Integration of behavioral health care into primary care can improve health and economic outcomes. This study adapted the Behavioral Health Integration in Medical Care (BHIMC) index to the Colombian context and assessed the baseline level of behavioral health integration in a sample of primary care organizations. The BHIMC was able to detect the capacity to provide integrated behavioral care in Colombian settings. Results indicate a minimal to partial integration level across all sites, and that it is possible to measure the degree of integrated care capacity and identify improvement areas for better behavioral health care provision.
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Amaya, J., Beltrán, A., Chavarro, D., Romero, G., Matallana, M., & Puerto, S. (2013). Estudio de disponibilidad y distribución de la oferta de médicos especialistas, en servicios de alta y mediana complejidad en Colombia. Documento técnico GPES/1682C-13. Disponible en: https://www.minsalud.gov.co/salud/Documents/Observatorio%20Talento%20Humano%20en%20Salud/DisponibilidadDistribuci%C3%B3nMdEspecialistasCendex.pdf.
Andrade, L. H., Alonso, J., Mneimneh, Z., Wells, J. E., Al-Hamzawi, A., Borges, G., … & Kessler, R. C. (2014). Barriers to mental health treatment: Results from the WHO World Mental Health surveys. Psychological Medicine, 44(6), 1303–1317.
Bautista, M. A. C., Nurjono, M., Lim, Y. W., Dessers, E., & Vrijhoef, H. J. (2016). Instruments measuring integrated care: A systematic review of measurement properties. The Milbank Quarterly,94(4), 862–917. https://doi.org/10.1111/1468-0009.12233.
Bernal, O., & Barbosa, S. (2015). La nueva reforma a la salud en Colombia: el derecho, el aseguramiento y el sistema de salud. Salud Pública de México,57, 433–440.
Butler, M., Kane, R., McAlpine, D., Kathol, R., Fu, S., Hagedorn, H., & Wilt, T. (2008). Integration of mental health/substance abuse and primary care No. 173 (Prepared by the Minnesota Evidence-based Practice Center under Contract No. 290-02-0009.) AHRQ Publication No. 09-E003. Rockville, MD: Agency for Healthcare Research and Quality.
Chaple, M., Sacks, S., Melnick, G., McKendrick, K., & Brandau, S. (2013). The predictive validity of the dual diagnosis capability in addiction treatment (DDCAT) index. Journal of Dual Diagnosis,9(2), 171–178. https://doi.org/10.1080/15504263.2013.779128.
Chaskel, R., Gaviria, S. L., Espinel, Z., Taborda, E., Vanegas, R., & Shultz, J. M. (2015). Mental health in Colombia. BJPsych. International,12(4), 95–97.
Crowley, R. A., & Kirschner, N. (2015). The integration of care for mental health, substance abuse, and other behavioral health conditions into primary care: executive summary of an American College of Physicians position paper. Annals of Internal Medicine,163(4), 298–299.
De Hert, M., Correll, C. U., Bobes, J., Cetkovich-Bakmas, M., Cohen, D. A. N., Asai, I., … & Leucht, S. (2011). Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World Psychiatry: Official Journal of the World Psychiatric Association (WPA), 10(1), 52–77.
Fajardo-Gonzalez, J. (2016). Inequality of opportunity in adult health in Colombia. The Journal of Economic Inequality,14(4), 395–416. https://doi.org/10.1007/s10888-016-9338-2.
Friedmann, P. D., Zhang, Z., Hendrickson, J., Stein, M. D., & Gerstein, D. R. (2003). Effect of primary medical care on addiction and medical severity in substance abuse treatment programs. Journal of General Internal Medicine,18(1), 1–8.
Gagnon, M.-P., Ngangue, P., Payne-Gagnon, J., & Desmartis, M. (2015). m-Health adoption by healthcare professionals: A systematic review. Journal of the American Medical Informatics Association,23(1), 212–220.
Giedion, U., & Uribe, M. V. (2009). Colombia’s Universal Health Insurance System. Health Affairs,28(3), 853–863. https://doi.org/10.1377/hlthaff.28.3.853.
