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Mental Health, Primary Care Integration Cuts Depression Scores

Patients receiving care at integrated mental health and primary care providers saw significant reductions in their depression symptoms.

Mental health and primary care integration

Source: Thinkstock

- Integrating mental healthcare into the primary care ecosystem can drastically reduce patient-reported depression scores and enhance the overall experience of care, says a new article published in the Journal of the American Board of Family Medicine.

Patients at 11 Colorado providers who received behavioral and mental healthcare alongside traditional clinical care saw significant positive changes when given the standard Patient Health Questionnaire (PHQ-9) assessment.

Fifty percent of participating patients saw a reduction of more than five points on their questionnaire scores, indicating improved management of depression symptoms.  Just under one third of participants saw their PHQ-9 scores cut in half.

“Integrating behavioral health and primary care is beneficial to patients and health systems,” stated the research team from the University of Texas, Oregon Health and Science University, and the University of Colorado.

“However, for integration to be widely adopted, studies demonstrating its benefits in community practices are needed.”

In order to close the research gap, the team enlisted the help of integrated primary and mental healthcare practices taking part in the Advancing Care Together (ACT) demonstration project. 

The four-year initiative, conducted between 2011 and 2015, encouraged organizations to place both types of care providers in the same location and provided a moderate amount of financial support to promote the development of new care strategies.

All of the practices used the PHQ-9 to evaluate patients for depression symptoms, and contributed data from their electronic health records to further the research process. 

For the purposes of the study, patients also participated in qualitative interviews with the research team that helped to assess their experiences with integrated care services.

Depression score changes in patients at integrated mental health and primary care providers

Source: JABFM

“The majority of interviewed patients receiving integrated care reported that having the behavioral health clinician (BHC) and primary care clinician as part of the same team and under the same roof was beneficial,” the study says. “They appreciated the care they received, and that their clinicians were working and talking with each other.”

A few patients reported neutral or negative reactions, mostly due to relatively minor personal conflicts or disagreements.

In general, patients appreciated the support of behavioral health clinicians who provided guidance for family members and promoted lifestyle changes to help patients cope with clinical concerns and social stresses.

“Patients reported that BHCs listened and helped them find new solutions that they could act on to manage common life stressors, events, and problems,” the researchers said. “Patients also valued how BHCs helped patients reframe how they viewed events, themselves, and others, and this helped them manage important relationships.” 

The study supports the notion that adding behavioral and mental healthcare to the primary care setting can improve patient engagement, foster self-management competencies, and positively impact the social determinates of health. 

Closer alignment between behavioral and clinical health may make it easier for healthcare providers to perform well in value-based purchasing arrangements that stress comprehensive care and financial responsibility for long-term outcomes.

Depression is particularly common in patients with multiple comorbidities and chronic diseases, and the mental health condition often makes it difficult for patients to adhere to their clinical self-care regimens. 

In addition, mentally ill patients are rarely screened appropriately for untreated or developing chronic conditions, indicating that primary care providers working on their own are not always able to adequately address these complex, intertwined needs.

Brining primary care and mental healthcare closer together is a promising strategy for allowing providers to engage in whole-person care while quickly and measurably improving the patient experience.

“This study provides evidence that when primary care–behavioral health integration approaches were translated to fit into community practices, they reduced depression severity and was perceived by patients as beneficial,” the article concludes.

“Patients liked having behavioral and medical care under one roof; they appreciated that different members of their care team worked together, they reported feeling the positive effects of integration after only a few visits, and their outcomes improved.”

“Findings from this study, together with a robust body of evidence from randomized controlled trials, makes a compelling case for practices to adopt integrated care and for payers to make this model feasible through finance reform.”

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