Integrating Behavioral Health Services into Primary Care Clinics within a Large Public Healthcare System: Provider Satisfaction and Patient Outcomes

Abstract Background: Behavioral health integration within primary care has demonstrated improved access to mental health services, patient outcomes, and satisfaction with care. This pre-post, mixed-methods quality improvement study examined factors of healthcare provider satisfaction in 10 integrated behavioral health (IBH) clinics in a Midwestern public healthcare system. This study also examined implementation indicators, including referral rates, scheduling time from referral to initial behavioral health encounter, and emergency department (ED) utilization to better understand patient experiences and outcomes. Methods: Providers were asked to complete online pre- and post-surveys (n = 110 patients, n = 115 patients, respectively) related to provider satisfaction with IBH services between October 2021 and April 2022. All other analyses were completed using electronic health record (EHR) patient data corresponding to IBH implementation across the 10 sites (pre-integration n = 42,397 patients, post-integration n = 37,129 patients). Results: Increases in organizational and relational scores were associated with significant improvements in provider satisfaction scores. Additionally, the results showed a significant increase in referrals to behavioral health in the post-integration period and a significant reduction in days to a behavior health appointment in the post-integration timeframe. Finally, ED utilization dropped from pre- to post-integration, but this was not statistically significant. Analysis of opened-ended questions revealed two main themes: positive regard for the value of IBH and structural and organizational barriers to IBH. Conclusions: Findings suggest that IBH implementation resulted in improvements in some areas of patient care and coordination and, importantly, points to areas where even more improvement is needed. This study highlights the value of collaboration among different providers toward creating a more supportive primary care environment for the patient.