Goldberg, D. (2010). The detection and treatment of depression in the physically ill. World Psychiatry: Official Journal of the World Psychiatric Association (WPA),9(1), 16–20.
Gómez-Restrepo, C., Escudero, C., Matallana, D., González, L., & Rodriguez, V. (2015). Encuesta Nacional de Salud Mental. Bogotá: Ministerio de Salud y Protección Social.
González, L. M., Enrique Peñaloza, R., Matallana, M. A., Gil, F., Gómez-Restrepo, C., & Vega Landaeta, A. P. (2016). Determining factors in the access to mental health services by the adult Colombian population. Revista Colombiana de Psiquiatría,45, 89–95.
Hill, J. M. (2015). Behavioral health integration: Transforming patient care, medical resident education, and physician effectiveness. International Journal of Psychiatry in Medicine,50, 36–49. https://doi.org/10.1177/0091217415592357.
Hoffman, L., Benedetto, E., Huang, H., Grossman, E., Kaluma, D., Mann, Z., et al. (2019). Augmenting mental health in primary care: A 1-year study of deploying smartphone apps in a multi-site primary care/behavioral health integration program. Frontiers in Psychiatry. https://doi.org/10.3389/fpsyt.2019.00094.
Katon, W., Unützer, J., Fan, M.-Y., Williams, J. W., Schoenbaum, M., Lin, E. H. B., et al. (2006). Cost-effectiveness and net benefit of enhanced treatment of depression for older adults with diabetes and depression. Diabetes Care,29(2), 265–270. https://doi.org/10.2337/diacare.29.02.06.dc05-1572.
Kwan, B. M., & Nease, D. E. (2013). The state of the evidence for integrated behavioral health in primary care. integrated behavioral health in primary care (pp. 65–98). New York: Springer.
Lehmann, U., Dieleman, M., & Martineau, T. (2008). Staffing remote rural areas in middle- and low-income countries: A literature review of attraction and retention. BMC Health Services Research,8, 19. https://doi.org/10.1186/1472-6963-8-19.
Ley N° 1616 de 2013, Diario Oficial del Congreso de la República de Colombia No. 48.680 de 21 de enero de 2013 (2013).
Lin, E. H. B., Rutter, C. M., Katon, W., Heckbert, S. R., Ciechanowski, P., Oliver, M. M., … & Von Korff, M. (2010). Depression and advanced complications of diabetes: A prospective cohort study. Diabetes Care, 33(2), 264–269.
Mbemba, G. I. C., Gagnon, M.-P., & Hamelin-Brabant, L. (2016). Factors influencing recruitment and retention of healthcare workers in rural and remote areas in developed and developing countries: An overview. Journal of Public Health in Africa,7(2), 565. https://doi.org/10.4081/jphia.2016.565.
McGough, P. M., Bauer, A. M., Collins, L., & Dugdale, D. C. (2016). Integrating behavioral health into primary care. Population Health Management,19(2), 81–87. https://doi.org/10.1089/pop.2015.0039.
McGovern, M. P., Lambert-Harris, C., McHugo, G. J., Giard, J., & Mangrum, L. (2010). Improving the dual diagnosis capability of addiction and mental health treatment services: Implementation factors associated with program level changes. Journal of Dual Diagnosis,6(3–4), 237–250. https://doi.org/10.1080/15504263.2010.537221.
McGovern, M. P., Urada, D., Lambert-Harris, C., Sullivan, S. T., & Mazade, N. A. (2012). Development and initial feasibility of an organizational measure of behavioral health integration in medical care settings. Journal of Substance Abuse Treatment,43, 402–409. https://doi.org/10.1016/j.jsat.2012.08.013.
Miller, B. F., Petterson, S., Brown Levey, S. M., Payne-Murphy, J. C., Moore, M., & Bazemore, A. (2014a). Primary care, behavioral health, provider colocation, and rurality. The Journal of the American Board of Family Medicine,27(3), 367–374. https://doi.org/10.3122/jabfm.2014.03.130260.
