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

Abstract

BackgroundChronic 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.Methods43 primary care practices, with existing onsite behavioral health care, will be randomized to the intervention or usual care arm. 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.DiscussionAs 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 registrationClinicalTrials.gov NCT02868983. Registered August 16, 2016. https://clinicaltrials.gov/ct2/show/NCT02868983

Differences in Occupational Burnout Among Primary Care Professionals

“…As part of IBH-PC, 45 primary care practices of diverse structures (privately owned, academic, hospital or health system, federally qualified health center), each having an onsite behavioral health provider (BHP), were recruited from diverse geographic regions (urban/ rural) in 13 US states. 20 The IBH-PC trial sought to test the effectiveness of a practice-level change process designed to enhance integrated behavioral health and improve the health of patients with multiple medical conditions. 20 An estimated 1100 practice members received at least 1 e-mail invitation from a practice delegate (ie, practice manager, behavioral health or medical director, etc.)…”

“…20 The IBH-PC trial sought to test the effectiveness of a practice-level change process designed to enhance integrated behavioral health and improve the health of patients with multiple medical conditions. 20 An estimated 1100 practice members received at least 1 e-mail invitation from a practice delegate (ie, practice manager, behavioral health or medical director, etc.) to complete the online anonymous survey at 1 time point.…”

Development and validation of the patient centeredness index for primary care

“…The Integrating Behavioral Health and Primary Care (IBH‐PC) Study (Crocker et al, 2021), a large‐scale cluster randomised pragmatic clinical trial of the effects of a practice‐level intervention on patient and practice‐level outcomes, generated data related to patient centeredness. The study sampled adults who received care from 44 Family Practice or Internal Medicine clinics with co‐located behavioural health services.…”

“…To evaluate the psychometrics of the PCI, we administered it as part of the IBH‐PC study, along with a variety of measures of physical and behavioural health symptoms and functioning (Crocker et al, 2021). For this embedded study, we examined each patient's number of chronic medical and behavioural health conditions upon entry to the study and their ratings of provider empathy, in addition to patient demographics.…”

Intraclass Correlation and Variance in the Characteristics of Primary Care Patients Managing Chronic Medical and Behavioral Conditions

“…This study was embedded in a large cluster-randomized pragmatic clinical trial of adult primary care patients managing MCC, the Integrating Behavioral Health and Primary Care study (IBH-PC) [7]. IBH-PC collected demographics and patient-reported health outcomes on over 3,000 adults from 44 primary care practices in 13 states across the US.…”