Access to and Engagement in Evidence-Based Integrated Care

Abstract

Patients seen in general medical settings commonly have behavioral health conditions comorbid with other chronic medical disorders, each requiring high levels of integrated care management. With recent health care policy reform, the number of such patients recognized in the US health care system will likely increase, intensifying the need for practical integrated care models that address co-occurring behavioral and general medical disorders. Access to evidence-based integrated care can be enhanced by viewing general medical settings, especially primary care settings where people with behavioral health comorbidities are frequently seen for general medical problems, as opportunities for engagement in behavioral health care. We now have multiple evidence-based models for delivering integrated care in general medical settings. Embedded within these models are specific strategies to promote access to and engagement in evidence-based behavioral health care, such as patient activation, culturally acceptable care, shared decision making, patient education, self-management support, care coordination, reducing patients’ logistical barriers to care, and use of health information technology. Yet many settings in which integrated behavioral health care could and should be accessed remain untapped or underutilized. While barriers at multiple levels hinder progress, abundant opportunities to overcome these deficits exist, such as the development of flexible integrated care models applicable to large patient populations, enhanced training for the workforce delivering integrated care, health information technology tools that support delivery of integrated care, minimization of financial barriers to evidence-based integrated care, and expansion of the integrated care science base.