Many Family Physicians Collaborate on Behavioral Health
More Work Needed to Increase Access, Improve Patient Outcomes
May 17, 2023, Michael Devitt — About four in 10 family physicians work collaboratively with behavioral health professionals such as psychiatrists and psychologists, with significantly higher rates among FPs who work as core or salaried faculty members and those who work in federal practice sites.
Those are among the most notable findings in a recent Annals of Family Medicine study that reviewed data from more than 25,000 American Board of Family Medicine questionnaires. The study also found that the percentage of FPs who work collaboratively with behavioral health professionals increased considerably over a five-year period, with variations based on geography and patient population.
“Integrating behavioral health into primary care has been shown to improve access to behavioral health, resulting in improved patient outcomes and clinician satisfaction,” said Sebastian Tong, M.D., M.P.H., an assistant professor in the Department of Family Medicine at the University of Washington School of Medicine in Seattle, and the study’s corresponding author. “Identifying groups of family physicians who are less likely to have integrated behavioral health helps for future implementation efforts.”
Methods and Findings
The researchers analyzed data collected from ABFM Continuing Certification Examination Registration Questionnaires between 2017 and 2021. The researchers excluded questionnaire data for family physicians who did not provide continuity care, practiced outside the United States or had missing geographic data.
Overall, nearly 39% of family physicians reported working with one or more types of behavioral health professionals. Of these, FPs worked most frequently with psychologists and/or other behavioral health professionals, followed by licensed social workers, psychiatrists and psychiatric nurse practitioners.
Story Highlights
The analysis also found that the proportion of family physicians working collaboratively with any behavioral health professional increased over time, from less than 35% in 2017 to 43% in 2021.
Family physicians who identified as female were more likely to collaborate with behavioral health professionals compared with those who identified as male. In addition, FPs who worked as core/salaried faculty members were more than 2.3 times as likely to collaborate than FPs who were not faculty members.
In terms of practice characteristics, FPs who worked at federal sites such as military hospitals or Veterans Affairs medical centers, federally qualified health centers or look-alikes, and Indian Health Service facilities were most likely to collaborate with behavioral health professionals. Those who worked in independently owned practices were least likely to collaborate.
Geographically, the prevalence of collaboration with behavioral health professionals by state ranged from 17.6% to 78.0%. FPs who worked in the southern United States were statistically less likely to collaborate with behavioral health professionals, as the five states with the lowest collaboration rates were all located in the South. Conversely, the five states with the highest collaboration rates were spread across the Northeast, Midwest and West.
Implications
The researchers offered a number of solutions to address disparities in collaboration. Among the efforts discussed were increased use of behavioral telehealth services (which would reduce geographic barriers to care and promote the use of shared resources), adapting models that have higher rates of behavioral health collaboration into other practice settings, and integrating behavioral health into family medicine residency programs.
The authors also admitted some study limitations, primarily with regard to terms such as “working collaboratively” and “integrated care,” which individual family physicians could interpret subjectively.
Despite these limits, they noted several potential benefits associated with collaborative relationships between FPs and behavioral health professionals. They added that although significant disparities in behavioral health care are evident, “understanding why these disparities exist and exploring how to best support behavioral health integration in these settings could help improve behavioral health access for patients in these settings and improve overall patient outcomes.”
Family Physician Perspective
Tong detailed the benefits of integrated behavioral health for AAFP News.
“Integrating behavioral health into family medicine can support improved access to behavioral health and lead to improved mental health and physical health outcomes in patients,” said Tong. He added that integration “can also improve clinician satisfaction and well-being since clinicians feel more supported in caring for patients with behavioral health needs.”
Tong indicated that family physicians could use the study’s findings to advocate for support in helping them implement models to collaborate with behavioral health professionals — something Tong currently does in practice.
“I am fortunate to have a psychiatrist who comes to our clinic once a week to work collaboratively with me to care for patients with complicated psychiatric comorbidities and to help with diagnoses,” Tong said. “We also have a licensed clinical social worker who helps with social needs and a psychotherapist who collaborates on all mental health conditions.”
Tools for Family Physicians
Multiple behavioral health integration resources are available from the AAFP and other organizations. The Academy’s recently launched Behavioral Health Integration Learning Forum contains CME activities, an online community and links to tools and reference materials. In March, the Academy debuted a new online CME series that addresses several behavioral and mental health topics.
In addition, Tong recommended that members visit the Behavioral Health Integration Collaborative, a partnership of the AAFP and seven other medical organizations that promotes the integration of behavioral and mental health care into overall health care, and the AHRQ Academy, an effort from the Agency for Healthcare Research and Quality that supports the integration of behavioral health into primary and ambulatory care.
Tong noted that he has received funding from the ABFM Foundation to conduct a qualitative study to explore the barriers and facilitators to implementing integrated behavioral health into settings that have lower rates of integration. He plans on using the findings from that research to develop future implementation supports and strategies.