Integrated primary care‐behavioral health program development and implementation in a rural context

Abstract

Objective Despite the known benefits of integrated primary care and behavioral health services, integrated behavioral health services have not been readily used in medical clinics in interior Alaska. With minimal resources, we recently developed an integrated primary care–behavioral health program in a medical clinic in interior Alaska to meet clinic and community needs. The objective of this study was to explore initial program outcomes and determine the feasibility of program development and implementation. Methods We initially conducted a needs assessment for integrating behavioral health services into primary care. Program development was informed by specific clinic needs. Following program implementation, initial program outcomes were tracked with use of data from the electronic health record and patient and provider use and satisfaction surveys. The level of integration of primary care and behavioral health services was evaluated with the Practice Integration Profile. Results A total of 188 patients were seen by behavioral health consultants during the initial pilot phase, including 44.0% referred for mental health symptoms, 33.1% referred for physical health issues, and 22.3% referred for both mental and physical health issues. The initial program outcomes indicate modest clinical improvement (measured by the nine-item Patient Health Questionnaire) as well as patient and provider satisfaction with the model, and a moderate level of practice integration. Conclusion On the basis of the initial findings, it appears that our integrated primary care–behavioral health program has the potential to serve an important role in addressing the behavioral health needs of the local population. Our implementation procedure and initial program outcomes suggest that such models are feasible in rural and small-scale settings with minimal overhead costs. Significance statement Integrating behavioral health services into primary care medical settings offers a variety of benefits, including improved continuity of care and access to service, more effective health prevention and management, and clinical cost-effectiveness. Integrated models have not been readily used in rural US settings. With minimal resources, we developed an integrated primary care–behavioral health program in the family medicine department of a semirural medical clinic in Alaska to meet clinic and community needs. The initial program outcomes suggest that this integrated primary care–behavioral health program is helping to address the behavioral health needs of the local population. Our findings suggest that integrated healthcare models are feasible in rural or small-scale settings.