Developing a strategy for managing behavioral health care within the context of primary care
L. Fisher and D. C. Ransom
Department of Family and Community Medicine, University of California, San Francisco, USA.
Although most patients with psychological disorders are diagnosed and
treated within the primary care setting, there are few guidelines to help
primary care physicians and managed care plan administrators construct
programs of behavioral health care that are compatible with the primary
care environment. We report the findings from a review of the literature
from 1970 to 1996 on factors that predict the use of mental health and
substance abuse services with specific reference to primary care. We use a
heuristic framework of service use that includes the characteristics of
patients, primary care physicians, practice settings, and managed care
plans. Recognizing that the factors associated with the use of services
center on the primary care practice, we argue that programs of behavioral
health care will work best when they are decentralized to account for
variations among primary care patients, physicians, and practices; when
they are integrated clinically, financially, and administratively within
the primary care setting; and when primary care physicians are active
leaders in the design and implementation of these services, for clinical
and financial reasons.
