Primary care patients 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, including psychologists, within primary care practice has been receiving an increasing amount of research and policy support as the most appropriate way to address this health care problem. However, behavioral health integration appears to remain uncommon. Although several experts in the field have suggested that the lack of specialized training, professional culture, and attitudes among behavioral health providers has significantly hampered collaboration and integration with primary care, there exists little research to support their claims. This study examined the effects of educational experiences and professional practice on collaborative practices with and attitudes toward primary care. 104 licensed US psychologists were administered a survey constructed by this author based on expert theories and limited past research. Analysis of variance (ANOVA) and t-tests were conducted to examine the effects of training experiences, coursework, professional practice setting, and theoretical orientation on positive attitudes toward primary care (PAPC) and integrative practice behaviors (IPB).
Results evidenced no significant difference in attitudes toward collaboration with primary care based on education or professional experiences. However, some differences were found on actual practice behaviors, including those endorsing training and professional experiences in medical settings being more likely to engage in collaborative care with primary care providers and those completing graduate coursework directly related to practice in medical settings more likely to obtain and review their clients' medical records. These findings suggest openness among psychologists to collaborative care with primary care providers but a difficulty engaging in collaborative practices unless having past or current experience within a medical setting. This attitude-behavior disconnect may belie significant external and internal barriers to integrative care that psychologists experience, including infrastructure (physical separation, separate record systems, etc.), financial (collaboration non-billable for private practitioners), and discomfort from lack of experience of interacting professionally with medical providers. Additional research is needed to establish and expand upon these findings and provide further understanding of the professional factors affecting the implementation of interprofessional collaborative and integrated care.
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