Miller, B. F., Petterson, S., Burke, B. T., Phillips, R. L., Jr., & Green, L. A. (2014b). Proximity of providers: Colocating behavioral health and primary care and the prospects for an integrated workforce. American Psychologist,69(4), 443–451. https://doi.org/10.1037/a0036093.
Organisation for Economic Co-operation and Development (OECD). (2015). OECD Reviews of Health Systems: Colombia 2016: Turpin Distribution Services (OECD).
Rivera, F. (2017). Health opportunities in Colombia. Lecturas de Economía,87, 125–164.
Roselli Cock, D. A. (2000). La medicina especializada en Colombia: una aproximación diagnóstica: Diego Rosselli.
Ruiz Gómez, F., Zapata Jaramillo, T., & Garavito Beltrán, L. (2013). Colombian health care system: Results on equity for five health dimensions, 2003-2008. Revista Panamericana de Salud Pública,33, 107–115.
Sacks, S., Chaple, M., Sirikantraporn, J., Sacks, J. Y., Knickman, J., & Martinez, J. (2013). Improving the capability to provide integrated mental health and substance abuse services in a state system of outpatient care. Journal of Substance Abuse Treatment,44(5), 488–493. https://doi.org/10.1016/j.jsat.2012.11.001.
Van Ginneken, N., Tharyan, P., Lewin, S., Rao, G. N., Meera, S. M., Pian, J., … & Patel, V. (2013). Non-specialist health worker interventions for the care of mental, neurological and substance-abuse disorders in low-and middle-income countries. The Cochrane Database of Systematic Reviews, 11(11), CD009149.
Vigo, D., Thornicroft, G., & Atun, R. (2016). Estimating the true global burden of mental illness. The Lancet Psychiatry,3(2), 171–178. https://doi.org/10.1016/S2215-0366(15)00505-2.
Walker, E. R., McGee, R. E., & Druss, B. G. (2015). Mortality in mental disorders and global disease burden implications: A systematic review and meta-analysis. JAMA Psychiatry,72(4), 334–341. https://doi.org/10.1001/jamapsychiatry.2014.2502.
WHO. (2012). Global burden of mental disorders and the need for a comprehensive, coordinated response from health and social sectors at the country level Report by the Secretariat. Retrieved from http://apps.who.int/gb/ebwha/pdf_files/WHA65/A65_R4-en.pdf.
WHO & WONCA. (2008). Integrating mental health into primary care: a global perspective. In: World Health Organization Geneva.
World Health Organization (WHO). (2002). Innovative care for chronic conditions: Building blocks for actions: Global report. World Health Organization.
This research was supported via a grant from the U.S. National Institute of Mental Health (Bethesda, MD, USA, Grant No. 1U19MH109988-01; Multiple Principal Investigators: Lisa A. Marsch, Ph.D. and Carlos Gómez-Restrepo, MD). The contents are solely the opinion of the authors and do not necessarily represent the views of the NIH or the United States Government.
Conflicts of interest
All authors declare that they have no conflict of interest.
This research project was approved by the Institutional Review Board at Dartmouth College in the United States of America and Pontificia Universidad Javeriana in Colombia.
It is important to note that in this project a treatment intervention was not tested, patients were not interviewed individually, and no personal information or confidential data were requested; instead, clinical and administrative staff were collectively interviewed about the program, and data collection related to the program, not to its staff or subjects. Dartmouth College’s and Pontificia Universidad Javeriana’s IRBs determined that informed consent was not necessary.
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Castro, S.M., Cubillos, L., Uribe-Restrepo, J.M. et al. Assessing the Integration of Behavioral Health Services in Primary Care in Colombia. Adm Policy Ment Health 47, 435–442 (2020). https://doi.org/10.1007/s10488-019-01002-4
- Primary health care
- Behavioral health
- Integrated care
- International collaboration
- Substance use disorders treatment