title: Provider perspectives on integrating primary and behavioral health: a report from the High Plains Research Network.
abstract: BACKGROUND
  Integrated primary care, a health care delivery model that combines medical and behavioral health services, provides better patient access to care at a lower cost, with better outcomes compared with usual nonintegrated care models. The perspectives of primary care providers (PCPs) and behavioral health care providers (BHPs) toward integration are especially valuable because their input and endorsement are key to successful and sustained integration. However, there is little research assessing or comparing PCP and BHP perspectives on integration, especially in rural areas. The objective of this study was to identify rural PCP and BHP perspectives on integration.
  
  
  METHODS
  Written and electronic surveys were distributed to PCPs and BHPs in the High Plains Research Network in rural eastern Colorado. Items included perspectives on improving behavioral health care, barriers to integration, and confidence in the ability to integrate primary and behavioral care.
  
  
  RESULTS
  Surveys were completed by 88 PCPs (60%), and 49 BHPs (63%), for an overall response rate of 61%. PCPs were significantly more likely than BHPs to prefer improving referral methods (odds ratio [OR], 2.2; P = .03) and significantly less likely to prefer colocation (OR, 0.2; P < .0001), warm hand-offs (OR, 0.3; P < .01), improved behavioral health training for PCPs (OR, 0.4; P < .01), and shared visits (OR, 0.4; P =.03) as ways to improve health care. Lack of sufficient methods of payment for behavioral health care services was the most commonly selected barrier to integration by both groups. PCPs were significantly more likely than BHPs to select recruitment (OR, 3.8; P < .001) and retention (OR, 2.7; P < .01) of behavioral health care staff as a major barrier. BHPs were slightly more optimistic than PCPs about the achievability of integration.
  
  
  CONCLUSIONS
  Important differences of perspective exist between rural PCPs and BHPs regarding the best ways to improve behavioral health care, barriers to integration, and the achievability of integration. These differences may have important implications for rural communities and health care systems considering a transition to an integrated primary care model.
authors.affiliation: the High Plains Research Network, Department of Family Medicine, University of Colorado School of Medicine, Aurora.
authors.forename: Gregory
authors.initials: G
authors.lastname: Burfeind
authors.forename: Deborah
authors.initials: D
authors.lastname: Seymour
authors.forename: Stefan H
authors.initials: SH
authors.lastname: Sillau
authors.forename: Linda
authors.initials: L
authors.lastname: Zittleman
authors.forename: John M
authors.initials: JM
authors.lastname: Westfall
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001524:Behavioral Medicine; D003120:Colorado; D019033:Delivery of Health Care, Integrated; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D019035:Rural Health Services
keywords: Integrated Health Care Systems; Mental Health; Primary Health Care; Rural Health