Effects of different models of integrated collaborative care in a family medicine residency program

Abstract

Integrated collaborative care (ICC) combines medical and behavioral health services in the primary care setting. Our family medicine residency program implemented care across three different models of integration over five years, allowing retrospective, cohort evaluation of the changes in behavioral health services and patient outcomes for depression. We identified three time periods representing increasing levels of services: Colocation of behavioral health services in 2004-05 (CL), primary care behavioral health model (behavioral health providers embedded in primary care) in 2009 (PCBH), and a blended model of PCBH and care management for depression in early 2010 (BM). All adult patient charts (n = 552) with PHQ9 scores ≥10 were analyzed for number of provider contacts (physician and behavioral health) and changes in scores during the 12-week follow-up. The percent of patients receiving adequate care (≥3 provider contacts in 12 weeks) improved from 43.5% (CL) to 55.1% (PCBH) to 60.6% (BM; Pearson chi-square, p = .02). Forty-two percent of patients in BM achieved remission (PHQ9 ≤ 4), 25.2% in PCBH and 12% in CL (Pearson chi-square, p = .02). The Blended Model resulted in better access to behavioral health care and outcomes for patients with depression symptoms.