Skip to main content

Advertisement

Log in

Toward a Unified Integration Approach: Uniting Diverse Primary Care Strategies Under the Primary Care Behavioral Health (PCBH) Model

  • Published:
Journal of Clinical Psychology in Medical Settings Aims and scope Submit manuscript

Abstract

Primary care continues to be at the center of health care transformation. The Primary Care Behavioral Health (PCBH) model of service delivery includes patient-centered care delivery strategies that can improve clinical outcomes, cost, and patient and primary care provider satisfaction with services. This article reviews the link between the PCBH model of service delivery and health care services quality improvement, and provides guidance for initiating PCBH model clinical pathways for patients facing depression, chronic pain, alcohol misuse, obesity, insomnia, and social barriers to health.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • Altschuler, J., Margolius, D., Bodenheimer, T., & Grumbach, K. (2012). Estimating a reasonable patient panel size for primary care physicians with team-based task delegation. Annals of Family Medicine, 10(5), 396–400.

    Article  PubMed  PubMed Central  Google Scholar 

  • America’s Health Insurance Plans Center for Policy and Research. (2016). Ensuring access to quality behavioral health care: Health plan examples.

  • American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, & American Osteopathic Association. (2007). Joint principles of the patient-centered medical home.

  • Balasubramanian, B. A., Cohen, D. J., Jetelina, K. K., Dickinson, M., Davis, M., Gunn, R., … Green, L. (2017). Outcomes of integrated behavioral health with primary care. Journal of the American Board of Family Medicine, 30(2), 130–139.

    Article  PubMed  Google Scholar 

  • Bauman, D. (2014). A brief acceptance and commitment therapy intervention in a primary care, underserved setting: ACTing your way with anxiety (Unpublished doctoral dissertation). The School of Professional Psychological at Forest Institute, Springfield, MO.

  • Beachy, B. (2014). Utilizing ACT principles to address weight management through brief sessions in the primary care setting (Unpublished doctoral dissertation). The School of Professional Psychological at Forest Institute, Springfield, MO.

  • Berwick, D. M., Nolan, T. W., & Whittington, J. (2008). The triple aim: care, health, and cost. Health Affairs, 27(3), 759–769.

    Article  PubMed  Google Scholar 

  • Bikson, K., McGuire, J., Blue-Howells, J., & Seldin-Sommer, L. (2009). Psychosocial problems in primary care: Patient and provider perceptions. Social Work in Health Care, 48(8), 736–749.

    Article  PubMed  Google Scholar 

  • Blumenthal, D., Rasmussen, P. W., Collins, S. R., & Doty, M. (2015). Does Medicaid make a difference? Findings from the Commonwealth Fund biennial health insurance survey, 2014. Commonwealth Fund Publication, 1825(19), 1–9.

    Google Scholar 

  • Bodenheimer, T., & Sinsky, C. (2014). From triple to quadruple aim: Care of the patient requires care of the provider. Annals of Family Medicine, 12, 573–576.

    Article  PubMed  PubMed Central  Google Scholar 

  • Boscarino, J. A., Rukstalis, M., & Hoffman, S. N. (2010). Risk factors for drug dependence among out-patients on opioid therapy in a large U.S. health-care system. Addiction (Abingdon, England), 105, 1776–1782. doi:10.1111/j.1360-0443.2010.03052.x.

    Article  Google Scholar 

  • Bryan, C. J., Corso, K. A., Corso, M. L., Kanzler, K. E., Ray-Sannerud, B., & Morrow, C. E. (2012). Therapeutic alliance and change in suicidal ideation during treatment in integrated primary care settings. Archives of Suicide Research, 16, 316–323.

    Article  PubMed  Google Scholar 

  • Burt, J. D., Garbacz, S. A., Kupzyk, K. A., Frerichs, L., & Gathje, R. (2012). Examining the utility of behavioral health integration in well-child visits: Implications for rural settings. Families, Systems, & Health, 32(1), 20–30.

    Article  Google Scholar 

  • Burwell, S. M. (2015). Setting value-based payment goals: HHS efforts to improve U.S. health care. New England Journal of Medicine, 372, 897–899.

