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Meeting ReportBehavioral, psychosocial, and mental illness

Integrating behavioral health & primary care for multiple chronic diseases: Clinical trial of a practice redesign toolkit

Benjamin Littenberg, Paula Reynolds, Lisa Natkin, Constance van Eeghen, Peter Callas, Wilson Pace, Gail Rose, Juvena Hitt, Abigail Crocker, Daniel Mullin, Laura-Mae Baldwin, Levi Bonnell, Elizabeth Waddell, Richard Pinckney, Sylvie Frisbie, Brenda Mollis, C.R. Macchi, Zsolt Nagykaldi, Kathryn Teng, Kurt Stange, Jennifer O’Rourke-Lavoie, Kari Stephens, William Sieber, Jennifer Jewiss, Sarah Scholle, Lauren Eidt Pearson, George Leibowitz, Ryan Breshears, Jessica Clifton, Roger Kathol, Terry Stancin, Mark McGovern, Mary Hekman and Douglas Pomeroy
The Annals of Family Medicine April 2022, 20 (Supplement 1) 2679; DOI: https://doi.org/10.1370/afm.20.s1.2679
Benjamin Littenberg
MD
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Paula Reynolds
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Lisa Natkin
PhD
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Constance van Eeghen
DrPH, MHSA
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Peter Callas
PhD
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Wilson Pace
MD, FAAFP
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Gail Rose
PhD
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Juvena Hitt
MPH
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Abigail Crocker
PhD
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Daniel Mullin
PsyD
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Laura-Mae Baldwin
MD, MPH
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Levi Bonnell
MPH
Roles: PhD Candidate
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Elizabeth Waddell
PhD, MA
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Richard Pinckney
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Sylvie Frisbie
BSc
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Brenda Mollis
MA, MPA, MPH
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C.R. Macchi
PhD
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Zsolt Nagykaldi
PhD
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Kathryn Teng
MD, MBA
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Kurt Stange
MD, PhD
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Jennifer O’Rourke-Lavoie
BS
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Kari Stephens
PhD
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William Sieber
PhD
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Jennifer Jewiss
EdD
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Sarah Scholle
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Lauren Eidt Pearson
MSW, LICSW
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George Leibowitz
PhD, LICSW
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Ryan Breshears
PhD
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Jessica Clifton
PhD
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Roger Kathol
MD
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Terry Stancin
PhD, ABPP
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Mark McGovern
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Mary Hekman
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Douglas Pomeroy
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Abstract

Context: Most patients in need of behavioral health (BH) care are seen in primary care, which often has difficulty responding. Some practices integrate behavioral health care (IBH), with medical and BH providers at the same location, working as a team. However, it is difficult to achieve high levels of integration.

Objective: Test the effectiveness of a practice intervention designed to increase BH integration.

Study Design: Pragmatic, cluster-randomized controlled trial.

Setting: 43 primary care practices with on-site BH services in 13 states.

Population: 2,460 adults with multiple chronic medical and behavioral conditions.

Intervention: 24-month practice change process including an online curriculum, a practice redesign and implementation workbook, remote quality improvement coaching services, and an online learning community.

Outcomes: Primary outcomes were changes in the 8 Patient-Reported Outcomes Measurement Information System (PROMIS-29) domain scores. Secondary outcomes were changes in medication adherence, self-reported healthcare utilization, time lost due to disability, cardiovascular capacity, patient centeredness, provider empathy, and several condition-specific measures. A sample of practice staff completed the Practice Integration Profile at each time point to estimate the degree of BH integration in that site. Practice-level case studies estimated the typical costs of implementing the intervention.

Results: The intervention had no significant effect on any of the primary or secondary outcomes. Subgroup analyses showed no convincing patterns of effect in any populations. COVID-19 was apparently not a moderating influence of the effect of the intervention on outcomes. The intervention had a modest effect on the degree of practice integration, reaching statistical significance in the Workflow domain. The median cost of the intervention was $18,204 per practice. In post-hoc analysis, level of BH integration was associated with improved patient outcomes independent of the intervention, both at baseline and longitudinally.

Conclusions: The specific intervention tested in this study was inexpensive, but had only a small impact on the degree of BH integration, and none on patient outcomes. However, practices that had more integration at baseline had better patient outcomes, independent of the intervention. Although this particular intervention was ineffective, IBH remains an attractive strategy for improving patient outcomes.

  • © 2021 Annals of Family Medicine, Inc.
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The Annals of Family Medicine: 20 (Supplement 1)
The Annals of Family Medicine: 20 (Supplement 1)
Vol. 20, Issue Supplement 1
1 Apr 2022
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Integrating behavioral health & primary care for multiple chronic diseases: Clinical trial of a practice redesign toolkit
Benjamin Littenberg, Paula Reynolds, Lisa Natkin, Constance van Eeghen, Peter Callas, Wilson Pace, Gail Rose, Juvena Hitt, Abigail Crocker, Daniel Mullin, Laura-Mae Baldwin, Levi Bonnell, Elizabeth Waddell, Richard Pinckney, Sylvie Frisbie, Brenda Mollis, C.R. Macchi, Zsolt Nagykaldi, Kathryn Teng, Kurt Stange, Jennifer O’Rourke-Lavoie, Kari Stephens, William Sieber, Jennifer Jewiss, Sarah Scholle, Lauren Eidt Pearson, George Leibowitz, Ryan Breshears, Jessica Clifton, Roger Kathol, Terry Stancin, Mark McGovern, Mary Hekman, Douglas Pomeroy
The Annals of Family Medicine Apr 2022, 20 (Supplement 1) 2679; DOI: 10.1370/afm.20.s1.2679

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Integrating behavioral health & primary care for multiple chronic diseases: Clinical trial of a practice redesign toolkit
Benjamin Littenberg, Paula Reynolds, Lisa Natkin, Constance van Eeghen, Peter Callas, Wilson Pace, Gail Rose, Juvena Hitt, Abigail Crocker, Daniel Mullin, Laura-Mae Baldwin, Levi Bonnell, Elizabeth Waddell, Richard Pinckney, Sylvie Frisbie, Brenda Mollis, C.R. Macchi, Zsolt Nagykaldi, Kathryn Teng, Kurt Stange, Jennifer O’Rourke-Lavoie, Kari Stephens, William Sieber, Jennifer Jewiss, Sarah Scholle, Lauren Eidt Pearson, George Leibowitz, Ryan Breshears, Jessica Clifton, Roger Kathol, Terry Stancin, Mark McGovern, Mary Hekman, Douglas Pomeroy
The Annals of Family Medicine Apr 2022, 20 (Supplement 1) 2679; DOI: 10.1370/afm.20.s1.2679
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