Primary Behavioral Health Research Articles

Predictive modeling of service discontinuation in transitional age youth with recent behavioral health service use.

To develop and test predictive models of discontinuation of behavioral health service use within 12 months in transitional age youth with recent behavioral health service use. Administrative claims for Medicaid beneficiaries aged 15-26 years in Connecticut. We compared the performance of a decision tree, random forest, and gradient boosting machine learning algorithms to logistic regression in predicting service discontinuation within 12 months among beneficiaries using behavioral health services. We identified 33,532 transitional age youth with ≥1 claim for a primary behavioral health diagnosis in 2016 and Medicaid enrollment of ≥11 months in 2016 and ≥11 months in 2017. Classification accuracy for identifying youth who discontinued behavioral health service use was highest for gradient boosting (80%, AUC=0.86), decision tree (79%, AUC=0.84), and random forest (79%, AUC=0.86), as compared with logistic regression (71%, AUC=0.71). Predictive models based on Medicaid claims can assist in identifying transitional age youth who are at risk of discontinuing from behavioral health care within 12 months, thus allowing for proactive assessment and outreach to promote continuity of care for younger persons who have behavioral health needs.

Applying Lessons From Behavioral Health Integration to Social Care Integration in Primary Care.

Interest and incentives are increasing around strategies whereby the health care sector can better identify and address patients' social and economic needs in the context of primary care delivery. This interest is likely to accelerate during the economic recession following the OVID-19 pandemic. Yet effective and sustainable strategies for integrating social care practices (eg, patient-facing social risk screening and activities to address identified needs) have not been clearly established. Lessons learned from more than 2 decades of research on behavioral health integration could be applied to efforts to integrate social care into primary care. In this article, we synthesize learnings from primary care and behavioral health care integration, and translate them into organizing principles with the goal of advancing social care integration practices to improve the health of both patients and communities.

Decreasing the Use of Restraints on Children Admitted for Behavioral Health Conditions.

Pediatric behavioral health admissions to children's hospitals for disposition planning are steadily increasing. These children may exhibit violent behaviors, which can escalate to application of physical limb restraints for safety. Using quality improvement methodology, we sought to decrease physical restraint use on children admitted to our children's hospital for behavioral health conditions from a baseline mean of 2.6% of behavioral health patient days to <1%. We included all children ≥3 years of age admitted to our hospital medicine service with a primary behavioral health diagnosis from July 1, 2016, to February 1, 2020. A multidisciplinary team, formed in July 2018, tested interventions based on key drivers targeted toward our aim. The primary outcome measure was the percent of behavioral health patient days on which physical restraints were ordered. The balancing measure was the percent of patient days with a staff injury event. Statistical process control charts were used to view and analyze data. Our cohort included 3962 consecutive behavioral health patient encounters, encompassing a total of 9758 patient days. A 2-year baseline revealed physical restraint orders placed on 2.6% of behavioral health patient days, which was decreased to 0.9% after interventions and has been sustained over 19 months without any change in staff injuries. Team-based quality improvement methodology was associated with a sustained reduction in physical restraint use on children admitted for behavioral health conditions to our children's hospital. These results indicate that physical restraint use can be safely reduced in children's hospitals.

Latinos understanding the need for adherence in diabetes (LUNA-D): a randomized controlled trial of an integrated team-based care intervention among Latinos with diabetes.