    Article  PubMed  CAS  Google Scholar 

  • Buysse, D. J., Germain, A., Moul, D. E., Franzen, P. L., Brar, L. K., Fletcher, M. E., … Monk (2011). Efficacy of brief behavioral treatment for chronic insomnia in older adults. Archives of Internal Medicine, 171(10), 887–895.

    Article  PubMed  PubMed Central  Google Scholar 

  • Cape, J., Whittington, C., Buszewicz, M., Wallace, P., & Underwood, L. (2010). Brief psychological therapies for anxiety and depression in primary care: Meta-analysis and meta-regression. BMC Medicine, 8(1), 38.

    Article  PubMed  PubMed Central  Google Scholar 

  • Centers for Disease Control and Prevention. (2013). Mental health basics. Retrieved from http://www.cdc.gov/mentalhealth/basics.htm.

  • Centers for Disease Control and Prevention. (2014a). Opioid painkiller prescribing: Where you live makes a difference. Atlanta, GA: Centers for Disease Control and Prevention. Retrieved from http://www.cdc.gov/vitalsigns/opioid-prescribing/.

  • Centers for Disease Control and Prevention. (2014b). Planning and implementing screening and brief intervention for risky alcohol use: A step-by-step guide for primary care practices. In Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities. Atlanta, GA.

  • Center for Disease Control and Prevention. (2017). Retrieved from https://www.cdc.gov/drugoverdose.

  • Cicero, T. J., Ellis, M. S., Surratt, H. L., & Kurtz, S. P. (2014). The changing face of heroin use in the United States: A retrospective analysis of the past 50 years. Journal of the American Medical Association, Psychiatry, 71(7), 821–826.

    Google Scholar 

  • Damberg, C. L., Sorbero, M. E., Lovejoy, S. L., Martsolf, G. R., Raaen, L., & Mandel, D. (2014). Measuring success in health care value-based purchasing programs: Findings from an environmental scan, literature review, and expert panel discussions. Rand Health Quarterly, 4(3), 9.

    PubMed  PubMed Central  Google Scholar 

  • DeRubeis, R. J., Siegle, G. J., & Hollon, S. D. (2008). Cognitive therapy vs. medications for depression: Treatment outcomes and neural mechanisms. Nature Reviews. Neuroscience, 9(10), 788–796.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Edwards, S. T., Bitton, A., Hong, J., & Landon, B. E. (2014). Patient-centered medical home initiatives expanded in 2009–13: Providers, patients and payment incentives increased. Health Affairs, 33, 1823–1831.

    Article  PubMed  Google Scholar 

  • Eidus, R., Pace, W. D., & Staton, E. W. (2012). Managing patient populations in primary care: Points of leverage. Journal of the American Board of Family Medicine, 25, 238–244.

    Article  PubMed  Google Scholar 

  • Felitti, V. J., & Anda, R. F. (1997). The adverse childhood experiences (ACE) study. Centers for disease control and prevention. Retrieved from http://www.cdc.gov/ace/index.htm.

  • Ford, E. S., Wheaton, A. G., Cunningham, T. J., Giles, W. H., Chapman, D. P., & Croft, J. B. (2014). Trends in outpatient visits for insomnia, sleep apnea, and prescriptions for sleep medications among US adults: Findings from the national ambulatory medical care survey 1999–2010. Sleep, 37(8), 1283–1293.

    Article  PubMed  PubMed Central  Google Scholar 

  • Gerrity, M. (2016). Evolving models of behavioral health integration: Evidence update 2010–2015. Millbank Memorial Fund. Retrieved from https://www.milbank.org/wp-content/uploads/2016/05/Evolving-Models-of-BHI.pdf.

  • Gum, A. M., Areán, P. A., Hunkeler, E., Tang, L., Katon, W., Hitchcock, P., … Unützer, J. (2006). Depression treatment preferences in older primary care patients. The Gerontologist, 46(1), 14–22.

    Article  PubMed  Google Scholar 

  • Haas, L. J., Leiser, J. P., Magill, M. K., & Sanyer, O. N. (2005). Management of the difficult patient. American Family Physician, 72(10), 2063–2068.

    PubMed  Google Scholar 

  • Health Resources and Services Administration. (2016). Uniform data system: Reporting instructions for 2016 health center data.

