Integrated Primary Care : A Systematic Review of Study Design and Program Characteristics

Abstract

Integrated primary care (IPC), the integration of medical and behavioral health professionals, is a viable part of the solution for the United States' fragmented health care delivery system. Over the past decade or so, efforts have been made to examine the theory behind and effectiveness of this health care framework. As researchers and program developers continue to examine the impact of IPC on patient populations, it is becoming increasingly important to highlight the study design and program characteristic trends of IPC to ascertain the next steps in research development. This researcher sought to identify those trends by using a systematic review design to examine studies of IPC. Of the two systematic reviews conducted for this dissertation, the first review includes information from 112 articles regarding study design, sampling procedure, patient population characteristics, treatment outcome, geographical setting, and psychosocial measurement. The findings of this review indicate that a majority of researchers examined depression outcomes using experimental designs and that the average participant in such studies was a Caucasian female in her early 50s. Moreover, the researcher found that almost none of the IPC programs were oriented towards family systems. For the second systematic review, the researcher extracted data from 76 of the 112 articles to examine the characteristics of each IPC program including communication practices, models, interventions, provider type, training and supervision practices, and setting. Findings from this review show that most IPC programs include psychoeducation, medication, follow-up contacts, psychotherapy, and at least one care management strategy as part of treatment but that less than half of researchers are reporting communication between providers and even fewer are reporting collaboration practices. Moreover, the findings indicate that a third of researchers trained and/or supervised behavioral health providers to work in an IPC program, and a fourth recruited nurses as behavioral health providers. Suggestions for future research include more diverse research methods and patient populations as well as a focus on increasing communication and collaboration between providers.