A Quasi-Experimental Evaluation of a Primary Care Behavioral Health Integration Program Based on the Chronic Care Model.

Abstract

Background: Mental health conditions are often underdiagnosed and undertreated in primary care, particularly in underserved areas. Integrated behavioral health models can address this gap, but their reliance on mental health professionals may limit scalability. A multi-level intervention based on the chronic care model may enhance mental health care delivery in resource-limited settings.

Objective: To evaluate the effectiveness of a chronic care model-based primary care behavioral health integration program for improving the diagnosis and management of mental health conditions in a primary care setting.

Design: Quasi-experimental, pre-post observational study using interrupted time series analysis over a 10-year period (2010-2019).

Participants: In total, 59,723 adult patients aged >18 who had at least two medical visits between 2010 and 2019. The patient population was 58% non-Hispanic Black, 29% non-Hispanic White, and 64% female.

Interventions: Implementation of clinical decision support systems for common mental health conditions (e.g., depression, anxiety, ADHD), self-management support, delivery system re-design within integrated behavioral health services, and health system community support with weekly behavioral health tips.

Main measures: Changes in the rate of mental health diagnoses and follow-up care (including psychiatric medications, referrals to psychiatry or behavioral medicine, and primary care visits with a mental health diagnosis).

Key results: The rate of mental health diagnoses increased by 58.8 per 1000 person-years in the first year after intervention implementation (p = 0.001). Follow-up care in primary care increased by 102.1 per 1000 person-years (p = 0.03), while psychiatry referrals decreased by 59.8 per 1000 person-years annually after the intervention (p = 0.004).

Conclusions: This chronic care model-based system-level intervention was associated with significant increases in mental health diagnosis and treatment within primary care. Expanding the role of primary care in managing mental health conditions may offer a scalable solution to mental health professional shortages, especially in underserved areas.