MODULE 1

INTRODUCTION TO

INTEGRATED
PRIMARY CARE
MODULE 1

INTRODUCTION TO
INTEGRATED PRIMARY CARE
Curriculum developed by the Integrated Primary Care Curriculum Committee of
the Society for Health Psychology:
Barbara Ward-Zimmerman, PhD, William B. Gunn, Jr., PhD, and Nancy Ruddy, PhD, Co-Chairs

Mark E. Vogel, PhD, ABPP, Barbara A. Cubic, PhD, Lisa K. Kearney, PhD, ABPP, Christopher Neumann, PhD, Mark A.
Stillman, PhD, and Shanda Wells, PsyD

The Society for Health Psychology and the APA Education Directorate
are gratefully acknowledged for their financial support.

© 2017 by the
LEARNING OBJECTIVES

Following this presentation, participants will be able to:

define primary care, integrated primary care, and the

patient-centered medical home;

identify key factors leading to the integration of behavioral health

into primary care;

compare and contrast the role of the traditional mental health provider
to the role of the psychologist in primary care.
 WHAT IS PRIMARY CARE?

PRIMARY CARE

“… integrated,
accessible health
care services provided
by clinicians who are
accountable for
addressing a large
majority of health care
needs, developing sustained
partnership with patients,
and practicing in the context
of family and community.”1
WHAT ARE PRIMARY CARE DISCIPLINES?

INTERNAL PEDIATRIC FAMILY OBSTETRICS &

AND AND MEDICINE GYNECOLOGY
GERIATRIC ADOLESCENT
MEDICINE MEDICINE
INTERACTIVE EXERCISE
 What are your What are your
experiences as a patient family’s experiences
in primary care? in primary care?

How would you

For what reasons have you
made an appointment with a
primary care practitioner over
the last two years?
describe your family’s
relationship with primary
care providers?
PATIENT NEEDS ACROSS THE LIFE SPAN
WHAT IS INTEGRATED PRIMARY CARE?

INTEGRATED
PRIMARY CARE

…combines medical and

behavioral health services
for problems patients bring
to primary care, including
stress-linked physical
symptoms, maladaptive health
behaviors, and/or mental
health or substance misuse
concerns and disorders. 1,2,3

For any problem, patients

have come to the right
place… no wrong door
 INTEGRATED PRIMARY CARE:
A POPULATION HEALTH PERSPECTIVE1

“Community or ‘population’ interventions can succeed by making

SMALL CHANGES IN A
LARGE NUMBER OF PEOPLE,
rather than large changes in a small number of people.”
 Integrated Primary Care
Addresses Population Needs
Through Personalized Patient Care
TRADITIONAL MENTAL HEALTH CARE VS.
INTEGRATED PRIMARY CARE

TRADITIONAL INTEGRATED
MENTAL HEALTH PRIMARY CARE
Services provided outside primary care Services on-site in primary care

Patient must find and then access services Services often offered in “real time”

Siloed healthcare professionals Interdisciplinary team

Referral occurs after symptoms affect Opportunity for prevention

functioning and early intervention

Tendency toward longer treatment Brief interventions

Mental health focus only Focus on health behaviors,

mental health concerns, and substance
misuse
THE “TEAM” INCLUDES THE PATIENT (AND FAMILY)
AND EVERYONE WHO INTERACTS WITH THEM AND
THE OTHER TEAM MEMBERS
THE
PATIENT-
CENTERED SAFETY AND
WHOLE-
PERSON
QUALITY ORIENTATION
MEDICAL
HOME:
WHERE WE PERSONAL
PHYSICIAN-
DIRECTED
PHYSICIAN
BEGAN PRACTICE

(PCMH)1,2,3,4

CARE IS
COORDINATED ENHANCED
AND ACCESS
INTEGRATED
THE
PATIENT-
CENTERED SAFETY AND
WHOLE-
PERSON
QUALITY ORIENTATION
HEALTH
HOME: TEAM-BASED CARE

WHERE
TECHNOLOGY QUALITY
WE ARE INTEGRATION MEASURES

HEADED
CARE IS
(PCMH)1,2 COORDINATED ENHANCED
AND ACCESS
INTEGRATED

PAYMENT FOR ADDED VALUE

THE PATIENT-CENTERED MEDICAL HOME CURRENTLY
GOES FOR THE TRIPLE AIM1,2

Improve individual
experience

Control inflation
of per capita costs

Improve population health

THE PATIENT-CENTERED MEDICAL HOME MAY MOVE
TOWARD THE QUADRUPLE AIM1

Improve individual
experience
THE AT THE Control inflation of
BEST LOWEST per capita costs
CARE COST

DELIVERED
Improve provider FOR
BY HEALTHY
experience THE Improve
PROVIDERS
WHOLE population
POPULATION health
 KEY FACTORS LEADING TO
THE INTEGRATION OF BEHAVIOAL
HEALTH AND PRIMARY CARE
IN A TRADITIONAL MODEL OF HEALTH CARE,
PATIENTS WITH MENTAL HEALTH CHALLENGES…1

VERY FEW
see a mental
health specialist1,2

50%
of primary care patients with
depression go undiagnosed3
Most who need mental health
help will not seek it, particularly
those individuals belonging to
<33% racial and ethnic minorities,
of people treated for mental perhaps due to stigma.6
health disorders receive EVEN
minimally adequate treatment4

In addition:
66% of primary care
providers report
that they are unable
to access outpatient mental
health services for patients5
IN A TRADITONAL MODEL OF CARE,
10 PERCENT OF PATIENTS USE 70 PERCENT OF THE
HEALTHCARE RESOURCES1,2

