Mental Health Services in Patient-Centered Medical Homes
Mental Health Services in Patient-Centered Medical Homes
We received 123 responses, for a 52% response rate. A total of 115 surveys were collected electronically and the rest by phone and mail. The practices were located in 24 states, and the highest concentration came from states with active PCMH demonstration programs (New York, Pennsylvania, and New Jersey).
Responders did not differ significantly from nonrespondents in recognition level, practice size, specialty, or location (Table 1). About half of the responding practices were small (<5 physicians, 55%), and 12 (10%) were FQHCs or community health centers. Over half had the highest level of NCQA 2008 PCMH recognition (level 3, 56%); 7% had level 2 recognition and 37% had level 1. Of practices, 42% reported the presence of a behavioral health clinician—a psychiatrist, psychologist, counselor, social worker, or certified substance use counselor—on site as part of the practice staff; 63% had a care manager. Table 2 summarizes the frequencies of behavioral providers in the practices and engagement in clinical and organizational practice activities.
Less than half of surveyed practices had behavioral health practitioners. Practices were more likely to have care managers than psychiatrists, psychologists, and social workers combined; substance abuse clinicians were less than half as frequent as psychologists and social workers. Scheduling processes for the behavioral health clinicians are the same as other practice providers only a third of the time (36%), and same-day appointments are available less than 30% of the time (28%). The availability of evidence-based protocols for mental health, substance abuse, and health behavior presentations was identified in 54% of practices. Protocols for smoking cessation were present in 71% of practices, obesity in 59%, insomnia in 38%, and headaches in 34%. About 62% of practices reported recording results of depression screening and monitoring in an electronic data system.
Table 3 compares practice processes between behavioral health and endocrinology and cardiology. Questions 6 through 12 in Online Appendix 1 identify the questions used as comparison. Fewer practices report having standardized referral processes for mental health and substance use issues compared with cardiology and endocrinology. In addition, two thirds of practices report using a formal depression screening tool, and 62% report recording those data in an electronic data system. Of those practices that used behavioral health screening, practices were more likely to screen for depression (80%) than for alcohol (71%) or substance use (65%). Insurance status was related to both the mental health organizational and clinical indices (Table 4 and Table 5). Practices serving >20% of patients with Medicaid, other public insurance, or no insurance were more likely to perform these activities.
Respondents also were presented a list of potential barriers. The greatest barriers were lack of time (92%), reimbursement issues (91%), and lack of expertise (74%) (Table 6).
Results
We received 123 responses, for a 52% response rate. A total of 115 surveys were collected electronically and the rest by phone and mail. The practices were located in 24 states, and the highest concentration came from states with active PCMH demonstration programs (New York, Pennsylvania, and New Jersey).
Responders did not differ significantly from nonrespondents in recognition level, practice size, specialty, or location (Table 1). About half of the responding practices were small (<5 physicians, 55%), and 12 (10%) were FQHCs or community health centers. Over half had the highest level of NCQA 2008 PCMH recognition (level 3, 56%); 7% had level 2 recognition and 37% had level 1. Of practices, 42% reported the presence of a behavioral health clinician—a psychiatrist, psychologist, counselor, social worker, or certified substance use counselor—on site as part of the practice staff; 63% had a care manager. Table 2 summarizes the frequencies of behavioral providers in the practices and engagement in clinical and organizational practice activities.
Less than half of surveyed practices had behavioral health practitioners. Practices were more likely to have care managers than psychiatrists, psychologists, and social workers combined; substance abuse clinicians were less than half as frequent as psychologists and social workers. Scheduling processes for the behavioral health clinicians are the same as other practice providers only a third of the time (36%), and same-day appointments are available less than 30% of the time (28%). The availability of evidence-based protocols for mental health, substance abuse, and health behavior presentations was identified in 54% of practices. Protocols for smoking cessation were present in 71% of practices, obesity in 59%, insomnia in 38%, and headaches in 34%. About 62% of practices reported recording results of depression screening and monitoring in an electronic data system.
Table 3 compares practice processes between behavioral health and endocrinology and cardiology. Questions 6 through 12 in Online Appendix 1 identify the questions used as comparison. Fewer practices report having standardized referral processes for mental health and substance use issues compared with cardiology and endocrinology. In addition, two thirds of practices report using a formal depression screening tool, and 62% report recording those data in an electronic data system. Of those practices that used behavioral health screening, practices were more likely to screen for depression (80%) than for alcohol (71%) or substance use (65%). Insurance status was related to both the mental health organizational and clinical indices (Table 4 and Table 5). Practices serving >20% of patients with Medicaid, other public insurance, or no insurance were more likely to perform these activities.
Respondents also were presented a list of potential barriers. The greatest barriers were lack of time (92%), reimbursement issues (91%), and lack of expertise (74%) (Table 6).
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