We developed and tested a culturally appropriate, team-based, integrated primary care and behavioral health intervention in low income, Spanish-speaking Latinos with type 2 diabetes, at a federally qualified health center. This pragmatic randomized controlled trial included 456 Latino adults, 23-80 years, 63.7% female, with diabetes [recruitment glycosylated hemoglobin (HbA1c) ≥ 7.0%/53.01 mmol/mol)]. The Special Intervention occurred over 6 months and targeted improvement of HbA1c, blood pressure, and lipids. The intervention included: (i) four, same-day integrated medical and behavioral co-located visits; (ii) six group diabetes self-management education sessions addressing the cultural dimensions of diabetes and lifestyle messages; (iii) and care coordination. Usual Care participants received primary care provider led standard diabetes care, with referrals to health education and behavioral health as needed. HbA1c and lipids were obtained through electronic health records abstraction. Blood pressure was measured by trained research staff. Multi-level models showed a significant group by time interaction effect (B = -0.32, p < .01, 95% CI -0.49, -0.15), indicating statistically greater improvement in HbA1c level over 6 months in the Special Intervention group (ΔHbA1c = -0.35, p = <.01) versus Usual Care (ΔHbA1c = -0.02, p = .72). Marginally significant group by time interactions were also found for total cholesterol and diastolic blood pressure, with significant improvements in the Special Intervention group (p < .05). This culturally appropriate model of highly integrated care offers strategies that can assist with self-management goals and disease management for Latinos with diabetes in a federally qualified health center setting.

Initial Clinical Needs Among Transgender and Non-binary Individuals in a Large, Urban Gender Health Program.

Transgender and gender-diverse individuals are particularly vulnerable to healthcare discrimination and related health sequelae. To demonstrate diversity in demographics and explore variance in needs at the time of intake among patients seeking care at a large, urban gender health program. We present summary statistics of patient demographics, medical histories, and gender-affirming care needs stratified by gender identity and sexual orientation. We reviewed all intake interviews with individuals seeking care in our gender health program from 2017 to 2020. Clients reported all the types of care in which they were interested at the time of intake as their "reason for call" (i.e., establish primary care, hormone management, surgical services, fertility services, behavioral health, or other health concerns). Of 836 patients analyzed, 350 identified as trans women, 263 as trans men, and 223 as non-binary. The most prevalent sexual identity was straight among trans women (34%) and trans men (38%), whereas most (69%) non-binary individuals identified as pansexual or queer; only 3% of non-binary individuals identified as straight. Over half of patients reported primary care, hormone management, or surgical services as the primary reason for contacting our program. Straight, transgender women were more likely to report surgical services as their primary reason for contacting our program, whereas gay transgender men were more likely to report primary care as their reason. Individuals contacting our gender health program to establish care were diverse in sexual orientation and gender-affirming care needs. Care needs varied with both gender identity and sexual orientation, but primary care, hormone management, and surgical services were high priorities across groups. Providers of gender-affirming care should inquire about sexual orientation and detailed treatment priorities, as trans and gender-diverse populations are not uniform in their treatment needs or goals.

Primary Care and Behavioral Health Provider Communication: Strategy for Improvement

Limited communication between primary care and behavioral health providers was identified as a barrier to access care and effective collaborative care of patients seeking behavioral health treatment in the Matanuska-Susitna Borough, Alaska. A 1-group, pretest–posttest design, quality improvement project was created to develop and implement a standardized communication template to facilitate communication and collaboration between behavioral health and primary care providers in the project group. Relational coordination within the group as a whole improved 11.07% from pre- to postintervention. Significant cultural differences, most notably in understanding the application of Health Insurance Portability and Accountability Act, were identified between the 2 provider types.

Disruptive Resilience: Harnessing Leadership to Build a More Equitable Health Care System After COVID-19.

Disruptive Resilience: Harnessing Leadership to Build a More Equitable Health Care System After COVID-19.

Integrating Behavioral Health and Primary Care (IBH-PC) to improve patient-centered outcomes in adults with multiple chronic medical and behavioral health conditions: study protocol for a pragmatic cluster-randomized control trial

