introductionmentioning

confidence: 99%

Measuring the integration of primary care and behavioral health services

Mullin

Hargreaves

Auxier

et al. 2019

Health Services Research

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Objective To perform a factor analysis of the Practice Integration Profile (PIP), a 30‐item practice‐level measure of primary care and behavioral health integration derived from the Agency for Healthcare Research and Quality's Lexicon for Behavioral Health and Primary Care Integration. Data Sources The PIP was completed by 735 individuals, representing 357 practices across the United States. Study Design The study design was a cross‐sectional survey. An exploratory factor analysis and assessment of internal consistency reliability via Cronbach's alpha were performed. Data Collection Methods Participant responses were collected using REDCap, a secure, web‐based data capture tool. Principal Findings Five of the PIP's six domains had factor loadings for most items related to each factor representing the PIP of 0.50 or greater. However, one factor had items from two PIP domains that had loadings >0.50. A five‐factor model with redistributed items resulted in improved factor loadings for all domains along with greater internal consistency reliability (>0.80). Conclusions Five of the PIP's six domains demonstrated excellent internal consistency for measures of health care resources. Although minor improvements to strengthen the PIP are possible, it is a valid and reliable measure of the integration of primary care and behavioral health.

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Section: Introductionmentioning

confidence: 99%

Measuring the integration of primary care and behavioral health services

Mullin

Hargreaves

Auxier

et al. 2019

Health Services Research

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“…In addition, policymakers, providers, consumers, and payers agree that healthcare systems largely reward quantity of services delivered at the expense of higher quality care [8]. While significant reform is often required for successful integration, there is no national or international consensus regarding the best guidelines or set of implementation strategies for integrated care efforts [9]. To address this lack of consensus, we used a multiple case study design and the Exploration, Preparation, Implementation, Sustainment (EPIS) framework [10], a widely cited implementation science framework [11], to prioritize goals and strategies to advance integrated care implementation research generalizable across countries and healthcare systems.…”

Section: Introductionmentioning

confidence: 99%

Comparative case studies in integrated care implementation from across the globe: a quest for action

Stadnick

Sadler

Sandall

et al. 2019

BMC Health Serv Res

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BackgroundIntegrated care is the coordination of general and behavioral health and is a highly promising and practical approach to improving healthcare delivery and patient outcomes. While there is growing interest and investment in integrated care implementation internationally, there are no formal guidelines for integrated care implementation applicable to diverse healthcare systems. Furthermore, there is a complex interplay of factors at multiple levels of influence that are necessary for successful implementation of integrated care in health systems.MethodsGuided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework (Aarons et al., 2011), a multiple case study design was used to address two research objectives: 1) To highlight current integrated care implementation efforts through seven international case studies that target a range of healthcare systems, patient populations and implementation strategies and outcomes, and 2) To synthesize the shared and unique challenges and successes across studies using the EPIS framework.ResultsThe seven reported case studies represent integrated care implementation efforts from five countries and continents (United States, United Kingdom, Vietnam, Israel, and Nigeria), target a range of clinical populations and care settings, and span all phases of the EPIS framework. Qualitative synthesis of these case studies illuminated common outer context, inner context, bridging and innovation factors that were key drivers of implementation.ConclusionsWe propose an agenda that outlines priority goals and related strategies to advance integrated care implementation research. These goals relate to: 1) the role of funding at multiple levels of implementation, 2) meaningful collaboration with stakeholders across phases of implementation and 3) clear communication to stakeholders about integrated care implementation.Trial registrationNot applicable.

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“…1 As such, there is a clear need to deliver high-quality behavioral health care integrated directly in primary care. 2 Broadly speaking, a recent review summarized that integrated behavioral health care has been associated with improved access to care, improved health outcomes, higher patient satisfaction and decreased health care costs. 2 Although integrated care exists across a continuum with many service delivery models, one particular model that has been well studied is the primary care behavioral health (PCBH) model.…”

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confidence: 99%

“…2 Broadly speaking, a recent review summarized that integrated behavioral health care has been associated with improved access to care, improved health outcomes, higher patient satisfaction and decreased health care costs. 2 Although integrated care exists across a continuum with many service delivery models, one particular model that has been well studied is the primary care behavioral health (PCBH) model. PCBH is patient-centered, with a behavioral health professional serving as a consultant to a physician-led team.…”

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confidence: 99%

“…3 In the PCBH model, the behavioral health consultant provides behavioral health services that are routine, accessible, and high volume, while practicing as a generalist in a biopsychosocial framework. 3 The PCBH model has been practiced on a large scale in the military health system (MHS) for over 20 years, 2,4 and has been evaluated positively in regards to patient satisfaction, 5 provider satisfaction, 6 health outcomes, 7 and improved access for populations in both military and civilian settings. 8 In addition to positive clinical findings, competency-based training for behavioral health care professionals in the PCBH model have been well established.…”

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confidence: 99%

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Primary Care Behavioral Health Training in Family Medicine Residencies:

Landoll

Cervero

Quinlan

et al. 2020

Fam Med

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Background and Objectives: Primary care behavioral health (PCBH) is a service delivery model of integrated care linked to a wide variety of positive patient and system outcomes. However, considerable challenges with provider training and attrition exist. While training for nonphysician behavioral scientists is well established, little is known about how to train physicians to work efficiently within integrated teams. Methods: We conducted a case study analysis of family medicine residencies in the military health system using a series of 30 to 45-minute semistructured interviews. We conducted qualitative template analysis of these cases to chart programs’ current educational processes related to PCBH. Thirteen individuals consisting of program directors, behavioral and nonbehavioral faculty, and residents across five programs participated in the study. Results: Current educational processes included a variety of content on PCBH (eg, treatment for depression, clinical referral pathways, patient-centered communication), primarily using a mix of didactic and practice-based placements. Resource allocation was seen as a critical contributor to quality. There was variability in the degree to which integrated behavioral health providers were incorporated as residency faculty, such that programs where these specialists were more incorporated reported more intentional curriculum development and health care systems-level content. Conclusions: While behavioral health content was well represented in family medicine residency curriculum, the depth and integration of content was inconsistent. More intentional and integrated curriculum accompanied faculty development and integration of behavioral health faculty. Future research should evaluate if faculty development programs and faculty status of behavioral scientists results in different educational or health care outcomes.

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Primary Care Behavioral Health (PCBH) Model Research: Current State of the Science and a Call to Action

Cited by 99 publications

References 63 publications

Measuring the integration of primary care and behavioral health services

Measuring the integration of primary care and behavioral health services

Comparative case studies in integrated care implementation from across the globe: a quest for action

Primary Care Behavioral Health Training in Family Medicine Residencies:

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