title: Outcomes of Integrated Behavioral Health with Primary Care.
abstract: BACKGROUND
  Integrating behavioral health and primary care is beneficial to patients and health systems. However, for integration to be widely adopted, studies demonstrating its benefits in community practices are needed. The objective of this study was to evaluate effect of integrated care, adapted to local contexts, on depression severity and patients' experience of care.
  
  
  METHODS
  This study used a convergent mixed-methods design, merging findings from a quasi-experimental study with patient interviews conducted as part of Advancing Care Together, a community demonstration project that created an innovation incubator for practices implementing evidence-based integration strategies. The study included 475 patients with a 9-item Patient Health Questionnaire (PHQ-9) score ≥10 at baseline, from 5 practices.
  
  
  RESULTS
  Statistically significant reductions in mean PHQ-9 scores were observed in all practices, ranging from 2.72 to 6.46 points. Clinically, 50% of patients had a ≥5-point reduction in PHQ-9 score and 32% had a ≥50% reduction. This finding was corroborated by patient interviews that demonstrated positive experiences with behavioral health clinicians and acquiring new skills to cope with adverse situations at work and home.
  
  
  CONCLUSIONS
  Integrating behavioral health and primary care, when adapted to fit into community practices, reduced depression severity and enhanced patients' experience of care. Integration is a worthwhile investment; clinical leaders, policymakers, and payers should support integration in their communities.
authors.affiliation: From the Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Dallas, TX (BAB, KKJ); the Department of Family Medicine, Oregon Health and Science University, Portland (DJC, MD, RG, KG); and the Department of Family Medicine, University of Colorado School of Medicine, Denver (LMD, FVdG, BFM, LAG). bijal.a.balasubramanian@uth.tmc.edu.
authors.forename: Bijal A
authors.initials: BA
authors.lastname: Balasubramanian
authors.affiliation: From the Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Dallas, TX (BAB, KKJ); the Department of Family Medicine, Oregon Health and Science University, Portland (DJC, MD, RG, KG); and the Department of Family Medicine, University of Colorado School of Medicine, Denver (LMD, FVdG, BFM, LAG).
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Cohen
authors.affiliation: From the Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Dallas, TX (BAB, KKJ); the Department of Family Medicine, Oregon Health and Science University, Portland (DJC, MD, RG, KG); and the Department of Family Medicine, University of Colorado School of Medicine, Denver (LMD, FVdG, BFM, LAG).
authors.forename: Katelyn K
authors.initials: KK
authors.lastname: Jetelina
authors.affiliation: From the Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Dallas, TX (BAB, KKJ); the Department of Family Medicine, Oregon Health and Science University, Portland (DJC, MD, RG, KG); and the Department of Family Medicine, University of Colorado School of Medicine, Denver (LMD, FVdG, BFM, LAG).
authors.forename: L Miriam
authors.initials: LM
authors.lastname: Dickinson
authors.affiliation: From the Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Dallas, TX (BAB, KKJ); the Department of Family Medicine, Oregon Health and Science University, Portland (DJC, MD, RG, KG); and the Department of Family Medicine, University of Colorado School of Medicine, Denver (LMD, FVdG, BFM, LAG).
authors.forename: Melinda
authors.initials: M
authors.lastname: Davis
authors.affiliation: From the Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Dallas, TX (BAB, KKJ); the Department of Family Medicine, Oregon Health and Science University, Portland (DJC, MD, RG, KG); and the Department of Family Medicine, University of Colorado School of Medicine, Denver (LMD, FVdG, BFM, LAG).
authors.forename: Rose
authors.initials: R
authors.lastname: Gunn
authors.affiliation: From the Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Dallas, TX (BAB, KKJ); the Department of Family Medicine, Oregon Health and Science University, Portland (DJC, MD, RG, KG); and the Department of Family Medicine, University of Colorado School of Medicine, Denver (LMD, FVdG, BFM, LAG).
authors.forename: Kris
authors.initials: K
authors.lastname: Gowen
authors.affiliation: From the Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Dallas, TX (BAB, KKJ); the Department of Family Medicine, Oregon Health and Science University, Portland (DJC, MD, RG, KG); and the Department of Family Medicine, University of Colorado School of Medicine, Denver (LMD, FVdG, BFM, LAG).
authors.forename: Frank V
authors.initials: FV
authors.lastname: deGruy
authors.affiliation: From the Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Dallas, TX (BAB, KKJ); the Department of Family Medicine, Oregon Health and Science University, Portland (DJC, MD, RG, KG); and the Department of Family Medicine, University of Colorado School of Medicine, Denver (LMD, FVdG, BFM, LAG).
authors.forename: Benjamin F
authors.initials: BF
authors.lastname: Miller
authors.affiliation: From the Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Dallas, TX (BAB, KKJ); the Department of Family Medicine, Oregon Health and Science University, Portland (DJC, MD, RG, KG); and the Department of Family Medicine, University of Colorado School of Medicine, Denver (LMD, FVdG, BFM, LAG).
authors.forename: Larry A
authors.initials: LA
authors.lastname: Green
mesh_terms: D000288:Administrative Personnel; D000328:Adult; D003120:Colorado; D003156:Community Mental Health Services / Q000458:organization & administration*; D019033:Delivery of Health Care, Integrated / Q000379:methods*; D003863:Depression / Q000453:epidemiology*; D019317:Evidence-Based Medicine / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D000073222:Patient Health Questionnaire; D011320:Primary Health Care / Q000379:methods / Q000458:organization & administration*; D012720:Severity of Illness Index
keywords: Behavioral Medicine; Community Health Services; Depression; Integrated Health Care Systems; Primary Health Care; Surveys and Questionnaires