BackgroundChronic diseases that drive morbidity, mortality, and health care costs are largely influenced by human behavior. Behavioral health conditions such as anxiety, depression, and substance use disorders can often be effectively managed. The majority of patients in need of behavioral health care are seen in primary care, which often has difficulty responding. Some primary care practices are providing integrated behavioral health care (IBH), where primary care and behavioral health providers work together, in one location, using a team-based approach. Research suggests there may be an association between IBH and improved patient outcomes. However, it is often difficult for practices to achieve high levels of integration. The Integrating Behavioral Health and Primary Care study responds to this need by testing the effectiveness of a comprehensive practice-level intervention designed to improve outcomes in patients with multiple chronic medical and behavioral health conditions by increasing the practice’s degree of behavioral health integration.MethodsForty-five primary care practices, with existing onsite behavioral health care, will be recruited for this study. Forty-three practices will be randomized to the intervention or usual care arm, while 2 practices will be considered “Vanguard” (pilot) practices for developing the intervention. The intervention is a 24-month supported practice change process including an online curriculum, a practice redesign and implementation workbook, remote quality improvement coaching services, and an online learning community. Each practice’s degree of behavioral health integration will be measured using the Practice Integration Profile. Approximately 75 patients with both chronic medical and behavioral health conditions from each practice will be asked to complete a series of surveys to measure patient-centered outcomes. Change in practice degree of behavioral health integration and patient-centered outcomes will be compared between the two groups. Practice-level case studies will be conducted to better understand the contextual factors influencing integration.DiscussionAs primary care practices are encouraged to provide IBH services, evidence-based interventions to increase practice integration will be needed. This study will demonstrate the effectiveness of one such intervention in a pragmatic, real-world setting.Trial registrationClinicalTrials.gov NCT02868983. Registered on August 16, 2016.

Telehealth Use Among Safety-Net Organizations in California During the COVID-19 Pandemic

This study describes trends in use of in-person, telephone, and video primary care and behavioral health visits to California Federally Qualified Health Centers from 2019 to August 2020 before and during the coronavirus disease 2019 (COVID-19) pandemic.

Factors Related to Providers Screening Children for Behavioral Health Risks in Primary Care Settings

PurposeTo provide information from a large sample of pediatric and family medicine primary care providers on practices in screening children for behavioral health risks. Design and methodsParticipants were a sample of physicians (n=319) and nurse practitioners (n=292) from across the U.S. who completed a confidential online survey about screening practices through a computer-assisted self-interview. ResultsAlmost all respondents (89%) reported screening children for depression/anxiety and behavior problems. Child substance use (82%), family social support (74%), significant household changes (73%), bullying (72%), child abuse (62%) and domestic violence (52%) were also asked about regularly, although with high rates of informal screening methods. Caregiver mental health (49%), caregiver substance use (35%), family financial strain (33%) and transportation difficulties (27%) were screened less frequently. Screening was associated with higher rates of referral for risk-related problems, and was more likely when providers reported greater confidence providing support to clients, perceived community resource availability as higher, and worked in systems with integrated primary care and behavioral health. ConclusionsFindings suggest a great amount of diversity in how providers screen for behavioral health risks. There is reluctance to screen when options for addressing the problems are seen as limited. Research is needed to better guide healthcare providers in determining the right context and methods for screening social risks. Practice implicationsProtocols for screening adverse childhood events (ACES) and other social risk factors should be accompanied by adequate training and efforts to improve community resource and support networks.

Integrated care effectiveness for adults with co-occurring disorders

PurposeThis study examined effectiveness of an integrated care program on emergency department visits within a longitudinal sample of patients with both primary care and behavioral health diagnoses.Design/methodology/approachPatients with co-occurring disorders enrolled in an integrated care clinic and were followed over time to determine whether participation in the clinic, including engagement in wellness/peer services, predicted decreases in Emergency Department (ED) use. Associations between socio-demographic characteristics of patients and ED use were also analyzed.FindingsAfter 6 months, clinic patients had decreases in ED use that continued for twelve months, albeit to a lesser degree. Demographics and program services were not related to ED use; however, multiple associations existed between high ED utilizers, severe mental illness (SMI), substance use disorders (SUD) and non-retention in services.Research limitations/implicationsThe study lacked a comparison group and there was no distinction between avoidable and unavoidable ED visits. A small sample size across time points led to inconclusive post hoc findings.Originality/valueThis study explored effectiveness of primary care integration into a behavioral health clinic for persons with multiple morbidities. Although initial decreases in ED visits were present, results indicate that these models may not be effective for persons with SMI or SMI/SUD who are already high ED users. This study provides support for integrated care in reducing ED use among persons with multiple morbidities and calls for further research on designing effective integrated models for persons with SMI and SUD.

