ABSTRACT
Although the benefits of integrating behavioral health (BH) services into primary care are well established (World Health Organization and World Organization of Family Doctors, 2012; Chiles et al. in Clin Psychol–Sci Pr 6:204–220, 1999; Cummings 1997; O’Donohue et al. 2003; Olfson et al. in Health Aff 18:79–93, 1999; Katon et al. in Ann Intern Med 124:917–925, 2001; Simon et al. in Arch Gen Psychiatry 52:850–856, 1995; Anderson et al. in Diabetes Care 24:1069–1078, 2001; Ciechanowski et al. in Arch Intern Med 160:3278–3285, 2000; Egede et al. in Diabetes Care 25:464–470, 2002), research has focused primarily on describing the types of interventions behavioral health providers (BHPs) employ rather than on reasons for referral, treatment initiation rates, or the patient characteristics that may impact them. This study presents the results of a multisite card study organized by The Collaborative Care Research Network, a subnetwork of the American Academy of Family Physicians’ National Research Network devoted to conducting practice-based research focused on the provision of BH and health behavior services within primary care practices. The goals of the study included: (1) identifying the characteristics of patients referred for BH services; (2) codifying reasons for referral and whether patients were treated for the referral; (3) exploring any differences between patients who initiated BH contact and those who did not; and (4) assessing the types and frequency of BH services provided to patients who attended at least one appointment. Of the 200 patients referred to a BHP, 81 % had an initial contact, 71 % of which occurred on the same day. Men and women were equally likely to engage with a BHP although the time between appointments varied by gender. Depression and anxiety were the primary reasons for referral. Practice-based research is a viable strategy for advancing the knowledge about integrated primary care.
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Implications
Practice: In order to maximize the chances of higher rates of behavioral health treatment initiation than what is commonly achieved through referrals to specialty mental health care, primary care practices should integrate on-site behavioral health services.
Policy: Resources should be directed toward the further development of policies that facilitate the provision of behavioral health services to patients in primary care.
Research: Card study methodology can be effectively implemented across different kinds of integrated primary care practices to assess patient variables associated with behavioral health treatment initiation.
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Auxier, A., Runyan, C., Mullin, D. et al. Behavioral health referrals and treatment initiation rates in integrated primary care: a Collaborative Care Research Network study. Behav. Med. Pract. Policy Res. 2, 337–344 (2012). https://doi.org/10.1007/s13142-012-0141-8
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DOI: https://doi.org/10.1007/s13142-012-0141-8