Behavioral healthcare is being integrated into primary care all over the country in a variety of ways. Various models are being used within primary care settings to address the psychosocial, psychoeducational, and mental health needs of primary care patients. A typical visit to the primary care doctor no longer means just treatment of illness. Now, patients can expect behavioral treatments in addition to traditional biomedical and pharmacological treatment methods, such as relaxation techniques for anxiety over a cancer diagnosis or smoking cessation classes for cardiac patients.
Including health psychologists as members of a primary care team can provide a unique opportunity to improve health care by conducting research in disease prevention and health promotion and applying the results of that research. For example, there is a need to explore how to promote health outcomes and prevent disease within cultural contexts (DeLeon, Giesting, & Kenkel, 2004). Most preventative services within primary care have been delivered in ways that are based on insurance coverage (Borowsky, et al., 2000). This is particularly evident for those who are underserved or have low incomes.
One challenge for health psychologists is to level the field for all people by determining ways to provide prevention services and promote healthy living without regard to insurance or income. Identifying how to provide these services and implementing them in clinical settings is critically important if we are to provide culturally informed and integrated healthcare. Health psychologists co-located within primary care settings can learn first hand how to design research studies to inquire about effective methods for service delivery by multidisciplinary teams (Blount, 2003).
Screening for behavioral health problems is another opportunity to develop health prevention and promotion strategies within primary care. Many health problems, like high blood pressure or cardiovascular disease, are preventable problems that if left untreated can develop into serious chronic and life threatening conditions. Also, many behavioral health problems, such as depression, anxiety, and increased stress commonly occur with physical illness. Lifestyle behaviors such as avoiding smoking, avoiding overeating, and exercising regularly are viewed as extremely important in preventing the onset of disease and arresting the development of diseases when they do occur. Screening methods for risk factors in behavioral health that co-occur with other physical health problems can provide the foundation for disease prevention and health promotion strategies as demonstrated by lower health care costs as a result of decreasing health service utilization (Sobel, 2000). In addition, screening research can lead to gaining important insights into how various populations respond to screening and how certain individuals use or ignore screenings in primary care.
Health psychologists can be instrumental in helping to change the behaviors that contribute to the development of chronic disease processes by developing primary care practice evaluation and research. Demands for improved allocation of health care dollars and resources by insurers and others have placed great pressure on health care professionals to provide cost effective treatment while demonstrating treatment efficacy (Suls & Rothman, 2004). Specific areas of interest for primary care program evaluation include clinical efficacy, patient satisfaction, medical utilization, and provider satisfaction (Blount, 2003). Clinical efficacy evaluations are typically associated with improvement in symptoms and clinical markers of disease, reduction or maximizing pharmacological treatment, and improved functional status and quality of life (Garcia-Shelton, 2006). Practice evaluations should also investigate how integrated care may lead to improving mental and physical health outcomes for racial and ethnic minorities. Integrative care practice evaluation research needs to advance current knowledge about integrated care models for various racial, ethnic, and cultural communities to improve health related outcomes.
Health psychologists conducting research in clinical settings provide a significant opportunity for transcending the real and perceived chasms between research and practical application (Suls & Rothman, 2004). Various local and national initiatives for integration strengthen health psychology leadership by demonstrating the importance of research in integrated behavioral health and primary care practice research. These opportunities extend beyond integration research, to implementation of culturally informed health promotion and prevention interventions provided by interdisciplinary teams. This rapidly developing and empirically validated approach to treating the whole patient by providing integrated health care has the potential to significantly influence how future health care services can be delivered.
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