Intervention Stage Completion and Behavioral Health Outcomes: An Integrated Behavioral Health and Primary Care Randomized Pragmatic Trial

PLAIN-LANGUAGE SUMMARY

Original Research

Flexible Practice-Centric Approach Improves Behavioral Health Integration in Primary Care Practices 

Background and Goal: Many patients with mental health needs receive care in primary care settings rather than from specialized settings. Integrated behavioral health (IBH), which combines behavioral health and primary care, improves patient outcomes and experience. However, implementing IBH is challenging due to the need for practice-specific changes. This study evaluated whether a tailored, toolkit-based intervention could improve IBH and patient outcomes in primary care practices serving patients with multiple chronic medical and behavioral health conditions.

Study Approach: The study used a cluster randomized controlled trial design. Practices were randomized into two groups. The intervention arm received a comprehensive toolkit that included four components: workbooks to guide the quality improvement project, online education tailored to specific practice personnel roles, an online learning community to facilitate collaboration, and remote coaching provided by a trained quality improvement professional paired with a psychologist experienced in IBH. The control arm continued with their usual IBH services without receiving additional support. Completion of the toolkit stages—planning, workflow redesign, and implementation—was measured. Patient outcomes, including physical and mental health, and practice integration levels, assessed through Practice Integration Profile scores, were evaluated over a two-year period.

Main Results: A total of 42 practices were randomized in the study with one practice unable to provide eligible patient data and therefore not included in the patient-level analysis. 

• Practices completing more intervention stages showed significant improvements in IBH integration, particularly in workflows, integration methods, and patient identification.

• No significant clinically relevant differences were found in patient health outcomes—including depression, anxiety, fatigue, sleep disturbance, pain, pain interference, and physical function—between the intervention and control groups. 

Why It Matters: The findings from this study suggest that a practice-centered, flexible intervention may help primary care practices tailor behavioral health integration to their specific needs, which may lead to better systems of care. 

Intervention Stage Completion and Behavioral Health Outcomes:  An Integrated Behavioral Health and Primary Care Randomized Pragmatic Trial

Kari A. Stephens, PhD, et al 

Department of Family Medicine, University of Washington, Seattle, Washington