Psychological approach to population-based clinical health care
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The primary care behavioral health (PCBH) consultation model is a psychological approach to population-based clinical health care that is simultaneously co-located, collaborative, and integrated within the primary care clinic. The goal of PCBH is to improve and promote overall health within the general population. This approach is important because approximately half of all patients in primary care present with psychiatric comorbidities, and 60% of psychiatric illness is treated in primary care.[1]
Primary care practice has traditionally adopted a generalist approach whereby physicians are trained in the medical model and solutions to problems typically involve medications, procedures, and advice. Appointment times are short, with the goal of seeing a large number of patients in a day. Many patients present with behavioral health care needs that may overlap with medical disorders and that may exacerbate, complicate, or masquerade as physical symptoms. In addition, many medical problems present with associated psychological sequelae (such as stress, emotional reactions, dysfunctional lifestyle behaviors), that are amenable to change through behavioral interventions that can improve outcomes for these health problems.
The PCBH model enables early identification and behavioral/medical intervention that can prevent some acute problems from becoming chronic health care problems (such as chronic pain, diabetes, COPD, hypertension, obesity), which are the cause of many medical visits to primary care clinics. Behavioral health consultants (BHCs) work side-by-side with all members of the clinical care team (including primary care providers (PCPs) and nursing staff) to enhance preventive and clinical care for mental health problems that have traditionally been treated solely by physicians. The role of the BHC is to facilitate systemic change within primary care that facilitates a multidisciplinary approach both from a treatment and reimbursement standpoint. BHCs typically collaborate with physicians to develop treatment plans, monitor patient progress, and flexibly provide care to meet patients' changing needs.[2] Moreover, the integrated care model increases behavioral health accessibility, fosters communication between patients and their primary care team, and improves patients' experiences receiving primary care.[3]
^Pirl, W.F.; Beck, B.J.; Safren, S. A.; Kim, H (2001). "A descriptive study of psychiatric consultations in a community primary care center". Primary Care Companion Journal of Clinical Psychiatry. 3 (5): 190–194. doi:10.4088/PCC.v03n0501. PMC 181214. PMID 15014572.
^Robinson, P.J. and Reiter, J.T. (2007). Behavioral Consultation and Primary Care (pp 1–16). N.Y.: Springer Science + Business Media.
^Koehler, AN, et al. (2019). "Patient Views of Behavioral Health Providers in Primary Care: A Qualitative Study of 2 Southeastern Clinics." Journal of Patient Experience. https://doi.org/10.1177/2374373519860357
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