  • Henry, S. G., Bell, R. A., Fenton, J. J., & Kravitz, R. L. (2017). Goals of chronic pain management: Do patients and primary care physicians agree and does it matter? Clinical Journal of Pain. doi:10.1097/AJP.0000000000000488.

    Article  PubMed  Google Scholar 

  • Impact of the Affordable Care Act on physician practices and the quality of care (Part I). (2015). MedPanel. Retrieved from http://medpanel.com/Expert-Insight/Insights/Impact-of-the-Affordable-Care-Act-on-Physician-Pra.aspx.

  • Institute of Medicine. (2012). Primary care and public health: Exploring integration to improve population health. Washington, DC: The National Academies Press.

    Google Scholar 

  • Jolly, J. B., Fluet, N. R., Reis, M. D., Stern, C. H., Thompson, A. W., & Jolly, G. A. (2016). Review of behavioral health care integration in primary care at Baylor Scott and White Healthcare, Central Region. Baylor University Medical Center Proceedings, 29(2), 131–136.

    Article  PubMed  PubMed Central  Google Scholar 

  • Jonas, D. E., Garbutt, J. C., Amick, H. R., Brown, J. M., Brownley, K. A., Council, C. L., … Harris, R. P. (2012). Behavioral counseling after screening for alcohol misuse in primary care: A systematic review and meta-analysis for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 157, 645–654.

    Article  PubMed  Google Scholar 

  • Kanter, J. W., Baruch, D. E., & Gaynor, S. T. (2006). Acceptance and commitment therapy and behavioral activation for the treatment of depression: Description and comparison. The Behavior Analyst, 29(2), 161–185.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kanzler, K. E., Robinson, P. J., Munante, M., McGeary, D., Potter, J., & MacIntyre, B., … Velligan, D. (2017). A novel treatment delivery of acceptance and commitment therapy for chronic pain in an integrated primary care setting. Texas: Presentation at Collaborative Family Health Association annual conference, Houston.

    Google Scholar 

  • Katon, W., Robinson, P., Von Korff, M., Lin, E., Bush, T., Ludman, E., … Walker, E. (1996). A multifaceted intervention to improve treatment of depression in primary care. Archives of General Psychiatry, 53, 924–932.

    Article  PubMed  CAS  Google Scholar 

  • Kinman, C. R., Gilchrist, E. C., Payne-Murphy, J. C., & Miller, B. F. (2015). Provider-and practice-level competencies for integrated behavioral health in primary care: A literature review. Report prepared by the Agency for Healthcare Research and Quality. Retrieved from https://integrationacademy.ahrq.gov/sites/default/files/AHRQ_AcadLitReview.pdf.

  • LeBlanc, E. S., O’Connor, E. O., Whitlock, E. P., Patnode, C. D., & Kapka, T. (2011). Effectiveness of primary care–relevant treatments for obesity in adults: A systematic evidence review for the US Preventive Services Task Force. Annals of Internal Medicine, 155,(7), 434–447.

    Article  Google Scholar 

  • McGovern, L., Miller, G., & Cromwick, P. H. (2014). Health policy brief: The relative contribution of multiple determinants to health outcomes. Health Affairs. https://doi.org/10.1377/hpb20140821.404487

  • Miller, B. F., Teevan, B., Phillips, R. L. Jr., Petterson, S. M., & Bazemore, A. W. (2011). The importance of time in treating mental health in primary care. Families, Systems & Health, 29(2), 144–145.

    Article  Google Scholar 

  • National Alliance on Mental Illness. (2015). Depression. Retrieved from https://www.nami.org/Learn-More/Mental-Health-Conditions/Depression.

  • National Association Medical Staff Services. (2017). NAMSS comparison of accreditation standards 2017. Retrieved from http://www.namss.org/Portals/0/Education/CertPrepResources/namss_comparison_of_accreditation_standards.pdf.

  • National Committee for Quality Assurance. (2014). Patient-centered medical home standards and guidelines.

