Integrating Behavioral Health and Primary Care for Comorbid Behavioral and Medical Problems

Summary

Behavioral problems are part of many of the chronic diseases that cause the majority of illness, disability and death. Tobacco, diet, physical inactivity, alcohol, drug abuse, failure to take treatment, sleep problems, anxiety, depression, and stress are major issues, especially when chronic medical problems such as heart disease, lung disease, diabetes, or kidney disease are also present. These behavioral problems can often be helped, but the current health care system doesn't do a good job of getting the right care to these patients.

Behavioral health includes mental health care, substance abuse care, health behavior change, and attention to family and other psychological and social factors. Many people with behavioral health needs present to primary care and may be referred to mental health or substance abuse specialists, but this method is often unacceptable to patients. Two newer ways have been proposed for helping these patients. In co-location, a behavioral health clinician (such as a Psychologist or Social Worker) is located in or near the primary practice to increase the chance that the patient will make it to treatment. In Integrated Behavioral Health (IBH), a Behavioral Health Clinician is specially trained to work closely with the medical provider as a full member of the primary treatment team.

The research question is: Does increased integration of evidence-supported behavioral health and primary care services, compared to simple co-location of providers, improve outcomes? The key decision affected by the research is at the practice level: whether and how to use behavioral health services.

The investigators plan to do a randomized, parallel group clustered study of 3,000 subjects in 40 practices with co-located behavioral health services. Practices randomized to the active intervention will convert to IBH using a practice improvement method that has helped in other settings. The investigators will measure the health status of patients in each practice before and after they start using IBH. The investigators will compare the change in those outcomes to health status changes of patients in practices who have not yet started using IBH.

The investigators plan to study adults who have both medical and behavioral problems, and get their care in Family Medicine clinics, General Internal Medicine practices, and Community Health Centers.

Conditions

• Arthritis
• Asthma
• Chronic Obstructive Lung Disease
• Diabetes
• Heart Failure
• Hypertension
• Anxiety
• Chronic Pain
• Depression
• Fibromyalgia
• Insomnia
• Irritable Bowel Syndrome
• Problem Drinking
• Substance Use Disorder

Interventions

OTHER

Integration

The intervention consists of training for practice leaders, BHCs, PCPs, and office staff, a Protocolized Redesign Process support for practice redesign, and a toolkit of suggested tactics for implementing Tasks A through D: A. Identification B. Assessment C. Treatment D. Surveillance

Sponsors & Collaborators

• Arizona State University

  collaborator OTHER

• State University of New York at Buffalo

  collaborator OTHER

• Case Western Reserve University

  collaborator OTHER

• DARTNet

  collaborator UNKNOWN

• National Committee for Quality Assurance

  collaborator OTHER

• University of Massachusetts, Worcester

  collaborator OTHER

• Patient Centered Outcomes Oriented Research Institute

  collaborator UNKNOWN

• University of Vermont

  lead OTHER

Principal Investigators

• Benjamin Littenberg, MD · University of Vermont

Study Design

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

SINGLE

Model

PARALLEL

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2016-04-30

Primary Completion

2021-09-30

Completion

2021-09-30

Countries

• United States

Study Locations