Date of Award

4-18-2014

Degree Type

Dissertation

Degree Name

Doctor of Psychology (PsyD)

Committee Chair

Jennifer R. Antick, PhD

Second Advisor

Katherine Elder, PhD

Third Advisor

Christiane Brems, PhD

Abstract

Patients in primary care clinics frequently present with behavioral health related concerns, but for various reasons often fail to receive effective treatment for these problems. The integration of behavioral health providers within primary care practice has been receiving an increasing amount of research, policy, and funding support as the most appropriate way to address this health care problem. Experts in the field have suggested that specific education and training as well as a shift in professional cultures and attitudes regarding integrated primary care among the various disciplines implicated are necessary for overall success of this emerging model of care. However, little research currently exists to support their claims. An examination of the effects of educational, training, and profession experiences as well as clinic structure, provider type, and type of health organization on level of integrated practice was performed by this author. Providers (n=203) working collaboratively in primary care (PCPs=118, BHPs=85) were administered a survey constructed by this author based on expert theory and limited past research. Participants included family medicine, internal medicine, pediatric, and obstetric/gynecologic physicians, nurse practitioners, and physician assistants as well as psychologists, social workers, psychiatrists, and professional counselors.

Results of a statistical multiple regression and ANCOVA analyses indicated that clinic structure (i.e., shared clinic space, shared health records, shared treatment plan, and integrated office visits) is a strong predictor of providers’ integrated practice, explaining 33% of the variance. Education, training, professional experience, and provider age were found to have no statistically significant effect on integrated practice. These findings suggest that the structures and resources of primary care clinics are considerably more important to supporting behaviorally integrated primary care practice than are educational, training, and professional experience factors. Therefore, it appears that policy makers and administrators tasked with producing effective integrated primary care practitioners in an era of Patient-Center Medical Home (PCMH) transformation would do well to prioritize resources toward clinic structure improvements over education and training factors. However, given the exploratory nature of this research, additional research is needed to confirm and expand upon these findings.

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