RT Journal Article
SR Electronic
T1 New Directions from Studying Integrated Behavioral Health and Primary Care for Patients with Multiple Chronic Conditions
JF The Annals of Family Medicine
JO Ann Fam Med
FD American Academy of Family Physicians
SP 3807
DO 10.1370/afm.21.s1.3807
VO 21
IS Supplement 1
A1 van Eeghen, Constance
A1 Kessler, Rodger
A1 Bonnell, Levi
A1 O’Rourke-Lavoie, Jennifer
A1 Hitt, Juvena
A1 Rose, Gail
A1 Littenberg, Benjamin
A1 Clifton, Jessica
YR 2023
UL http://www.annfammed.org/content/21/Supplement_1/3807.abstract
AB Context: Despite a growing commitment to integrating behavioral health (IBH) in primary care (PC), high levels of integration that improve care and outcomes are elusive. As previously reported to NAPCRG (2021), “IBH-PC” studied the effectiveness of an intervention to support BH integration in a randomized controlled trial (RCT). A small improvement in BH integration was detected; there was no observed effect on patient outcomes.Objective: Secondary analysis to understand relationships among intervention completion, timing of study measures relative to COVID-19, level of BH integration, and patient reported outcomes.Study Design: Post-hoc analysis of pragmatic RCT.Setting: 42 primary care clinics with on-site BH services, in 13 states, Sep 2017-Dec 2020.Population: 2,426 adults with multiple chronic behavioral and medical conditions.Intervention: Clinic-level support to implement IBH using online curricula, workbooks, remote coaching, and online learning community.Outcomes and Predictors: Change in mean Patient-Reported Outcomes Measurement Information System scores (PROMIS) and median Practice Integration Profile (PIP); timing relative to COVID-19; and completion of the implementation stage of the intervention.Results: Higher PIP scores were associated with better patient outcomes in all 8 PROMIS domains at baseline and follow-up. This association was significant for Anxiety (CI -0.12, 0.00, P=0.05 and CI -0.09, -0.01, P=0.01, respectively), Social Participation (CI +0.01, +0.09, P=0.02 and CI +0.02, +0.10, P=0.01), and Mental Health Summary (CI 0.00, +0.09, P=0.05 and CI 0.00, +0.09, P=0.04). Additional analysis found that a longer lapse between the start of COVID-19 and collection of final outcomes was associated with smaller improvement in PIP (P=0.04). Among clinics in the intervention arm (n=20), those that completed implementation (n=13) had significantly larger improvement in PIP scores (P=0.013) than those that did not; their patients also reported more improvement in PROMIS scores for Mental Health Summary (P=0.02), Social Participation (P=0.01), and Fatigue (P=0.04).Conclusions: Post-hoc analyses identified associations among level of integration, improved patient reported health outcomes, and intervention completion. COVID-19 may have affected intervention completion. To help the field advance, future study must identify necessary conditions for successful implementation of IBH and the relationship between integration and health.