How do models of integrated primary care work? A proposed model for mechanisms of change using primary care behavioral health.

Abstract

Embedding a behavioral health consultant (BHC) into primary care settings is a common way to address the challenge of providing mental health services to primary care patients. Systematic research on the mechanisms of change that underlie the relationship between the active components of these integrated models of care delivery on patient outcomes is needed to help maximize effectiveness and, in turn, guide future implementation efforts. Using the existing primary care behavioral health (PCBH) literature, this article provides a conceptual framework using a common presenting problem, depression and identifies the active ingredients of PCBH and hypothesized mechanisms of patient change that result in decreased depressive symptoms and improved functioning within a patient. Eight hypothesized mechanisms (i.e., belief that PCBH services provided by BHC is a standard part of care within primary care; increased credibility of BHC and PCBH care provided; increased receptivity to the PCBH services offered; increased understanding of problem and options; realignment of patient expectations for care; increased readiness to change; decrease stigma; increase capacity to cope and manage symptoms) are proposed within this conceptual framework along with four potential mediators/moderators (i.e., team processes, PCBH factors, common factors, treatment engagement). The theoretical conceptualization included calls for future research to provide an evidence base to inform clinical practice. An increased understanding of the relationship between these active ingredients and the identified mechanisms of change is essential to maximize PCBH's effectiveness. (PsycInfo Database Record (c) 2024 APA, all rights reserved).