In this post we will be discussing the peer-reviewed article, Improvement in Behavioral Health Symptoms and Functioning Among Rural Patients Cared for by Primary Care Teams Using the Extension for Community Health Care Outcomes Model. This article was written by Komaromy, Madden, Hager, Qeadan, Ceballos, Duhigg, Carlson, and Arora, and was published in the Journal of Rural Mental Health in 2019.

What did they do?

The primary aim of this study was to assess health changes in rural healthcare patients who received treatment from primary care teams. This research was carried out to further evaluate the efficacy of a Community Health Care Outcomes model in alleviating behavioral health difficulties.

Why did they do it?

The authors of this study highlight a huge ongoing problem in our country: rural communities are often faced with shortages in behavioral health professionals. Accordingly, patients with mental health difficulties have less accessibility to mental health treatment. To highlight the extent to which this shortage affects rural communities, the authors provide an example of eight rural counties in New Mexico that have absolutely no psychiatrists, prescribing psychologists, or psychiatric nurse practitioners.

One way to combat the shortage in mental health professionals is to train primary care providers to address behavioral health conditions. The existing literature examining integrated health in rural communities is rather extensive regarding clinician and practitioner barriers and successes; however, there is limited research on how the implementation of telehealth interventions impact patient’s behavioral health symptoms.

How did they do it?

This study examined how 243 patients responded to the delivery of behavioral health care by a primary care team through the Extension for Community Healthcare Outcomes (ECHO) Access program. The training for PCP’s in this program included 1 week of face to face training, followed by weekly video-conference training that focused on screening for and treating behavioral health conditions. Longitudinal survey data (provided by patients) was analyzed to assess changes in mental health symptoms across time.

Of the 243 patients who participated, 213 received treatment and 30 did not receive treatment (~70% female in each group).

What did they find?

Patients who were treated via the ECHO Access program experienced significant symptom change over the course of treatment across 3 primary domains; anxiety, sleep problems, and cognitive functioning. The largest improvements were in cognitive functioning, followed by anxiety, and then sleep problems. Other improvements were noted, though changes were not statistically significant.

What does it all mean (our take)?

It is estimated that roughly 60 million people live in “rural America.” 60 million. On top of that, it is estimated that 60% of these individuals live in areas with shortages of mental health providers, and that more than half are already receiving mental health care from their primary care providers. The problem with this model is that primary care doctors do not have time to effectively intervene on mental health problems given the short visit lengths and high demands placed on these physicians. Further, often times these primary care doctors do not have the specific training that would lead to highly valid diagnoses and subsequent efficacious treatment.

This article demonstrated that it is possible to integrate behavioral healthcare into the primary care setting, and have that care be delivered by a primary care team. We note that the effects from this study are not huge by any means, but they importantly indicate that integration of behavioral care directly into primary care can and should be strongly considered.

But where do we go and how do we do it? To continue moving this trend in the right direction, it will be imperative that systems are developed to improve the validity of mental health diagnosis and progress monitoring in primary care. Of equal importance, if we are going to add yet another task to the ever-growing list of primary care duties, let’s make sure we do it in a minimally demanding way.

We at Mindyra are very excited about the integration of physical and behavioral healthcare. As a society, we can do better when it comes to treating the whole person...let’s continue moving in the right direction!

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