Integrating Primary Care and Behavioral Health in Remote Military Settings

Abstract

Background: Active-duty military servicemembers experiencing mental illness while stationed at geographically remote bases may encounter barriers to behavioral health treatment. Purpose: This Defense Health Agency (DHA) Quadruple Aim Initiative-aligned quality improvement project sought to increase access to on-site mental health services for active-duty personnel at remote bases by developing, implementing, and evaluating care processes to improve individual medical readiness, organizational readiness (availability of behavioral health appointments), quality of care, patient satisfaction, and efficiency. Methods: The project followed a pre- and post-implementation design over three months at four military primary care clinics. Training curricula over primary care behavioral health (PCBH) screening and treatment were developed and implemented. Clinical staff also received training on PCBH screening and treatment resources. Primary care providers completed surveys measuring self-efficacy with PCBH. Evaluated outcomes included patient satisfaction, cost, and individual and organizational readiness. Results: Nine providers completed pre- and post-implementation surveys. A paired samples t-test revealed clinically and statistically significant increased self-efficacy scores (t = -2.612, df = 8, p = 0.031), and Cohens d = 0.87, indicating a large effect size. Patient satisfaction scores remained unchanged at 100%. Individual readiness measures increased at one clinic and organizational readiness measures improved 8%. Behavioral health referrals, claims, and overall cost decreased 11%, 26%, and 19%, respectively. Conclusions: Changes in care processes were associated with significant increases in provider self-efficacy, organizational readiness, and cost savings. Limitations included loss to follow up from deployment, Covid-19 pandemic, and small sample size.