Provider Perspectives on Integrating Primary and Behavioral Health: A Report from the High Plains Research Network

Abstract

Background: Integrated primary care, a health care delivery model that combines medical and behavioral health services, provides better patient access to care at a lower cost, with better outcomes compared with usual nonintegrated care models. The perspectives of primary care providers (PCPs) and behavioral health care providers (BHPs) toward integration are especially valuable because their input and endorsement are key to successful and sustained integration. However, there is little research assessing or comparing PCP and BHP perspectives on integration, especially in rural areas. The objective of this study was to identify rural PCP and BHP perspectives on integration.Methods: Written and electronic surveys were distributed to PCPs and BHPs in the High Plains Research Network in rural eastern Colorado. Items included perspectives on improving behavioral health care, barriers to integration, and confidence in the ability to integrate primary and behavioral care.Results: Surveys were completed by 88 PCPs (60%), and 49 BHPs (63%), for an overall response rate of 61%. PCPs were significantly more likely than BHPs to prefer improving referral methods (odds ratio [OR], 2.2; P ‫؍‬ .03) and significantly less likely to prefer colocation (OR, 0.2; P < .0001), warm handoffs (OR, 0.3; P < .01), improved behavioral health training for PCPs (OR, 0.4; P < .01), and shared visits (OR, 0.4; P ‫)30.؍‬ as ways to improve health care. Lack of sufficient methods of payment for behavioral health care services was the most commonly selected barrier to integration by both groups. PCPs were significantly more likely than BHPs to select recruitment (OR, 3.8; P < .001) and retention (OR, 2.7; P < .01) of behavioral health care staff as a major barrier. BHPs were slightly more optimistic than PCPs about the achievability of integration.Conclusions: Important differences of perspective exist between rural PCPs and BHPs regarding the best ways to improve behavioral health care, barriers to integration, and the achievability of integration. These differences may have important implications for rural communities and health care systems considering a transition to an integrated primary care model. (J Am Board Fam Med 2014;27:375-382.)

A systematic review of evaluation research in integrated behavioral health care: Operational and financial characteristics.

“…Assessments of referral practices and methods included referral method preferences (e.g., by email or pager; Burfeind, Seymour, Sillau, Zittleman, & Westfall, 2014; Pratt et al, 2012) and preferred referral methods when BHCs were occupied with other patients at time of need (Davis et al, 2013). The evaluations of referral practices and methods (see code “REF-P” in Table 6) provided evidence that face-to-face referrals (e.g., warm handoffs) were preferred by BHCs and PCPs, and were typically more successful than alternate referral methods (e.g., flags in the medical record).…”

“…Reimbursement. In these studies, researchers assessed the payment methods, policies, and practices related to reimbursement for IBHC services (Burfeind et al, 2014;Ellison, 2014;Kessler et al, 2014; see code "REIMB" in Table 6).…”

FLOW: Early results from a clinical demonstration project to improve the transition of patients with mental health disorders back to primary care.

“…Barriers to transferring patient care can be categorized into three broad categories: care coordination, provider/patient capability and beliefs, and support structures. Care-coordination barriers highlight that an intervention to increase care transitions can involve a role change for PC providers and may require attention to communication processes and workload challenges (e.g., Benzer et al, 2015; Burfeind, Seymour, Sillau, Zittleman, & Westfall, 2014). Barriers around capabilities and beliefs suggest that transitions can sometimes be threatening to patients and providers (e.g., Brez et al, 2009; Forrest, Nutting, von Schrader, Rohde, & Starfield, 2006).…”

A Panoply of Information for the Practice of Family Medicine

“…Given that colocation should help providers interact regarding the care of individual patients, integrated care is likely more difficult in rural areas. Yet Burfeind et al 16 reported differing opinions on integrating mental health and primary care services by the respective providers. 18 report on improvements in asthma care and guideline adherence through a group self-assessment module.…”