Facilitating Primary Care-Behavioral Health Communication

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Facilitating Primary Care-Behavioral Health Communication

Throughout their careers, all primary care providers (PCPs) will care for patients with concurrent behavioral health needs, some of whom may already be seeing a behavioral health provider outside their care. In many ways, the impact of PCPs’ responses to this will depend on whether and to what degree behavioral health is integrated into their practice.

While full integration of behaviorists is the ideal, the current realities for some practices make full integration or co-location of behavioral health impractical, whether due to the financial, workforce, or other challenges.

However, you do not need to have fully integrated or even co-located services to meaningfully connect primary and behavioral health care. As we heard in this month’s podcast, even integration at the coordination level can greatly benefit patients with behavioral health needs. That is because, as research shows, when patients have both behavioral and physical health issues, poor communication between primary care and behavioral health providers is associated with poorer outcomes and increased health care costs (Matthews, 2021).

If it’s not full integration or co-location, what, then, does ‘integration’ look like? According to one model, at the coordination level of integration, PCPs develop strong relationships with outside behavioral health providers who work in physically separate facilities & have separate health record systems. Communication, at this level, is usually based on a particular need for specific information about a mutual patient.

Levels of Integrated Behavioral Health

Coordination: PCPs develop strong relationships with outside behavioral health providers who work in physically separate facilities & have separate health record systems.
Co-Location: Behavioral health & PCPs deliver care in the same physical space or practice, but the behavioral health provider often is not hired by the practice
Full Integration: Practices hire behavioral health provider who is part of the team and works with the PCP to design & implement shared care plans.

But, for this to be effective, practices must consider establishing standardized communication processes or protocols for engaging with external behavioral health providers. There should be clarity for all staff about when and how to share sensitive patient information. But, most importantly, there needs to be a culture of collaboration within practices that support communication and working with others – even external, cross-disciplinary providers – towards shared goals for their patients. Providers within such a culture must recognize the value of effective communication as best practice.

So, when providers are not co-located or hired by the same entity, some other strategies that are helpful in facilitating effective communication and collaboration include:

Behavioral health training for PCPs – this includes training on mental health and substance use disorders as well as education on the value of integration.
Intentional initiatives to reduce behavioral health stigma among providers, staff, and patients.
Administrative staff support and facilitation of communication.
Some form of ongoing, routine communication plan such as weekly/monthly calls or updates to review treatment issues regarding shared patients.
Use of a registry tool to communicate which patients are not responding to treatment, so that primary and behavioral health providers can adjust treatment accordingly based on evidence-based guidelines.
Even if they are not co-located or hired by the same entity, primary and behavioral health care providers may also want to consider scheduled case conferences, particularly for more complex problems or patients experiencing significant changes or lack of improvement.

All of this to say, just because co-location or full integration is not a realistic goal at this time for your practice doesn’t mean communication and collaboration with behavioral health providers should go to the wayside.

This month’s podcast is just one example of the impact of primary-behavioral health communication. And it highlights that integrated care, even at the coordination level, has the potential to greatly improve patient outcomes and enhance provider and patient satisfaction.

Listen to HealthTeamWorks podcast: Integrated Care

References:
Matthews, K. (2021). Primary care and behavioral health provider communication: Strategy for improvement. The Journal for Nurse Practitioners, 17(7), 865-869.