The impact of funding for federally qualified health centers on utilization and emergency department visits in Massachusetts.

ImportanceFederally qualified health centers (FQHCs) receive federal funding to serve medically underserved areas and provide a range of services including comprehensive primary care, enabling services, and behavioral health care. Greater funding for FQHCs could increase the local availability of clinic-based care and help reduce more costly resource use, such as emergency department visits (ED).ObjectiveTo examine the impact of funding increases for FQHCs after the ACA on the use of FQHCs and EDs.MethodsRetrospective study using the Massachusetts All Payer Claims Database (APCD) 2010–2013 that included APCD enrollees in 559 Massachusetts ZIP codes (N = 6,173,563 in 2010). We calculated shift-share predictions of changes in FQHC funding at the ZIP code-level for FQHCs that received Community Health Center funds in any year, 2010–13 (N = 31). Outcomes were the number of ZIP code enrollees with visits to FQHCs and EDs, overall and for emergent and non-emergent diagnoses.ResultsIn 2010, 4% of study subjects visited a FQHC, and they were more likely to be younger, have Medicaid, and live in low-income areas. We found that a standard deviation increase in prior year FQHC funding (+31 percentage point (pp)) at the ZIP code level was associated with a 2.3pp (95% CI 0.7pp to 3.8pp) increase in enrollees with FQHC visits and a 1.3pp (95% CI -2.3pp to -0.3pp) decrease in enrollees with non-emergent ED visits, but no significant change in emergent ED visits (0.3pp, 95% CI -0.8pp to 1.4pp).ConclusionsWe found that areas exposed to greater FQHC funding increases had more growth in the number of enrollees seen by FQHCs and greater reductions in ED visits for non-emergent conditions. Investment in FQHCs could be a promising approach to increase access to care for underserved populations and reduce costly ED visits, especially for primary care treatable or non-emergent conditions.

Public health response to COVID‐19 for persons living with dementia in communities, acute care, and long‐term care settings

BackgroundEmergencies and disasters can exacerbate or complicate unique vulnerabilities associated with dementia. The Healthy Brain Initiative’s State and Local Public Health Partnerships to Address Dementia: The 2018‐2023 Road Map calls for addressing the special needs of people with dementia and caregivers in emergency preparedness/response.MethodDuring the coronavirus (COVID‐19) pandemic, public health professionals play a critical role in protecting people living with dementia, their caregivers and families. The Alzheimer's Association and the Centers for Disease Control and Prevention (CDC) educated public health professionals and partners about the unique challenges associated with dementia during the pandemic and steps to tailor the emergency response. Homes in the community, acute care and long‐term care are three settings that require unique public health responses.ResultChallenges encountered vary by setting. In homes and the community, people living with dementia and their caregivers have been affected by the suspension of adult day services, social events, congregate meals, respite care, peer support groups, community education, physical activity classes and more, including virtual delivery of non‐urgent primary care, case management and behavioral health. Many emergency departments and hospitals adopted no‐visitor policies to reduce transmission of COVID‐19; however, caregivers for people living with dementia provide essential medical and emotional support that aids diagnosis and treatment. Long‐term care (LTC) facilities are especially prone to COVID‐19 outbreaks due to the concentration of vulnerable older adults, many with some form of cognitive impairment. Provision of person‐centered dementia care is hampered by no‐visitor policies without caregiver allowances and limited training of professionals working in LTC facilities during the crisis.ConclusionTaking immediate public health actions will not only help minimize the negative impacts of COVID‐19 on people living with dementia and their caregivers, but also support effective, efficient delivery of person‐centered care. Through this session, public health professionals will quickly learn about challenges posed by dementia in these settings, immediate steps to better protect health and safety for this population, and resources their departments can use. Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC.