10% OF PATIENTS USE 70% OF THE RESOURCES

IN A TRADITONAL MODEL OF CARE,
MENTAL HEALTH SERVICES ARE MORE FREQUENTLY PROVIDED
BY PRIMARY CARE THAN MENTAL HEALTH PROVIDERS 1,2,3

UP TO70 % OF MENTAL HEALTH SERVICES

ARE PROVIDED SOLELY IN PRIMARY CARE
BY PRIMARY CARE CLINICIANS
CHRONIC MEDICAL CONDITION +
MENTAL HEALTH DISORDER = HIGH FINANCIAL COST1, 2

HEALTH CARE COSTS

DOUBLE
TOTAL HEALTH CARE COSTS

2x
 POOR
OUTCOMES
IN:
DIABETES1
HEART DISEASE2,3
BLOOD CLOTTING4
DISORDERS
ASTHMA5
OTHER TELLING FACTS

PEOPLE WITH SERIOUS

Suicide and injury
MENTAL ILLNESS DIE, ON
AVERAGE, 13–30 YEARS
Undertreatment of chronic illnesses
EARLIER THAN THEIR
AGE COHORTS IN THE
GENERAL POPULATION1,2,3 Drug side effects
OTHER TELLING FACTS

20% of children and youth have a diagnosable

mental health condition1

In any given year, 6.6% of the population age 18 and older

will experience a major depressive disorder2

Mental health and substance misuse concerns are under-

recognized and undertreated in traditional primary care
settings3
Integrated Primary Care
WHAT ARE THE ADVANTAGES OF INTEGRATION?
POSITIVE OUTCOMES ARE RESULTING FROM THE
PATIENT-CENTERED MEDICAL HOME MODEL1

DIABETES CARE
ADHERENCE

PREVENTIVE CARE
(e.g., breast cancer screening)

PATIENT VISITS
TO PRIMARY CARE

OUTPATIENT SERVICES

OUTCOMES
INTENSIVE SERVICES & FOLLOW-THROUGH

POSITIVE
DECREASING INCREASING
SERVICES
COSTLY
HOSPITALIZATIONS

EMERGENCY
DEPARTMENT VISITS

AMBULATORY CARE VISITS

TO SPECIALISTS
 WHAT EVERY PSYCHOLOGIST SHOULD UNDERSTAND,
REGARDLESS OF WHERE THEY PLAN TO PRACTICE

The Context of Primary Care

MEDICAL PROVIDER’S TYPICAL MORNING IN PRACTICE
MEDICAL PROVIDER’S TYPICAL MORNING IN PRACTICE
THE CHALLENGES OF BEING A PRIMARY CARE PROVIDER

TIME
Average patient visit is 10 to 15 minutes in duration.

COMPLEX PATIENTS
At a visit, each patient presents approximately three complaints.

MODEL
No organic basis to many presenting complaints.

TRAINING
Primary care physicians state they have insufficient training
in behavioral health interventions.

OVERUSE
Patients with behavioral health issues utilize more services.
HOW PSYCHOLOGISTS ADD VALUE IN PRIMARY CARE

IMPROVING RELATIONSHIPS BETWEEN MEDICAL PROVIDERS AND PATIENTS

PROGRAM DEVELOPMENT, IMPLEMENTATION, OVERSIGHT, EVALUATION

INVOLVING PATIENTS IN THEIR OWN CARE

ADDRESSING PATIENT COMPLEXITY

ENSURING SOCIAL FACTORS CONSIDERED IN TREATMENT PLANNING

FOCUSING ON PATIENT FUNCTIONING AND QUALITY OF LIFE

IMPROVING ACCESS TO BEHAVIORAL HEALTH SERVICES

MEDICAL PROVIDERS DISCUSSING THE VALUE OF
INTEGRATING PSYCHOLOGISTS IN PRIMARY CARE
TYPICAL INTEGRATED PRIMARY CARE:
BEHAVIORAL HEALTH CLINICAL ACTIVITIES
“TYPICAL” DAY OF A PSYCHOLOGIST
IN PRIMARY CARE
SKILLS REQUIRED FOR PSYCHOLOGISTS TO THRIVE IN
INTEGRATED PRIMARY CARE1

PRACTICAL
VIEW OF
CONFIDENTIALITY

COORDINATION
DIVERSITY OF
SKILLS

REAL-WORLD
KNOWLEDGE OF
PRIMARY CARE

SUCCINCTNESS USEFUL
DOCUMENTATION

EFFICIENCY
INTEGRATED BEHAVIORAL HEALTH PATIENT CARE:
A FEW EXAMPLES

Helping a man with diabetes identify and address barriers to

self-managing his illness and making lifestyle changes

Coaching an overwhelmed, highly stressed woman experiencing family

and career challenges to establish realistic expectations and effectively assert
herself

Connecting a child’s stomach pain to school-related distress

and teaching anxiety management skills

Assisting a widowed man with slowly progressing Parkinson’s disease

identify social supports to help him manage daily life

Running a joint group medical appointment for pregnant

women and their partners
NONCLINICAL ROLES FOR
PSYCHOLOGISTS IN PRIMARY CARE: VALUE ADDED
THE BENEFITS OF INTEGRATED PRIMARY CARE:
AN INTERDISCIPLINARY PERSPECTIVE
SUMMARY POINTS

Integrated primary care may be the most effective model to meet

population physical and behavioral health needs.

A unique and diverse set of knowledge, skills, and attitudes

are necessary to practice in primary care.

Behavioral health is part of overall health.

Psychologists are an integral part of the new health care teams.

© 2017 by the