Mental health care integration and primary care patient experience in the Veterans Health Administration

Abstract

BackgroundMental health specialists and care managers facilitate comprehensive care provision within medical homes. Despite implementation challenges, mental health integration is thought to improve patient-centered primary care. ObjectivesTo examine the relationship between primary care patient experience and mental health integration. Research designCross-sectional surveys from 168 primary care clinicians (PCPs) (n = 226) matched with assigned patients’ surveys (n = 1734) in one Veterans Health Administration (VA) region, fiscal years 2012–2013. Multilevel regression models examined patient experience and mental health integration, adjusting for patient and PCP characteristics. MeasuresPatient experience outcomes were (1) experience with PCP and (2) receipt of comprehensive care, such as talked about “stress”. Independent variables represented mental health integration— (1) PCP-rated communication with mental health and (2) proportion of clinic patients who saw integrated specialists. Results50% and 43% of patients rated their PCPs 10/10 and reported receiving comprehensive care, respectively. Neither patient experience or receipt of comprehensive care was significantly associated with PCP's ratings of communication with mental health, nor with proportion of clinic patients who saw integrated specialists. Among a subsample of patients who rated their mental health as poor/fair, however, we detected an association between proportion of clinic patients who saw integrated specialists and patient experience (odds ratio = 1.05, 95% confidence interval = 1.01–1.09, p = .01). ConclusionsNo association was observed between mental health integration and primary care patients’ reported care experiences, but a significant association existed among patients who reported poor/fair mental health. More research is needed to understand patient experiences with regard to care model implementation.