Severity of mental health impairment and trajectories of improvement in an integrated primary care clinic.

Abstract

Patients treated within an integrated primary care behavioral health service demonstrate significant improvements in clinical status, even those with the most severe levels of distress at baseline.

Does integrated behavioral health care reduce mental health disparities for Latinos? Initial findings.

“…Furthermore, our follow-up rates were similar to those found in other IBHC models (Bryan et al, 2012; Corso et al, 2012). In particular, we found that approximately 28.0% of Latino patients and 34.7% of non-Latino White patients attended their scheduled follow-up sessions, which is similar to the 29.8% attendance rate found by Bryan and colleagues (2012) and the 28.4% found in Corso and colleagues (2012).…”

“…The two groups indicated that they were approaching levels of distress at their last BHC session that were in the mild or normal range of functioning. Given that patients who are more distressed at baseline tend to improve more in IBHC than those who are less distressed (Bryan et al, 2012) and that Latino patients referred for IBHC services showed lower levels of distress at baseline than non-Latino patients, one might have expected Latinos not to improve at a comparable rate with integrated behavioral health interventions. In this regard, our results are consistent with others (e.g., Sue, 1988) who find all patients, regardless of race or ethnicity, benefit similarly from psychological treatment.…”

“…Because there were significant gender differences in rates of psychiatric diagnoses: 74.4% of men and 82.1% of women received a diagnosis, χ 2 (1) = 6.78, p = .009; and likelihood of following up with a scheduled appointment, 29.2% of men and 24.1% of women kept a scheduled follow-up appointment, 29.2% of men and 10.3% of women were not scheduled for a follow-up appointment, χ 2 (2) = 15.50, p < .001, analyses also included gender as a covariate. For the evaluation of Hypotheses 3 through 5, we further included psychiatric diagnosis as a covariate, as it could influence therapeutic alliance, likelihood of needing a follow-up visit, and degree of improvement (Bryan et al, 2012). …”

“…Still, much of this evidence has been obtained through Veterans’ Affairs or active military primary care clinics and in primarily non-Latino White samples (Corso et al, 2012) or samples with unknown ethnic distributions (Bryan et al, 2012). However, over the past decade, the Latino population is expanding into more rural regions of the United States with historically small Latino populations (Ennis, RiosVargas, & Albert, 2011).…”

Tipping points in the Department of Defense’s experience with psychologists in primary care.

“…Without these factors, the fidelity and commitment to the PCBH model could not have been sustained. The implementation of the PCBH model in the Air Force was well received by physicians and patients (Runyan, Fonseca, & Hunter, 2003) and was shown to be effective for targeting a broad range of clinical concerns (Bryan et al, 2012) including insomnia (Goodie, Isler, Hunter, & Peterson, 2009) and posttraumatic stress disorder (Cigrang et al, 2011). A morning in the life of a BHC. As described above, the PCBH model of integrated primary care requires substantial shifts in the practice of most psychologists who have trained and practiced primarily in specialty mental health settings.…”