Primary care has undergone significant transformations in recent years with the creation of the Army Patient Centered Medical Home (PCMH) which focuses on readily accessible, comprehensive, in house, patient centered care. In the winter of 2010, the Army mandated the implementation of PCMHs across Army Medicine which included the requirement for all medical homes to provide integrated behavioral health services. The medical home has continued to transform over the past couple of years, now called the Army Medical Home, with Community Based Medical Homes in the neighborhoods where beneficiaries live and Soldier Centered Medical Homes for active duty Soldiers only. In addition, behavioral health team members are integrated in the medical home and have increased the quality and availability of preventive care and behavioral health services to all beneficiaries through our primary care clinics.
CDR (Dr.) Aditya Bhagwat, the Program Manager for Primary Care Behavioral Health (PCBH), in Army Medical Homes, explains that integrating behavioral health providers into the Army Medical Home has resulted in substantial changes in the way Army Medicine delivers healthcare. By integrating these professionals ("Internal Behavioral Health Consultants," or "IBHCs") and Behavioral Health Care Facilitators (BHCFs) directly into primary care clinics, IBHCs and BHCFs can partner with other Army Medical Home team members to provide comprehensive care to patients. They can assist the team by working with patients who could improve their current health or prevent future chronic illnesses through lifestyle changes. In addition, PCBH personnel can assist with early identification of behavioral health needs which has allowed more patients to receive appropriate level treatment in primary care, while continuing to provide those with more significant needs access to specialty behavioral health clinics.
Bhagwat, a United States Public Health Service officer and Board Certified Clinical Neuropsychologist explained data analysis of the Army PCBH program from January through December 2015 showed that treatment by Internal Behavioral Health Consultants is having a beneficial effect on the Army primary care patient population. The majority of patients seen by IBHCs were active duty (37.3%) and their dependents (32.6%). Patients were generally treated by IBHCs for symptoms of anxiety and depression (over 45% of referrals), but a number of other health conditions were also addressed.
IBHCs administer at least one objective symptom measure on every patient encounter to track patient progress. The data analysis revealed that for patients seeing IBHCs for at least two encounters, 22-43% of patients with elevated scores showed a reduction in symptoms on measures of anxiety, depression, and post-traumatic stress disorder. Bhagwat also stated an even larger percentage of the population could benefit from treatment by IBHCs, and primary care providers are strongly encouraged to incorporate IBHCs into the treatment plan for patients with other medical conditions that could respond to behavioral interventions (e.g. sleep difficulties, diabetes, chronic pain, obesity, nicotine use etc). "These results suggest the PCBH model of team-based primary care incorporating an IBHC is effective at addressing a number of symptoms in primary care," said Bhagwat.
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