Evaluating a Behavioral Health Integration Pilot in Primary Care Clinics Using Mixed Methods
Open Access
- Author:
- Pitcavage, James Matthew
- Graduate Program:
- Health Policy and Administration
- Degree:
- Doctor of Philosophy
- Document Type:
- Dissertation
- Date of Defense:
- July 23, 2018
- Committee Members:
- Caprice Knapp, Dissertation Advisor/Co-Advisor
Caprice Knapp, Committee Chair/Co-Chair
John Raymond Moran Jr., Committee Member
Christopher Samuel Hollenbeak, Committee Member
Douglas L Leslie, Outside Member
Joel E Segel, Committee Member
Sharon L Larson, Special Member - Keywords:
- Behavioral health
care integration - Abstract:
- Background: The current behavioral health care delivery system for children and adolescents fails patients and their families on multiple levels. One potential solution to improve behavioral health care is the integrated behavioral health model. This model integrates behavioral health services into primary care clinics through changes in the organization level approach to providing behavioral health services in primary care. There is uncertainty on the impact of the integrated BH model on patient and provider satisfaction as well as impact on clinical visit time, health care utilization, and costs. Objectives: This dissertation examines primary care providers views and expectations of integrated behavioral health care. It also examines providers’ satisfaction with a BH integration pilot in a large integrated health system as well as patient’s satisfaction with care in the integrated model. It also examines the impact of integration on total primary care provider time in a clinical visit as well as the impact of behavioral health integration on total health care utilization and costs. Methods: Qualitative interviews were conducted with primary care providers and responses from these interviews were analyzed to describe providers views on providing behavioral health services in non-integrated clinics. Surveys were conducted with primary care providers and patients in integrated behavioral health sites and in non-integrated sites. We also timed primary care clinic visits to measure the impact of integration on the visit length. Descriptive analysis was completed to describe the impact of BH integration on patient/provider satisfaction and clinic time length. Results: Patients who receive BH services in the integrated model waited less time between referral and first appointment with a BH provider and patients prefer the integrated model regarding provider communication and overall benefit of services. PCPs have better communication with BH providers in the integrated model. Overall clinic visit time was not reduced in the integrated BH model nor was there significant changes in costs between clinics that adopted integrated behavioral health care and those that did not adopt the integrated behavioral health model. Conclusion: This study gives insights into the potential for behavioral health integration to increase provider satisfaction as well as patient satisfaction. There is uncertainty on whether this will save clinical time and costs.