Photo Credit: Andrii Yalanskyi

The following is a summary of “A Cluster Randomized Trial of Primary Care Practice Redesign to Integrate Behavioral Health for Those Who Need It Most: Patients With Multiple Chronic Conditions,” published in the November 2023 issue of Primary Care by Littenberg, et al.

When primary care and behavioral health providers work together in a joint system of care, patient results can improve. However, making these services work together took a lot of work. Researchers examined how well a practice intervention could improve patient results by improving integrated behavioral health (IBH) tasks. 

For a study, researchers did a realistic, cluster randomized controlled study. The solution included redesigning the practice, teaching for quality improvement, educating providers and staff, and working together to learn. As a measure of IBH, staff at 42 primary care practices filled out the Practice Integration Profile (PIP) at the start and after 2 years. The Patient-Reported Outcomes Measurement Information System (PROMIS-29) study was completed by adult patients with several long-term medical and behavioral problems. 

The change in 8 PROMIS-29 area scores was the main result. Changes in the level of unity were one of the secondary results. Giving people an intervention remained the same as the results reported by the 2,426 patients who completed surveys at the start and after two years. The practices that were part of the strategy made PIP process scores better, but not PIP overall scores. There was a strong link between the baseline PIP total score and how well the patient said they were functioning, even after intervention. 

Thirteen active practices that finished intervention workbooks had better patient-reported results and practice integration (P ≤.05) than seven other active practices that did not finish an intervention workbook. The intervention assignment did not change the results for patients, but practices that started the study with higher IBH had better patient outcomes. It was also clear that active practices that finished the intervention had better integration and patient results than those that didn’t. More study was needed to determine how to best reach patients with implementation attempts to improve IBH.

Source: annfammed.org/content/21/6/483