Integrated Primary Specialty Care Access for Adults with Sickle Cell Disease in Delaware

INTRODUCTION A major gap in US care for Sickle Cell Disease (SCD) is a dearth of healthcare providers with expertise in adult SCD management. In 2014 TOVA Community Health launched a community-based primary specialty care clinic in Delaware (DE). The Delaware Department of Health and Social Services found that 96 individual adults in DE with Sickle Cell Disease (SCD) utilized hospital services 99.5% of the time for sickle cell crisis (Anderson et al., 2014). The majority of those adults lived in New Castle County, DE. The dearth of sickle cell hematologist/oncologists for adults in this county may drive them to seek recurrent care through the hospital system. Recognizing this as a nationwide public health crisis, the Delaware Department of Health and Social Services (DHSS) partnered with TOVA Community Health in 2014 to establish an adult primary specialty care clinic medical home in New Castle County, DE. This report describes the progress/impact of an integrated primary specialty clinic for adults with SCD METHODS Prospective/ Retrospective tracking of best practices for SCD are featured in the NIH 2014 guidelines. The staff included a hematologist with expertise in SCD, a primary care provider, an advanced practice nurse, a Social Worker (MSW), a nurse care coordinator, and a community health worker, were funded by Sickle Cell Disease Association of America (SCDAA) and Health Resources and Services Administration (HRSA). From 2014 to 2018, integrated primary specialty care services were provided for 33 discrete patients. RESULTS This first cohort of patients was notable for health complications that may be attributed to the lack of coordinated primary specialty sickle cell care access. Therapeutic counseling, support groups and preventive health maintenance services were measured by: outpatient visits to the clinic, access to disease modifying therapies (hydroxyurea therapy or chronic transfusion therapy), immunizations (Pneumococcal), Depression Screens and Personalized Sickle Care Plans (Table). 21 % percent of the patients had no sickle cell provider and/or hematologist/oncologist other than ED or inpatient care for the 12 months preceding their first visit to our clinic. 48% of the patients received a pneumococcal vaccine (Pneumovax 23 val - n=16/33 and Prevnar 13 - n=7/33) and three (n=3/33) received both Pneumococcal vaccines. 30% percent of the patients (n=10/33 patients) seen were offered access to HU but were not on the drug and 42% (n=14) were prescribed HU. All patients did not have a Personalized Sickle Cell Care Plan prior to receiving services at the Primary Specialty Care clinic. 12% (n=4/33) patients had a diagnosis of Substance Abuse Disorder, 15% (n=5/33) had a diagnosis of Opioid Use Disorder and 3% (n=1/33) had both Substance Abuse and Opioid Use Disorder. 70% (n= 7/10) were male and 30% (n-3/10) were female with a diagnosis of Substance Abuse and/or Opioid Use Disorder. 45% (n=15/33) had a Pain Management Agreement established within the time period at the primary specialty clinic. CONCLUSION The creation of an integrated practice primary specialty care clinic for adults with SCD in New Castle County, Wilmington, DE demonstrates the successful leverage of regional networks that engages an academic institution for telehealth consultation, public health, and community-based organizations to develop an adult SCD primary specialty care model. This safety net clinic provides team based primary specialty care to adults whose only option previously was the hospital and/or emergency room. Unique challenges in managing adult SCD acute and chronic pain were addressed. Overall, this is one model for access to integrated primary specialty care and behavioral health services for persons with SCD across their lifespan. Figure 1. Disclosures No relevant conflicts of interest to declare.

Effects of COVID-19 on the mental health of black and brown racialized populations in the U.S.

Effects of COVID-19 on the mental health of black and brown racialized populations in the U.S.

