Behavioral health integration in a VA women's health clinic

Background/significance: The integration of behavioral medicine in primary care can increase healthcare quality through improved coordination and access to care, eliminate additional steps to accessing care, facilitate “warm” handoffs, and foster a holistic, patient-centered care philosophy. As part of a Health Psychology/Primary Care Integration fellowship, a fully integrated care model, where psychology and medicine function as a coordinated team, was implemented into the women's health clinic (WHC).

Objective/purpose: The purpose of this approach was to 1) increase access to care and referrals to appropriate behavioral health treatment; and 2) offer brief Integrated Women's Health Treatment (IWHT) for acute behavioral and physical health problems such as: stress-related illnesses, depression, anxiety, chronic pain, substance abuse, domestic violence and relationship problems, sexual problems, and obesity.

Methods: Whenever possible, WHC patients are seen by both a psychologist and a physician or nurse practitioner for the clinical interview portion of their visit. Patients who received a fully integrated WHC appointment were identified and tracked to identify their health outcomes.

Results: Over a 10-month period 81 women participated in a fully integrated WHC appointment. Approximately 32 patients (40%) completed IWHT treatment; 29 patients (36%) were referred to additional services (e.g., weight-loss clinic); 44 patients (54%) received crisis counseling or an immediate intervention (e.g., smoking cessation); 13 patients (16%) declined services or did not present for their first IWHT appointment (no-show).

Conclusions: The fully-integrated model appears to be an effective method to reduce access barriers and engage women in brief treatment focused on specific behavioral health goals.