Developing a strategy for managing behavioral health care within the context of primary care

Summary & key facts

The authors reviewed research published from 1970 to 1996 about how people use mental health and substance abuse services in primary care. They found that most people with psychological problems are diagnosed and treated by their regular doctors, but there were few clear rules for how to build behavioral health programs that fit into primary care. The researchers said the best programs are those that are spread out across different practices to match local needs, are joined up with primary care in how they handle care and money, and are led by primary care doctors. Their conclusions come from past studies and may not apply everywhere or to newer health systems.

Key facts:

• Most people with psychological disorders are diagnosed and treated in primary care rather than in specialty mental health clinics.
• The authors searched and reviewed research published between 1970 and 1996 about who uses mental health and substance abuse services and why.
• They looked at four broad kinds of factors that seem to predict service use: features of patients, the primary care doctors, the practice setting, and the managed care plans.
• The paper reports that there were few practical guidelines available for primary care doctors and health-plan managers to build behavioral health programs that fit primary care.
• The authors argued that behavioral health programs are likely to work better when they are decentralized so they can match differences between patients and practices.
• They also argued programs should be integrated with primary care clinically, financially, and administratively so services and payments line up with normal primary care work.
• The researchers recommended that primary care doctors should take an active leadership role in designing and running behavioral health services for both clinical and financial reasons.
• Because this is a review of older studies up to 1996, the findings summarize past evidence and may not reflect newer research, policies, or health-system changes.

Abstract

Although most patients with psychological disorders are diagnosed and treated within the primary care setting, there are few guidelines to help primary care physicians and managed care plan administrators construct programs of behavioral health care that are compatible with the primary care environment. We report the findings from a review of the literature from 1970 to 1996 on factors that predict the use of mental health and substance abuse services with specific reference to primary care. We use a heuristic framework of service use that includes the characteristics of patients, primary care physicians, practice settings, and managed care plans. Recognizing that the factors associated with the use of services center on the primary care practice, we argue that programs of behavioral health care will work best when they are decentralized to account for variations among primary care patients, physicians, and practices; when they are integrated clinically, financially, and administratively within the primary care setting; and when primary care physicians are active leaders in the design and implementation of these services, for clinical and financial reasons.

Topics

Health Policy Implementation Science Mental Health Treatment and Access Substance Abuse Treatment and Outcomes

Categories

Psychology Social Psychology Social Sciences

Tags

Ambulatory care Biology Computer science Construct (python library) Context (archaeology) Economic growth Economics Economy Family medicine Health care Health policy HRHIS Managed care Medicine Mental health Nursing Paleontology Primary care Programming language Psychiatry Public health Service (business) Unlicensed assistive personnel

Conditions & symptoms

Anxiety Depression Substance abuse disorder Addiction or harmful habbits Anxiety or worry Sadness or low mood