OBJECTIVES To evaluate changes in access to and utilization of behavioral health (BH) services after the integration of psychologists into primary care clinics compared with clinics without integrated psychologists. METHODS We integrated 4 of 12 primary care clinics within our academic health system. We used the median wait time for BH services as a proxy for changes in access and defined BH utilization as the percentage of primary care visits that resulted in contact with a BH clinician within 180 days. We compared changes in access and utilization from the year before integration (September 2015 to September 2016) with the 2 years after integration (October 2016 to October 2018) within integrated clinics and between integrated and nonintegrated clinics. We used difference-in-difference analysis to test the association of study outcomes with the presence of integrated psychologists. RESULTS Access and utilization were similar across all practices before integration. After integration, BH utilization increased by 143% in integrated clinics compared with 12% in nonintegrated clinics. The utilization of BH services outside of the medical home (ie, specialty BH service) decreased for integrated clinics only. In clinics with integrated psychologists, 93% of initial BH visits happened on the same day as a need was identified. The median wait time for the 7% in integrated clinics who were not seen on the same day was 11.4 days (interquartile range = 5.3-17.7) compared with 48.3 days (interquartile range = 20.4-93.6) for nonintegrated clinics. CONCLUSIONS A team-based integration model increased BH utilization and access.

中文翻译：

---

通过综合初级保健增加行为保健的获取和利用。

目的 评估将心理学家纳入初级保健诊所后，与没有综合心理学家的诊所相比，获得和利用行为健康 (BH) 服务的变化。方法 我们将 12 个初级保健诊所中的 4 个纳入我们的学术医疗系统。我们使用 BH 服务的中位等待时间作为访问变化的代理，并将 BH 利用率定义为在 180 天内与 BH 临床医生取得联系的初级保健就诊的百分比。我们比较了整合前一年（2015年9月至2016年9月）与整合后两年（2016年10月至2018年10月）在综合诊所内以及综合诊所和非综合诊所之间的获取和利用的变化。我们使用双重差分分析来测试研究结果与综合心理学家的存在之间的关联。结果 整合之前，所有实践的访问和利用都是相似的。整合后，综合诊所的 BH 利用率增加了 143%，而非综合诊所的 BH 利用率为 12%。仅综合诊所对医疗之家以外的 BH 服务（即专业 BH 服务）的利用有所下降。在拥有综合心理学家的诊所中，93% 的初次 BH 就诊发生在确定需求的同一天。综合诊所中当天未就诊的 7% 的人的中位等待时间为 11.4 天（四分位距 = 5.3-17.7），而非综合诊所的等待时间中位为 48.3 天（四分位距 = 20.4-93.6）。结论 基于团队的集成模型提高了 BH 的利用率和访问权限。