Residents' Confidence Providing Primary Care With Behavioral Health Integration

Abstract

Background and objectives: Behavioral health integration (BHI) entails integrated behavioral health clinicians (IBHCs) providing care-generally for mental health and substance abuse disorders and behavioral comorbidity- within the operational functioning of primary care. Because limited data exist regarding BHI in residency, we studied its impact on resident education by examining whether increased behavioral health (BH) co-management improved residents' perceived ability to treat BH conditions.

Methods: We included residents from internal and family medicine training programs using BHI in residents' continuity clinics and assessed the level of co-management between primary care and IBHCs and the following domains: (1) confidence in managing BH conditions, (2) barriers to BH provision, (3) perception of autonomy when working with IBHCs, (4) satisfaction with the clinic, and (5) perceived educational value of BH learning modes.

Results: Altogether, 117 residents participated in our survey (73.1% response rate). Residents who had co-managed ≥ five patients alongside IBHCs reported significantly higher confidence than those who had co-managed < five patients with BH conditions. The association remained significant after adjustment for residents' level of training and specialty. In rating BH learning modes, residents rated most highly active collaboration with IBHCs and observation with feedback from clinic preceptors.

Conclusions: BHI training within residency enhances perceived learning and confidence in providing BH care.