This piece is the second in a series of posts highlight research on the Primary Care Behavioral Health model. Click here for the first post.
Why and how did we do this review?
My colleagues and I at the VA Center for Integrated Healthcare recently published a systematic review to assess the research evidence on how patients benefit from Primary Care Behavioral Health (PCBH) services. As PCBH providers, we regularly see patients who benefit from our services, however, prior to this publication no study had systematically assessed the strength of the evidence for PCBH. For this review we defined PCBH as services provided within primary care by licensed independent behavioral health providers with the goal of ongoing communication and collaboration between the behavioral health provider and other primary care members. We focused our review on studies that investigated how PCBH is typically delivered in clinics, not on special interventions delivered for the purposes of research. The review included 36 articles that reported on the patient outcomes of 1) access and utilization of care, 2) changes in symptoms or functioning, and 3) patient satisfaction.
What did we find?
The strongest evidence emerged for increased access and utilization of care. Patients who received PCBH services get quicker access to care, attend more sessions, and are more likely to step-up their care to specialty mental health then patients who do not receive PCBH. The studies that assessed changes in patient symptoms/ functioning and patient satisfaction tended to find positive results, however these studies were small and lacked comparison groups. In sum, we can be confident that PCBH improves access to care. Also, there is early evidence that PCBH leads to decreased symptoms and improved functioning, but the methodological quality of this research is weak.
What does this mean for primary care behavioral health providers?
The implementation of PCBH is ahead of the research evidence and PCBH providers can help to close this gap. Data from rigorously designed program evaluations can help the field to better understand how patients benefit from PCBH. A recent article by Drs. Funderburk and Shepardson (2017) provide a practical guide on how PCBH providers can conduct feasible, yet rigorous program evaluation. Also, more randomized clinical trials are desperately needed. PCBH providers can partner with health services researchers at medical and academic institutions to get pragmatic clinical trials conducted within their clinics. Many of us are passionate proponents of the PCBH model because we see that it meets the needs of a wide variety of the patients in our clinics. However, for PCBH services to continue to expand to new settings and new populations policy makers will need better evidence that these services benefit patients.
Possemato, K., Johnson, E.M., Beehler, G. P., Shepardson, R. L., King, P., Vair, C. L., Funderburk, J. S., Maisto, S. A., Wray, L. O. (in press). Patient Outcomes Associated with Primary Care Behavioral Health Services: A Systematic Review. General Hospital Psychiatry. doi: 10.1016/j.genhosppsych.2018.04.002
Funderburk, J. S., & Shepardson, R. L. (2017). Real-world program evaluation of integrated behavioral health care: Improving scientific rigor. Families, Systems, & Health, 35(2), 114-124.
|Kyle Possemato, Ph.D. is the Associate Director for Research at the VA Center for Integrated Healthcare|