Behavioral health collaborations in family medicine rose from 2017 to 2021

Key takeaways:

• Of 25,222 family physicians, 38.8% reported working with any behavioral health professional from 2017 to 2021.
• Behavioral health collaborations were less common in independent practices and in the South.

The proportion of family physicians who reported working collaboratively with a behavioral health professional increased from 34.8% in 2017 to 43% in 2021, a recent study found.

Sebastian T. Tong, MD, MPH, an assistant professor of family medicine at the University of Washington School of Medicine, told Healio his interest in evaluating behavioral health collaborations came about “given the benefit I’ve seen patients receive from having behavioral health integrated into a primary care setting,”

“It makes it easier to coordinate a patient’s care when, as a family physician, I can directly talk with the behavioral health professional (BHP) working with the patient,” Tong said. “In addition, studies have shown overall improved patient outcomes and satisfaction with care.”

As leading health organizations continue to push for such integration in primary care amid an ongoing mental health crisis, Tong and colleagues highlighted a need for more information on current prevalence and factors of BPH collaboration among family physicians. The findings, they added, could be critical for addressing implementation obstacles.

“Prior work has focused on colocation using claims data rather than integration or focused on limited settings,” they wrote in the Annals of Family Medicine.

Tong and colleagues used 2017 to 2021 data from the American Board of Family Medicine’s Continuing Certification Examination Registration Questionnaire, which asked physicians if they collaborated with various specialty professionals.

Overall, of the 25,222 family medicine physicians who were eligible for inclusion, 38.8% reported working collaboratively with any BHP: 27.2% reported working with psychologists or other BHPs; 26.9% with licensed social workers; 13.4% with psychiatrists; and 5.6% with psychiatric nurse practitioners. Over the years, from 2017 to 2021, the proportion significantly increased by about 8 percentage points.

Several physician characteristics were associated with increased odds of BHP collaboration, including identifying as female (OR = 1.09) and working as a core or salaried faculty when compared with not being faculty (OR = 2.32). Further positive associations were found for those working in a federal practice site and in counties with more psychiatrists.

Working in the South was associated with decreased odds of BHP collaboration. Mississippi had the lowest BHP collaboration prevalence of any state at 17.6%. Additionally, the five states with the lowest collaboration were all located in the South, while states with the highest collaboration were spread across the Northeast, Midwest and West.

“I was excited to find that over one-third of family physicians already work with behavioral health professionals in their practice,” Tong said. “However, I was concerned that there were significant disparities in this, especially in the U.S. South where health outcomes in general have been worse.”

A potential reason for the geographic differences is the overall lower number of psychiatrists, psychologists and nurse practitioners in the South, Tong and colleagues suggested.

“Work is needed on the barriers that independent practices and practices in the South face with integrated behavioral health implementation and on how to support overcoming these barriers,” they wrote.

Tong said independent practices could work towards implementing behavioral health services “by developing collaborative relationships with independent behavioral health professionals or by collaborating with other independent practices in the community to share behavioral health resources.”