The effect of behavioral health consultation on the care of depression by primary care clinicians

Purpose: The aim of this study is to assess the impact of an integrated care model, called the Behavioral Health Consultation model, in the delivery of care for depression in an urban Federally Qualified Health Center, and to gauge the receptiveness of primary care clinicians to increasing their responsibility for the mental health care of their patients. Methods: We reviewed electronic medical records to measure referral rates to mental health specialty care, patient engagement in care, management of psychotropic medications, and initiation of antidepressant medication, comparing data from the year prior to program implementation to that from the third year post-implementation. Clinician attitudes were assessed using an online anonymous questionnaire. Results: Statistically significant findings included post-implementation increases in the use of standardized measures of depression, documentation of behavioral goals and patient visits to the primary care clinician (increased engagement), decreases in initiation rates of antidepressant medications, and decreases in referrals to mental health specialty care. No significant difference was found in rates of dosage changes or change to new medications among patients who were already on psychiatric medications. Clinicians reported near universal acceptance of the behavioral health consultation program and willingness to increase their role in managing patient mental health issues. Conclusions: This study demonstrates that a behavioral health consultation program in an urban community health center can improve adherence to evidence-based indicators in the care of depression, making it possible to manage the majority of patients presenting with depression in the primary care setting.