Fifteen Years After Katrina: Paving the Way for Health Care Transformation.

Following the devastation of the Greater New Orleans, Louisiana, region by Hurricane Katrina, 25 nonprofit health care organizations in partnership with public and private stakeholders worked to build a community-based primary care and behavioral health network. The work was made possible in large part by a $100 million federal award, the Primary Care Access Stabilization Grant, which paved the way for innovative and sustained public health and health care transformation across the Greater New Orleans area and the state of Louisiana.

Mixed-Methods Evaluation of the Washington State Practice Transformation Support Hub.

Practice transformation initiatives have the potential to promote collaborations between public health, primary care, and behavioral health, but limited empirical evidence is available on how these programs affect participating clinical practices. To report the findings from a mixed-methods program evaluation of the Washington Practice Transformation Support Hub (Hub), a publicly funded, multicomponent practice transformation initiative in Washington State. We used quantitative and qualitative methods to evaluate the impact of Hub activities on participating primary care and behavioral health practices. Pre- and posttest survey data were combined with administrative program data to understand the effect of program components. Qualitative interviews contextualized findings. Urban and rural primary care and behavioral health practices in Washington State. One hundred seventy-five practices that were recruited to receive Hub coaching and facilitation from 8 coaches; of these, 13 practices and all coaches participated in key informant interviews. Practice coaching and facilitation supported by an online resource portal, from January 2017 through January 2019. Self-reported progress in specific activities in 3 practice-level domains: bidirectional integration of physical and behavioral health care (care integration); alignment with community-based services for whole-person care (clinical-community linkages); and value-based payment. Participation in Hub activities was associated with improvements in care integration and clinical-community linkages but not with progress toward value-based payment. Qualitative results indicated that practice progress was influenced by communication with practices, the culture of the practice, resource constraints (particularly in rural areas), and perceptions about sustainability. This statewide practice transformation initiative was successful in strengthening primary care and behavioral health integration and clinical-community linkages among participating practices but not value-based payment. Future practice transformation efforts may benefit from addressing barriers posed by communication, limited application of value-based payment, culture change, competing priorities, and resource limitations, particularly for rural communities.

Washington’s State Innovation Models (SIM) Project: Effects of Primary Care and Behavioral Health Integration on Participating Organizations

The Triple Aim is a framework designed by the Institute for Healthcare Improvement (IHI), aimed at enhancing health system performance. The IHI Triple Aim is defined by three components: improving population health, improving quality of care, and reducing per capita health care costs. Section 3021 of the Affordable Care Act (ACA) altered section 1115A of the Social Security Act, establishing the Center for Medicare and Medicaid Innovation (CMMI). Through CMMI, Medicaid and Medicare programs can test models to improve care, lower cost, and support patient‐centered practice. The State Innovation Models (SIM) initiative is one of these major reform models and is designed to test new payment approaches that address the Triple Aim.In Washington State, SIM Payment Model 1 (PM1) assists the transition from the traditional Medicaid payment system, with separate contracts for physical and behavioral health services, to a unified managed care model wherein each Medicaid managed care organization has single contract for delivering physical and behavioral health services. The primary goal is to incorporate behavioral health benefits into the capitated Medicaid managed care program so that beneficiaries have access to the full complement of physical and behavioral health services through a single integrated managed care plan. Our purpose is to evaluate stakeholders’ perspectives regarding the impact of the SIM PM1 initiative on participating payers, providers, and support agencies.The lead qualitative investigator contacted a purposive sample of clinical and administrative executives via email between June 2017 and October 2019. A total of 23 informants (n = 23) representing 11 organizations participated in a combination of face‐to‐face and telephonic interviews. Semi‐structured interviews were conducted using a single questionnaire aligned with an organization theory‐based conceptual framework, and each lasted 37 to 70 minutes.The research team identified health service payers (MCOs), behavioral health and primary care providers, and supporting agencies (eg, public health, crisis services, associations) participating in the development and/or implementation of PM1 physical‐behavioral health care integration initiative.PM1 implementation efforts required extensive consideration of organizational needs as well as agency‐based integration techniques. Integration depended on external and internal contributing factors, which informed and guided changes to the organization theory‐based conceptual framework. Efforts were influenced by a combination of external and internal factors, such as regional leadership and partnerships as well as each entity’s unique capacity to engage in organizational learning. While stakeholders expressed wide‐ranging opinions about the initiative and its effects, informants’ perspectives aligned largely by organization type. Thematically, findings included (a) organizational change management; (b) key priorities and approaches; (c) common facilitators and barriers to integration; (d) lessons learned; and (e) sustainability.Contextual factors influence organizations’ unique approaches to adoption and implementation of physical and behavioral health care integration policy. Value‐based policy implementation is a learning process. As such, organizations must hone their approaches to services delivered over time.When setting priorities for value‐based contracting, policy makers and health system leaders should consider the contextual and organizational factors that influence implementation, and should explore payment and purchasing structures that allow for flexibility and learning, particularly during early implementation.The study was funded by the Centers for Medicare and Medicaid Services.

