Implementing the Primary Care Behavioral Health model into routine practice in Swedish primary care: a pilot trial

Mental health problems are an increasing public health concern, and demand for care is exceeding available resources. The Primary Care Behavioral Health (PCBH) service delivery model shows promise for managing mental health problems in primary care, but its effects require further evaluation. This study examined how the implementation of PCBH in standard Swedish primary care was associated with accessibility of behavioral and mental health care and psychotropic prescription patterns.

This pragmatic multicenter stepped-wedge clinical trial reports results from the first four pilot centers implementing PCBH in southeast Sweden. These centers had 37,100 listed patients. Study participants included all individuals receiving mental health care during the study period (n = 6413, mean age 50 years, 60% women). Data from electronic medical records were analyzed regarding behavioral health consultant (BHC) accessibility (number of appointments and individual patients) and prescriptions of psychotropic drugs (ATC codes: N05A, N05B, N05C, and N06A). Three time periods were compared: baseline (period 1), implementation (period 2), and the year after implementation (period 3).

After the implementation of PCBH, mean waiting times for a first BHC appointment decreased between 30% and 39%: from 16 days in period 1 to 10 (period 2) respectively 11 days (period 3), p < 0.001 both comparisons. Waiting times for all BHC appointments decreased between 21% and 24%; from 18 days (period 1) to 13.7 (period 2) respectively 14.2 days (after implementation), p < 0.001 both comparisons. The total number of appointments with a BHC increased between 21% and 34%; from 1762 (period 1) to 2359 (period 2) and then 2127 (period 3), p < 0.001 both comparisons. Individuals receiving care from a BHC increased between 16% and 42%; from 702 (period 1) to 995 (period 2) and 815 (period 3), p < 0.005 both comparisons. The total prescription of psychotropic drugs decreased between 14% and 18%; from 8025 (period 1) to 6570 (period 2) and 6927 (period 3) p < 0.001 both comparisons.

These findings suggest that implementation of PCBH improves access to mental health care and reduces psychotropic prescriptions. However, the improved access to care and reduction in psychotropic medication declined somewhat the year after implementation. Future research should focus on longitudinal outcomes with the use of comparison groups and systematically include patient-reported outcomes, experience measures, and staff perspectives to assess effectiveness and implementation experiences.

ClinicalTrials.gov (NCT05633940), registered 2021-04-21.