  • Ogden, C. L., Carroll, M. D., Kit, B. K., & Flegal, K. M. (2014). Prevalence of childhood and adult obesity in the United States. Journal of the American Medical Association, 311(8), 806–814.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Peckham, C. (2015). Physician burnout: It just keeps getting worse. Medscape. Retrieved from http://www.medscape.com/viewarticle/838437.

  • Pratt, L., & Brody, D. (2014). Depression in the U.S. household population, 2009–2012. National Center for Health Statistics, 172, 1–8.

    Google Scholar 

  • Rao, S. K., Kimball, A. B., Lehrhoff, S. R., Hidrue, M. K., Colton, D. G., Ferris, T. G., & Torchiana, D. F. (2017). The impact of administrative burden on academic physicians: Results of a hospital-wide physician survey. Academic Medicine: Journal of the Association of American Medical Colleges, 92(2), 237–243.

    Article  Google Scholar 

  • Reiter, J. T., Dobmeyer, A. C., & Hunter, C. L. (2017). The primary care behavioral health (PCBH) model: An overview and operational definition. Journal of Clinical Psychology in Medical Settings (submitted).

  • Rittenhouse, D. R., & Shortell, S. M. (2009). The patient-centered medical home: Will it stand the test of health reform? Journal of the American Medical Association, 301(19), 2038–2040.

    Article  PubMed  CAS  Google Scholar 

  • Rittenhouse, D. R., Shortell, S. M., & Fisher, E. S. (2009). Primary care and accountable care: Two essential elements of delivery-system reform. New England Journal of Medicine, 3612, 2301–2303.

    Article  Google Scholar 

  • Robinson, P., & Reiter, J. (2016). Behavioral consultation and primary care: A guide to integrating services (2nd ed.). New York: Springer.

    Book  Google Scholar 

  • Strosahl, K. D., & Robinson, P. (2008). The mindfulness and acceptance workbook for depression: Using acceptance and commitment therapy to move through depression and create a life worth living. Oakland, CA: New Harbinger.

    Google Scholar 

  • Robinson, P. J., & Bauman, D. (2017). Improving care for a primary care population: Persistent pain as an example. In M. E. Maruish (Ed.), Handbook of psychological assessments in primary care settings (2nd ed.). New York: Routledge.

    Google Scholar 

  • Robinson, P. J., Bauman, D., & Beachy, B. (2016). Promoting healthy lifestyle behaviors in patients with persistent pain, Chap. 26. In J. Mechanick & R. F. Kushner (Eds.), Lifestyle medicine—manual for clinical practice. New York: Springer.

    Google Scholar 

  • Robinson, P. J., Gould, D. A., & Strosahl, K. D. (2010). Real behavior change in primary care: Improving patient outcomes and increasing job satisfaction. Oakland, CA: New Harbinger Publications.

    Google Scholar 

  • Rozanski, A., & Kubzanski, L. D. (2005). Psychologic functioning and physical health: A paradigm of flexibility. Psychosomatic Medicine, 67(Supplement), S47–S53.

    Article  PubMed  Google Scholar 

  • Shanafelt, T. D., Boone, S., Tan, L., Dyrbye, L. N., Sotile, W., Satele, D., … Oreskovich, M. R. (2012). Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Archives of Internal Medicine, 172(18), 1377–1385.

    Article  PubMed  Google Scholar 

  • Shi, L. (2012). The impact of primary care: A focused review. Scientifica. doi:10.6064/2012/432892.

    Article  PubMed  PubMed Central  Google Scholar 

  • Siu, A. L., Bibbins-Domingo, K., Grossman, D. C., Baumann, L. C., Davidson, K. W., Ebell, M., … Krist, A. H. (2016). Screening for depression in adults: US Preventive Services Task Force recommendation statement. Journal of the American Medical Association, 315(4), 380–387.

    Article  PubMed  CAS  Google Scholar 

  • Stelfox, H. T., Niven, D. J., Clement, F. M., Bagshaw, S. M., Cook, D. J., McKenzie, E., … Services, A. H. (2015). Stakeholder engagement to identify priorities for improving the quality and value of critical care. PLoS ONE, 10(10), 1–13. doi:10.1371/journal.pone.0140141.

    Article  CAS  Google Scholar 

  • Strosahl, K. (1996). Confessions of a behavior therapist in primary care: The Odyssey and the ecstasy. Cognitive and Behavioral Practice, 3, 1–28.

