Attendance rates for integrated psychology services in primary care

Abstract

Research Question: Does integrated and team-based care in patients referred for mental health services by their PCP, as compared to published patient samples, affect outcomes such as attendance and treatment initiation?

Background, Significance, and Rationale: Patients in primary care are frequently identified as having unaddressed mental health concerns or behavioral issues which impact their health (e.g., smoking, non-adherence). Despite ongoing efforts to improve the availability and access to mental and behavioral health resources, the probability that patients with an identified need will actually seek out and/or receive care is low. Numerous studies examining referral adherence to mental health specialists, including psychologists, have suggested that barriers can include funding, perceived lack of need, transportation, stigma, and others. To address these barriers, integrated models of primary care have been proposed, wherein mental health professionals provide on-site, readily available services in collaboration with the patient’s medical treatment team. Numerous systematic reviews have demonstrated the benefits of integrated psychology services on outcomes spanning medical and mental health metrics, reducing healthcare utilization, and lowering cost for services. However, far fewer studies have examined whether integrated mental health actually achieves its more fundamental goal of connecting patients to services after an identified need has been found.

Materials and Methods: This retrospective chart review study examined attendance rates of 181 individual patients following referral for Integrated Behavioral Health services in a within the context of a large Family Medicine residency training clinic.

Results: In all cases, the PCP initiated the consult during a routine Family Medicine encounter and contacted the behavioral health team. The behavioral health team then scheduled the patient for an initial BH consult at the same primary clinic (patient-centered medical home). No measures of referral compliance were shown to be associated with adherence outcomes and Specific measures, such as a patient’s insurance status (private vs not private), PHQ-9 score, and/or date latency, were found to have no bearing on adherence outcomes. Chi-square goodness of fit tests indicated that treatment initiation rates using an integrated behavioral health model were significantly higher than treatment initiation rates for traditional specialty mental health models (¿2 = 18.35, p = < 0.001).

Conclusions: The findings of this study demonstrate that the implementation of integrated behavioral health in a primary care setting can significantly improve referral adherence and facilitate access to mental health services for patients with mental illness. The provision of on-site mental health services, as part of an interdisciplinary team, has been shown to alleviate many barriers that prevent patients from initiating care. Therefore, the use of on-site mental health services can ultimately lead to better patient outcomes.