Practice-centered, flexible intervention may improve integration of behavioral health in primary care

Background and goal: Integrated behavioral health (IBH), which combines behavioral health and primary care, improves patient outcomes and experience. This study evaluated whether a tailored, toolkit-based intervention could improve IBH and patient outcomes in primary care practices serving patients with multiple chronic medical and behavioral health conditions.

Study approach: The study used a cluster randomized controlled trial design. Practices were randomized into two groups. The intervention arm received a comprehensive toolkit that included four components: workbooks to guide the quality improvement project, online education tailored to specific practice personnel roles, an online learning community to facilitate collaboration, and remote coaching provided by a trained quality improvement professional paired with a psychologist experienced in IBH. The control arm continued with their usual IBH services without receiving additional support. 

Main results: A total of 42 practices were randomized in the study. 

• Practices completing more intervention stages showed significant improvements in IBH integration, particularly in workflows, integration methods, and patient identification.

• No significant clinically relevant differences were found in patient health outcomes-including depression, anxiety, fatigue, sleep disturbance, pain, pain interference, and physical function-between the intervention and control groups. 

Why it matters: A practice-centered, flexible intervention may help primary care practices tailor behavioral health integration to their specific needs and lead to better systems of care.