New Directions from Studying Integrated Behavioral Health and Primary Care for Patients with Multiple Chronic Conditions

Abstract

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.