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Published on: August 1, 2019
Effects of Primary Care Provider Characteristics on Changes in Behavioral Health Delivery During a Collaborative Care
Elizabeth A McGuier1, David J Kolko2, K Ashana Ramsook3
1Department of Medicine, University of Pittsburgh School of Medicine (EA McGuier), Pittsburgh, Pa.
Insights
Pediatric primary care providers (PCPs) delivering behavioral health (BH) services benefit from collaborative care, especially older PCPs. This model enhances BH effort and competency over time.
Area of Science:
- Pediatric primary care
- Behavioral health integration
- Collaborative care models
Background:
- Pediatric primary care providers (PCPs) are increasingly tasked with delivering behavioral health (BH) services.
- Understanding PCP characteristics that influence BH service delivery is crucial for effective integration.
- Existing research has not fully elucidated how PCP traits impact BH-related effort and competency.
Purpose of the Study:
- To examine how PCP characteristics influence changes in BH-related effort and competency over time.
- To assess the role of collaborative care participation in modifying these changes.
- To identify specific PCP traits that facilitate or hinder BH service delivery within a primary care setting.
Main Methods:
- A cluster randomized trial involving 74 pediatric PCPs across 8 practices.
- PCPs completed self-report measures at baseline and at 6, 12, and 18 months.
- Latent growth curve models analyzed the impact of PCP characteristics (age, gender, beliefs, burden, competency) on identification/treatment of disruptive behavior disorders and competency.
Main Results:
- Collaborative care participation increased identification/treatment of disruptive behavior disorders, irrespective of PCP characteristics.
- Older PCPs (>50 years) showed significant competency gains in collaborative care, unlike those in the comparison group.
- Negative BH beliefs were associated with less identification/treatment; baseline competency positively predicted it, though this association weakened over time.
Conclusions:
- PCP characteristics significantly correlate with evolving BH effort and competency.
- Collaborative care models demonstrate particular advantages for older PCPs, fostering BH growth.
- Implementing collaborative care is a viable strategy to enhance PCPs' BH-related capabilities.
Objective:
Pediatric primary care providers (PCPs) are increasingly expected to deliver behavioral health (BH) services, yet PCP characteristics that facilitate or hinder BH service delivery are poorly understood. This study examined how PCP characteristics and collaborative care participation influenced changes in BH-related effort and competency over time.
Methods:
Pediatric PCPs (N = 74) participating in a cluster randomized trial (8 practices) of a collaborative care intervention for disruptive behavior problems completed self-report measures at 0, 6, 12, and 18 months. Latent growth curve models tested the impact of PCP characteristics (ie, age, gender, negative BH beliefs, BH burden, BH competency) on changes in identification/treatment of disruptive behavior disorders and competency over the course of the trial.
Results:
Participation in collaborative care was associated with increases in identification/treatment, with no evidence that PCP characteristics moderated changes in identification/treatment. For competency, however, older PCPs (>50 years) in collaborative care exhibited steep increases over time, while older PCPs in the comparison condition exhibited steep decreases, suggesting differential benefits of collaborative care participation by PCP age. In both conditions, PCPs with more negative BH beliefs reported less identification/treatment over time. Baseline competency was positively associated with identification/treatment and associations weakened over time. Gender and perceived burden had little impact.
Conclusions:
PCP characteristics are associated with changes in PCPs' BH-related effort and competency over time. Participation in a collaborative care model appears to be especially beneficial for older PCPs. Implementation of collaborative care can promote growth in BH-related effort and competency for PCPs.
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