Collaborative Care: Integrating Behavioral Health Into the Primary Care Setting

Abstract

INTRODUCTION Integrated behavioral health is a model of health care that aims to meet the complex health care needs of patients in primary care settings. Collaborative Care (CC) is an evidence-based model incorporating an interdisciplinary team to improve outcomes for behavioral health disorders commonly seen by primary care providers. OBJECTIVE CC was implemented in a nurse-managed health center in a medically underserved community of Chicago with a team of family nurse practitioners, psychiatric mental health nurse practitioners, and a licensed clinical social worker. METHOD Integration of the CC model required restructuring of the patient visit, the care team, and financial operations. Weekly team meetings were held for interdisciplinary case consultation and training for the primary care team by the psychiatric nurse practitioner. The model includes suggested goals of reducing patient scores of validated depression (Patient Health Questionnaire–9) and anxiety (Generalized Anxiety Disorder–7) screening tools to a score less than 5 points or to less than 50% of original score. RESULTS During the initial year of implementation, 166 patients received care under the CC model, with 64 patients currently receiving active care. In this cohort, 22% reached suggested goals for depression and 47% for anxiety. CONCLUSIONS CC has benefits for both patients and providers. Patients receive holistic treatment of both mental and physical health needs and access to psychiatric services for medication initiation and behavioral health modalities when necessary. We observed that the CC model improved collaboration with behavioral health specialists and the competence and confidence of family nurse practitioners.

Integration of collaborative care model ameliorates population level COVID-19 Pandemic-related depressive symptoms among orthopaedic clinic patient population in US major metropolitan area

“…Contrary to our expectations, data did not reflect more improvement in depression screening scores subsequent to CCM implementation nor greater proportion of patients who achieved MCII. These findings are contrary to the literature which reflects improved mental health screening outcomes upon adoption of a CCM in medical clinics 47–51. Nor, however, did we see a worsening as could be expected in light of the increase in population level depressive symptoms secondary to the pandemic.…”

“…These findings are contrary to the literature which reflects improved mental health screening outcomes upon adoption of a CCM in medical clinics. [47][48][49][50][51] Nor, however, did we see a worsening as could be expected in light of the increase in population level depressive symptoms secondary to the pandemic. It is reasonable to assume that our CCM may have ameliorated the expected increases in depressive symptoms screening scores reflecting that of the general population.…”

Mental Health in the Time of Coronavirus Disease 2019

“…79 New models are integrating behavioral healthcare into medical settings to improve screening, medication access, patient education, and care coordination. 80 Psychiatric mental health nurse practitioners (PMHNP) are providing leadership in this work in primary care practices. 81,71 These professionals provide medication and psychotherapy to patients and supervision and consultation for their NP colleagues and other professionals.…”

“…83 By partnering with primary care NPs, even during the pandemic, substance use disorders, depression, anxiety, and co-morbid conditions with chronic medical illness have been reduced. 80 There are many traditional psychological interventions such as Cognitive Behavioral Therapy 84 , social skills, and relationship training for loneliness, 56,57,58,59 and a variety of evidence-based strategies for traumatic stress 85 that benefit patients. However, for many individuals, just feeling connected to and understood by a compassionate NP or other healthcare professional is comforting, empowering, and efficacious.…”

Educational collaboration can empower patients, support doctors in training and future‐proof medical education

“…Patients derive a significant benefit from being treated holistically in terms of disease treatment and management. 14 The recognition and use of the patient voice both in teaching and care planning have shown significant improvements in both uptake of care and patient outcomes 15,16 as well improving self-worth and well-being. 17 Willingness of patients to participate in education is generally enthusiastically forthcoming.…”