    Article  Google Scholar 

  • Strosahl, K. (1998). Integration of primary care and behavioral health services: The primary mental health care model. In A. Blount (Ed.), Integrative primary care: The future of medical and mental health collaboration (pp. 43–66). New York: Norton Inc.

    Google Scholar 

  • Strosahl, K. D., Robinson, P. J., & Gustavsson, T. (2012). Brief interventions for radical change: Principles and practice of focused acceptance and commitment therapy. Oakland, CA: New Harbinger Publications.

    Google Scholar 

  • Substance Abuse and Mental Health Services Administration. (2012). National Survey on Drug Use and Health. Table 2.46B—Alcohol use, binge alcohol use, and heavy alcohol use in the past month among persons aged 18 or older, by demographic characteristics: Percentages, 2011 and 2012. Retrieved from http://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs2012/NSDUH-DetTabs2012/HTML/NSDUH-DetTabsSect2peTabs43to84-2012.htm#Tab2.46B.

  • Substance Abuse and Mental Health Services Administration. (2014). Highlights of the 2011 Drug Abuse Warning Network (DAWN) findings on drug-related emergency department visits. The DAWN Report. Rockville, MD: US Department of Health and Human Services; Substance Abuse and Mental Health Services Administration. Retrieved from http://www.samhsa.gov/data/2k13/DAWN127/sr127-DAWN-highlights.htm.

  • Trauer, J. M., Qian, M. Y., Doyle, J. S., Rajaratnam, S. M., & Cunnington, D. (2015). Cognitive behavioral therapy for chronic insomnia: A systematic review and meta-analysis. Annals of Internal Medicine, 163(3), 191–204.

    Article  PubMed  Google Scholar 

  • United States Preventive Services Task Force. (2013). Final recommendation statement: Alcohol misuse—screening and behavioral counseling interventions in primary care. Retrieved from https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/alcohol-misuse-screening-and-behavioral-counseling-interventions-in-primary-care.

  • United States Preventive Services Task Force. (2014). Final recommendation statement: Obesity in adults—screening and management. Retrieved from https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/obesity-in-adults-screening-and-management.

  • United States Preventive Services Task Force. (2016). Final update and summary: Depression in adults—screening. Retrieved from https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/depression-in-adults-screening1.

  • van Schaik, D. J., Klijn, A. F., van Hou, H. P., van Marwijk, H. W., Beekman, A. T., de Haan, M., & van Dyck, R. (2004). Patients’ preferences in the treatment of depressive disorder in primary care. General Hospital Psychiatry, 26(3), 184–189.

    Article  PubMed  Google Scholar 

  • Webster, L. R. & Grabois, M. (2015). Current regulations related to opioid prescribing. PM&R, 7(11), S236–S247.

    Article  Google Scholar 

  • Wise, C. G., Alexander, J. A., Green, L. A., Cohen, G. R., & Koster, C. R. (2011). Journey toward a patient-centered medical home: Readiness for change in primary care practices. The Millbank Quarterly, 89(3), 399–424.

    Article  Google Scholar 

  • World Health Organization & World Organization of Family Doctors. (2008). Integrating mental health into primary care: A global perspective. Retrieved from http://apps.who.int/iris/bitstream/10665/43935/1/9789241563680_eng.pdf.

  • Yarnall, K. S. H., Østbye, T., Krause, K. M., Pollak, K. I., Gradison, M., & Michener, J. L. (2009). Family physicians as team leaders: “Time” to share the care. Preventing Chronic Disease, 6(2), A59.

    PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Brian E. Sandoval.

Ethics declarations

Conflict of interest

Brian E. Sandoval, Jennifer Bell, Parinda Khatri, and Patricia J. Robinson declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

No animal or human studies were carried out by the authors for this article.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sandoval, B.E., Bell, J., Khatri, P. et al. Toward a Unified Integration Approach: Uniting Diverse Primary Care Strategies Under the Primary Care Behavioral Health (PCBH) Model. J Clin Psychol Med Settings 25, 187–196 (2018). https://doi.org/10.1007/s10880-017-9516-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10880-017-9516-9

Keywords

Navigation