Integrated Care Clinic: Creating Enhanced Clinical Pathways for Integrated Behavioral Health Care in a Family Medicine Residency Clinic Serving a Low-Income, Minority Population

• Published in: Families systems & health 2017-09, Vol.35 (3), p.283-294
• Main Authors: Berge, Jerica M., Trump, Lisa, Trudeau, Stephanie, Utržan, Damir S., Mandrich, Michele, Slattengren, Andrew, Nissly, Tanner, Miller, Laura, Baird, Macaran, Coleman, Eli, Wootten, Michael
• Format: Article
• Language: English
• Subjects: Ambulatory Care Facilities - organization & administration; Ambulatory Care Facilities - trends; Appointments and Schedules; Behavior Therapy - methods; Behavioral Health Services; Behavioral Medicine - methods; Buildings and facilities; Clinical medicine; Clinics; Critical Pathways; Delivery of Health Care, Integrated - methods; Family Health - ethnology; Family Health - trends; Family Medicine; Family physicians; Forecasts and trends; Health Care Psychology; Health Services Accessibility - standards; Health Services Accessibility - statistics & numerical data; Human; Humans; Integrated Services; Integrative medicine; Low income groups; Lower Income Level; Market trend/market analysis; Medical Residency; Minnesota - ethnology; Minority & ethnic groups; Minority Groups; Poverty - ethnology; Public health administration
• ISSN: 1091-7527; 1939-0602
• DOI: 10.1037/fsh0000285

Introduction: Research examining the implementation and effectiveness of integrated behavioral health (BH) care in family medicine/primary care is growing. However, research identifying ways to consistently use integrated BH in busy family medicine/primary care settings with underserved populations is limited. This study describes 1 family medicine clinic's transformation into a fully integrated BH care clinic through the development of an Integrated Care Clinic (ICC) and enhanced clinical pathways to promote regular use of behavioral health clinicians (BHCs). Method: We implemented the ICC at the Broadway Family Medicine Clinic serving a low-income (70% African American) in Minnesota. We conducted a pre- and postevaluation of the ICC during regular clinic activity. Results: Pilot findings indicated that the creation of ICC and the use of enhanced clinical pathways (e.g., 5-2-1-0 obesity prevention messages, Transitional Care Management, postpartum depression screening visits, warm hand-offs) to facilitate regular use of integrated BH care resulted in 6 integrated care visits per BHC per clinic half-day. In addition, changes in the behavioral/mental health therapy appointment time slot (from 60 to 30 min) reduced therapy no-show rates. Transitional Care Management (TCM) visits also showed improved pre- and postchanges in patient and clinician satisfaction and reductions in patient hospital readmission rates. Discussion: The transformation into a fully integrated BH family medicine clinic through the creation of ICC and enhanced clinical pathways to facilitate regular integrated BH care showed promising pilot results. Future research is needed to examine associations between ICC and patient outcomes (e.g., weight, depressive symptoms).