A Qualitative Study on the Barriers to Learning in a Primary Care-Behavioral Health Integration Program in an Academic Hospital: the Family Medicine Perspective

  • Monica AggarwalEmail author
  • Eva Knifed
  • Nicholas A. Howell
  • Purti Papneja
  • Nate Charach
  • Amy Cheung
  • Nikola Grujich
In Brief Report



Integrating behavioral health services into the primary care setting is a recognized approach to improving timely access and building capacity for primary care providers. The aim of this study was to examine barriers to family medicine resident learning in a co-located primary care-behavioral health integration program with psychiatrists in an academic hospital.


The authors used a descriptive qualitative study design to collect data on participants’ learning experiences from focus groups and semi-structured interviews with 5 family medicine residents, 3 psychiatry residents, 5 family physicians, 3 psychiatrists, 2 office coordinators, and 2 educational coordinators. Thematic analysis of transcripts was performed.


Three themes were identified with respect to barriers to learning in the program from the family medicine perspective. Organizational barriers encompassed lack of clear vision, goals, roles, and responsibilities. Administrative barriers involved complex appointment bookings and scheduling. Communication and engagement barriers included insufficient communication between team members and lack of patient engagement in the program.


The study findings highlight the importance of several factors for the successful implementation of a co-located academic primary care-behavioral health integrated model. This includes the formalization of program structure that encompasses shared vision, goals, roles, and responsibilities; coordinated processes for appointment bookings; team communication and patient engagement; and diverse educational and longitudinal care opportunities. With the growing number of integrated care programs, these results provide guidance for health care leaders involved in the design and management of primary care-behavioral health integration programs.


Shared care Behavioral health integration Primary care Mental health care Medical education 



Eva Knifed and Nicholas Howell contributed equally to this work.

Compliance with Ethical Standards

This study followed ethical standards and was approved by the Sunnybrook Health Sciences Centre (SHSC) Research Ethics Board. Informed consent was obtained from all participants included in the study.


On behalf of all authors, the corresponding author states that there is no conflict of interest.


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Copyright information

© Academic Psychiatry 2019

Authors and Affiliations

  1. 1.University of TorontoTorontoCanada

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