Comparison of Medicaid Reimbursements for Psychiatrists and Primary Care Physicians.

This study aimed to investigate whether state Medicaid programs systematically reimburse psychiatrists less than they reimburse primary care physicians. This study used outpatient Medicaid claims data from 2014 for 11 U.S. states. Claims with a primary behavioral health diagnosis (i.e., mental or substance use disorder) and an evaluation and management procedure code of 99213 or 99214 were identified. These are the most frequently used procedure codes by both psychiatrists and primary care physicians when treating patients with mental and substance use disorders. Average reimbursements were compared for nonfacility claims submitted by psychiatrists and primary care physicians. In 9 states, psychiatrists were reimbursed less on average than primary care physicians. In one state, reimbursements were nearly equivalent. Disparities in reimbursements across specialties may reduce access to psychiatric specialty care through Medicaid and are inconsistent with the Mental Health Parity and Addiction Equity Act.

Efficiencies and outcomes of depression treatment by a psychiatric pharmacist in a primary care clinic compared with treatment within a behavioral health clinic

ObjectiveThis study compared the efficiency and increased access to care by a psychiatric pharmacist (PP) incorporated into primary care versus behavioral health clinic (BHC) prescribers for depression treatment. SettingThe pharmacist’s practice was based in the primary care clinics of an urban Federally Qualified Community Health Center (FQCHC). Practice descriptionPP entered into a supervised collaborative practice agreement at the FQCHC. Primary care providers referred patients to PP for depression treatment. Practice innovationPPs have been utilized as psychiatric providers within psychiatric settings, but not in primary care. Integrating a PP within primary care can assist patients in obtaining more rapid, individualized mental health treatment. EvaluationInvestigators retrospectively screened the records of adults treated at a FQCHC with a primary diagnosis of depression referred for antidepressant management to (1) the PP over a 2 year period (study group [SG]), versus (2) the FQCHC’s BHC over the year preceding the PP’s arrival (control group [CG]). Both groups were compared using serial PHQ-9 data and wait time until initial evaluation. Pharmacist’s patients treated during a 2-month period also completed a satisfaction survey. ResultsThe SG and CG included 107 and 34 patients respectively. Average PHQ-9 scores decreased from 17.9 ± 6.51 at baseline to 14.7 ± 7.0 at follow-up #1 in the SG (P < 0.001), whereas there were minimal PHQ-9 data in CG. Time from treatment referral to initial medication evaluation averaged 31.3 days in the SG and 104.5 days in the CG (P < 0.001). The 39 SG patients demonstrated high satisfaction, with a mean of 26.8 out of 28 points. ConclusionPP incorporation into primary care produced positive outcomes and improved depression treatment access. Patients maintained reduced PHQ-9 scores and were seen in one-third the time versus those seen in the BHC. PP utilization in primary care is viable for treating depression.