Laiteerapong Neda, Ham Sandra A, Ari Mim, Beckman Nancy, Vinci Lisa M, Araújo Fabiana S, Yohanna Daniel, Moser Danica, Nandur Vivek, Staab Erin M
Department of Medicine, University of Chicago, Chicago, IL, USA.
Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA.
J Gen Intern Med. 2025 Jun 6. doi: 10.1007/s11606-025-09641-0.
Mental health conditions are often underdiagnosed and undertreated in primary care, particularly in underserved areas. Integrated behavioral health models can address this gap, but their reliance on mental health professionals may limit scalability. A multi-level intervention based on the chronic care model may enhance mental health care delivery in resource-limited settings.
To evaluate the effectiveness of a chronic care model-based primary care behavioral health integration program for improving the diagnosis and management of mental health conditions in a primary care setting.
Quasi-experimental, pre-post observational study using interrupted time series analysis over a 10-year period (2010-2019).
In total, 59,723 adult patients aged >18 who had at least two medical visits between 2010 and 2019. The patient population was 58% non-Hispanic Black, 29% non-Hispanic White, and 64% female.
Implementation of clinical decision support systems for common mental health conditions (e.g., depression, anxiety, ADHD), self-management support, delivery system re-design within integrated behavioral health services, and health system community support with weekly behavioral health tips.
Changes in the rate of mental health diagnoses and follow-up care (including psychiatric medications, referrals to psychiatry or behavioral medicine, and primary care visits with a mental health diagnosis).
The rate of mental health diagnoses increased by 58.8 per 1000 person-years in the first year after intervention implementation (p = 0.001). Follow-up care in primary care increased by 102.1 per 1000 person-years (p = 0.03), while psychiatry referrals decreased by 59.8 per 1000 person-years annually after the intervention (p = 0.004).
This chronic care model-based system-level intervention was associated with significant increases in mental health diagnosis and treatment within primary care. Expanding the role of primary care in managing mental health conditions may offer a scalable solution to mental health professional shortages, especially in underserved areas.
在初级保健中，心理健康状况常常诊断不足且治疗不充分，尤其是在服务欠缺地区。综合行为健康模式可以弥补这一差距，但其对心理健康专业人员的依赖可能会限制其可扩展性。基于慢性病护理模式的多层次干预可能会改善资源有限环境中的心理健康护理服务。
评估一项基于慢性病护理模式的初级保健行为健康整合项目在改善初级保健环境中心理健康状况的诊断和管理方面的有效性。
采用中断时间序列分析的准实验性前后观察研究，为期10年（2010 - 2019年）。
共有59723名年龄大于18岁的成年患者，他们在2010年至2019年间至少有两次就诊记录。患者群体中58%为非西班牙裔黑人，29%为非西班牙裔白人，64%为女性。
实施针对常见心理健康状况（如抑郁症、焦虑症、注意力缺陷多动障碍）的临床决策支持系统、自我管理支持、综合行为健康服务中的服务提供系统重新设计以及每周提供行为健康小贴士的卫生系统社区支持。
心理健康诊断率和后续护理的变化（包括精神科药物治疗、转介至精神科或行为医学科以及有心理健康诊断的初级保健就诊）。
干预实施后的第一年，心理健康诊断率每1000人年增加了58.8例（p = 0.001）。初级保健中的后续护理每1000人年增加了102.1例（p = 0.03），而干预后每年转介至精神科的人数每1000人年减少了59.8例（p = 0.004）。
这种基于慢性病护理模式的系统层面干预与初级保健中心理健康诊断和治疗的显著增加相关。扩大初级保健在管理心理健康状况方面的作用可能为心理健康专业人员短缺问题提供一个可扩展的解决方案，尤其是在服务欠缺地区。
