UMass Chan Medical School Faculty Publications
UMMS Affiliation
Department of Family Medicine and Community Health; Center for Integrated Primary Care
Publication Date
2021-03-10
Document Type
Article
Disciplines
Behavioral Medicine | Health Services Administration | Health Services Research | Integrative Medicine | Mental and Social Health | Primary Care | Psychiatry and Psychology
Abstract
BACKGROUND: Chronic diseases that drive morbidity, mortality, and health care costs are largely influenced by human behavior. Behavioral health conditions such as anxiety, depression, and substance use disorders can often be effectively managed. The majority of patients in need of behavioral health care are seen in primary care, which often has difficulty responding. Some primary care practices are providing integrated behavioral health care (IBH), where primary care and behavioral health providers work together, in one location, using a team-based approach. Research suggests there may be an association between IBH and improved patient outcomes. However, it is often difficult for practices to achieve high levels of integration. The Integrating Behavioral Health and Primary Care study responds to this need by testing the effectiveness of a comprehensive practice-level intervention designed to improve outcomes in patients with multiple chronic medical and behavioral health conditions by increasing the practice's degree of behavioral health integration.
METHODS: Forty-five primary care practices, with existing onsite behavioral health care, will be recruited for this study. Forty-three practices will be randomized to the intervention or usual care arm, while 2 practices will be considered "Vanguard" (pilot) practices for developing the intervention. The intervention is a 24-month supported practice change process including an online curriculum, a practice redesign and implementation workbook, remote quality improvement coaching services, and an online learning community. Each practice's degree of behavioral health integration will be measured using the Practice Integration Profile. Approximately 75 patients with both chronic medical and behavioral health conditions from each practice will be asked to complete a series of surveys to measure patient-centered outcomes. Change in practice degree of behavioral health integration and patient-centered outcomes will be compared between the two groups. Practice-level case studies will be conducted to better understand the contextual factors influencing integration.
DISCUSSION: As primary care practices are encouraged to provide IBH services, evidence-based interventions to increase practice integration will be needed. This study will demonstrate the effectiveness of one such intervention in a pragmatic, real-world setting.
TRIAL REGISTRATION: ClinicalTrials.gov NCT02868983 . Registered on August 16, 2016.
Keywords
Behavioral health, Multiple chronic conditions, Pragmatic trials, Primary care, Randomized control trial
Rights and Permissions
© The Author(s). 2021 Open Access: This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
DOI of Published Version
10.1186/s13063-021-05133-8
Source
Crocker AM, Kessler R, van Eeghen C, Bonnell LN, Breshears RE, Callas P, Clifton J, Elder W, Fox C, Frisbie S, Hitt J, Jewiss J, Kathol R, Clark/Keefe K, O'Rourke-Lavoie J, Leibowitz GS, Macchi CR, McGovern M, Mollis B, Mullin DJ, Nagykaldi Z, Natkin LW, Pace W, Pinckney RG, Pomeroy D, Pond A, Postupack R, Reynolds P, Rose GL, Scholle SH, Sieber WJ, Stancin T, Stange KC, Stephens KA, Teng K, Waddell EN, Littenberg B. Integrating Behavioral Health and Primary Care (IBH-PC) to improve patient-centered outcomes in adults with multiple chronic medical and behavioral health conditions: study protocol for a pragmatic cluster-randomized control trial. Trials. 2021 Mar 10;22(1):200. doi: 10.1186/s13063-021-05133-8. PMID: 33691772; PMCID: PMC7945346. Link to article on publisher's site
Related Resources
Journal/Book/Conference Title
Trials
PubMed ID
33691772
Repository Citation
Crocker AM, Mullin DJ. (2021). Integrating Behavioral Health and Primary Care (IBH-PC) to improve patient-centered outcomes in adults with multiple chronic medical and behavioral health conditions: study protocol for a pragmatic cluster-randomized control trial. UMass Chan Medical School Faculty Publications. https://doi.org/10.1186/s13063-021-05133-8. Retrieved from https://escholarship.umassmed.edu/faculty_pubs/1990
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
Included in
Behavioral Medicine Commons, Health Services Administration Commons, Health Services Research Commons, Integrative Medicine Commons, Mental and Social Health Commons, Primary Care Commons, Psychiatry and Psychology Commons
Comments
Full author list omitted for brevity. For the full list of authors, see article.