Intervention of interest: Programs to integrate behavioral health into the primary care setting

Providers in the US health care system often assess and treat patients with physical health conditions and behavioral health conditions (e.g., mental health and substance use disorders) in siloes, yet physical and behavioral health are inextricably linked. Up to 70% of physician visits are for issues with a behavioral health component. A similar proportion of adults with behavioral health conditions have one or more physical health issues. Having a chronic condition is a risk factor for having a behavioral health condition and vice versa. Depression and anxiety in particular are common in primary care settings but are often inadequately identified and treated, leading to a worsening of behavioral conditions and/or increased difficulty managing physical health conditions. Behavioral health integration (BHI) into primary care addresses both physical and behavioral health needs in primary care settings through systematic coordination and collaboration among health care providers.

At the public meeting both the CTAF and CEPAC voted unanimously that the evidence shows the collaborative care model (CCM) improves health outcomes related to depression and anxiety, as well as patient satisfaction, when compared to usual care. Both groups judged the CCM to represent a reasonable to high care value, a rating that accounts for clinical effectiveness, incremental costs per outcome achieved, additional benefits of the intervention, and contextual considerations. For models of integration other than the CCM, both groups judged that there is insufficient evidence to determine the models’ effects on key outcomes, but emphasized that the votes indicate the need for more research, not that other models fail to provide benefit.

Date of review: April 2015

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Final Documents

Below you will find the final documents from the assessment review process:

“On the front lines of providing quality primary care there is considerable interest and activity on integrating behavioral health. However, there is also a great deal of uncertainty on how to proceed. This final report provides guidance on how to move forward with integration based both on the available quantitative evidence and the qualitative recommendations of topic experts.”