Exploring the provider experience of primary care behavioral health integration in health centers transitioning to the patient-centered medical home model.

摘要

Healthcare in the United States is in a crucial state of transition. A wide body of research supports the assertion that behavioral health services are needed in the primary care setting (Cummings, O'Donahue, & Cummings, 2009; Collins, Hewson, Munger, & Wade, 2010; Melek, 2012). Leaders in national and state healthcare reform endorse emerging primary care models, such as the Patient-Centered Medical Home Model, that acknowledge behavioral health integration as a crucial component of primary care (Mullikin, 2011; Runyan, 2011). The integration of behavioral health services into primary care has been shown to improve outcomes (Miley, 1989; Barlow, Wright, Turner & Bancroft, 2005; Ray-Sannerud, et al., 2012), provider and patient satisfaction (Audet, Davis, & Schoenbaum, 2006; Pratt, DeBerard, Davis, & Wheeler, 2012); Funderbunk, Fielder, DeMartini, & Flynn, 2012), and cost-effectiveness over the past few decades (Blount, et al., 2007; Williams, Shore, & Foy, 2006; Collins, Hewson, Munger, & Wade, 2010; Melek, 2012).;This researcher strove to deepen the understanding of the experience of medical and behavioral health providers working in primary care settings that are transitioning to integrated primary care behavioral health under the Massachusetts Patient-Centered Medical Home Initiative. Twelve semi-structured interviews (five medical and seven behavioral health providers) were conducted inquiring about this experience. Interpretive Phenomenological Analysis (Smith, Jarman, & Osborn, 1999) was used to identify themes across these interviews in order to develop a richer understanding of this growing model of care. Themes were clustered into seven areas of experience: defining primary care behavioral health integration, the process of transition itself, barriers to integration, the impact of integration on provider practice and internal experience, the perceived impact of integration on patient experience, endorsement of the model within practices and systems, and recommendations regarding integrated primary care behavioral health. Participants commented on the multiple definitions and iterations of primary care behavioral health integration that currently exist. Notably, all twelve participants perceived more resistance to integration from the behavioral health community than the medical community. Overall, there were more commonalities than differences across medical and behavioral health providers' experiences that could inform future implementations and investigations of this model of care.