A Qualitative Study on the Barriers to Learning in a Primary Care-Behavioral Health Integration Program in an Academic Hospital: the Family Medicine Perspective

• Published in: Academic psychiatry 2020-02, Vol.44 (1), p.46-52
• Main Authors: Aggarwal, Monica, Knifed, Eva, Howell, Nicholas A., Papneja, Purti, Charach, Nate, Cheung, Amy, Grujich, Nikola
• Format: Article
• Language: English
• Subjects: Collaboration; Data Analysis; Family Practice (Medicine); Focus groups; Health sciences; In Brief Report; Internal Medicine; Learning Processes; Medical Education; Medical practices; Medical referrals; Medical residencies; Medicine; Medicine & Public Health; Mental disorders; Mental health; Nurse practitioners; Participation; Patients; Physicians; Primary care; Psychiatrists; Psychiatry; Social workers
• ISSN: 1042-9670; 1545-7230
• DOI: 10.1007/s40596-019-01117-8

Objective Integrating behavioral health services into the primary care setting is a recognized approach to improving timely access and building capacity for primary care providers. The aim of this study was to examine barriers to family medicine resident learning in a co-located primary care-behavioral health integration program with psychiatrists in an academic hospital. Methods The authors used a descriptive qualitative study design to collect data on participants’ learning experiences from focus groups and semi-structured interviews with 5 family medicine residents, 3 psychiatry residents, 5 family physicians, 3 psychiatrists, 2 office coordinators, and 2 educational coordinators. Thematic analysis of transcripts was performed. Results Three themes were identified with respect to barriers to learning in the program from the family medicine perspective. Organizational barriers encompassed lack of clear vision, goals, roles, and responsibilities. Administrative barriers involved complex appointment bookings and scheduling. Communication and engagement barriers included insufficient communication between team members and lack of patient engagement in the program. Conclusions The study findings highlight the importance of several factors for the successful implementation of a co-located academic primary care-behavioral health integrated model. This includes the formalization of program structure that encompasses shared vision, goals, roles, and responsibilities; coordinated processes for appointment bookings; team communication and patient engagement; and diverse educational and longitudinal care opportunities. With the growing number of integrated care programs, these results provide guidance for health care leaders involved in the design and management of primary care-behavioral health integration programs.