Does behavioral health integration improve primary care providers' perceptions of health-care system functioning and their own knowledge?

OBJECTIVE: To examine the impact of behavioral health integration (BHI) on primary care providers' (PCPs') (1) perceptions of behavioral health (BH)-primary care (PC) system functioning and (2) perceptions of their own knowledge regarding how to manage, triage, and access help in caring for patients with mental health conditions and substance use disorders.

METHODS: We implemented BHI based on evidence-based models consisting of seven elements: (1)Screening for mental health and substance use disorders, (2)Training of PC teams, (3)Integration of BH providers into PC teams, (4)Roll-out of unlicensed mental health care managers and establishment of a BH registry, (5)Psychiatry consult service, (6)Site-based BHI meetings, and (7)Site self assessments. The intervention was rolled out in early integration sites during two years and late integration sites during the subsequent two years. In this observational pre-post study, we administered an anonymous online survey annually to PCPs; 381 PCPs at 11 primary care clinics participated.

RESULTS: The proportion of PCPs with high perceived BH-PC systems functioning scores quadrupled from 14% to 55% (p<0.0001) and high perceived knowledge scores increased from 63 to 85% (p<0.001). Larger increases were demonstrated in early integration sites during the first two years and in late integration sites during the latter two years of the survey. Adjusting for participant and site level characteristics did not change these outcomes.

CONCLUSIONS: BHI improves PCP perceptions of BH-PC system functioning and perceptions of knowledge.