Results Summary

What was the research about?

When primary care clinics offer mental health care on-site, it’s called co-located care. But care teams at clinics with co-located care may not work together or share information about patients’ care. In integrated behavioral health, or IBH, mental health staff, like counselors and psychologists, and primary care clinicians, like doctors and nurse practitioners, work together to treat patients. They also share records and data systems.

In this study, the research team looked at whether a program to help clinics use IBH improved well-being among patients with physical and mental health conditions. They also wanted to see if the program improved how well primary and behavioral health care teams worked together. The research team compared clinics that did and didn’t receive the program.

What were the results?

After two years, patients in clinics that did and didn’t receive the IBH program didn’t differ in:

  • Anxiety, depression, or fatigue
  • Ability to fall and stay asleep
  • Disability, physical fitness, and ability to do activities
  • Pain and how pain interfered with their life
  • How often they took their medicine as directed
  • Self-care activities and social functioning
  • Use of care

Compared with clinics that didn’t receive the program, clinics that did:

  • Were better at tracking patient information and care
  • Didn’t differ in provider empathy and ability to communicate effectively with patients

Who was in the study?

The study included 2,426 patients receiving care in one of 41 primary care clinics with co-located care across the United States. Patients had at least one long-term health problem and one long-term mental health condition or at least three long-term health problems. Of these patients, 77 percent were White, 12 percent were African American, 3 percent were Asian, and 2 percent were Native Hawaiian or Pacific Islander. Also, 1 percent were American Indian or Alaska Native and 7 percent were another race or preferred not to say; 7 percent were Hispanic. The average age was 62, and 66 percent were women.

What did the research team do?

The research team assigned clinics by chance to receive the IBH program or not. Staff at clinics assigned to the program could learn about IBH using an online course and a workbook. They received access to an online learning community and coaching services. 

At the start of the study and one and two years later, the research team surveyed patients and clinic staff.

Patients, family members, clinicians, and behavioral health staff helped design the study.

What were the limits of the study?

The research team let clinics decide when to use the program and which parts to use. Results may have differed if the team required clinics to use the program within a set amount of time or in a certain way.

Future studies could look at other ways to encourage IBH in primary care.

How can people use the results?

Primary care clinics can use the results when looking for ways to improve how well mental health and primary care providers work together in patient care.

Final Research Report

This project's final research report is expected to be available by September 2024.

Journal Citations

Related Journal Citations

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments. 

Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:

  • The reviewers requested more information on how the researchers monitored treatment fidelity given that they allowed sites to skip some steps or strategies in the intervention toolkit.  The researchers explained that although they did obtain some information on toolkit completion for administrative purposes, analysis of treatment fidelity was beyond the scope of this study. Further, the researchers noted that the pragmatic nature of this study precluded their ability to assess whether study participants who received all elements of the toolkit fared better than participants who did not.
  • The reviewers questioned the approach the researchers took to assess the effect of missing data and whether the lack of significant differences between treatment groups could be the result of missing outcomes for a number of study participants. The researchers countered that their lost-to-follow-up rate was quite low given the pragmatic nature of the study, and that their approach to analyzing the effects of missing data did not indicate that this was a cause for the lack of difference between treatment groups. 
  • The reviewers asked the researchers to expand on the lessons learned and next steps for this research area, particularly related to the usefulness of integrated behavioral health (IBH). The researchers clarified that there is considerable evidence supporting IBH care despite the limited impact of their toolkit on the integration of this model into a range of clinical settings. Different study designs or focus on specific elements of the toolkit might provide more robust results.

Conflict of Interest Disclosures

Project Information

Benjamin Littenberg, MD
University of Vermont and State Agriculture College
$18,636,493
Integrating Behavioral Health and Primary Care

Key Dates

August 2015
July 2023
2015
2023

Study Registration Information

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Last updated: April 23, 2024