Behavioral Health in Primary Care

Integration of mental health into primary care is central to improving the health of the general population.  Much of the formative and evidence-based work in this area was done at the University of Washington's AIMS Center.  At UCSF PReMIUM, we build upon this prior work by trying to understand ways in which collaborative care approaches can be adapted in under-served and under-resourced settings. Below are examples of some of our work in this area.

Psychiatry eConsultant
Lead: Daniel Fulford
Collaborators: Christina Mangurian, Delphine Tuot, Hamilton Holt, Liz Goldman
Health Delivery System Partner: San Francisco Health Network

In collaboration with our partners at the San Francisco Department of Public Health, we recently conducted a pilot evaluation of an electronic consultation and referral program for psychiatry: Psychiatry eReferral. This unique program provides primary care providers with direct access to psychiatry specialists, all embedded within the electronic medical record. Given the lack of timely access to psychiatry specialty care among patients in the safety net—as well few opportunities for primary care providers to get expert consultation on detection and treatment of mental illness—this program has the potential to make a significant impact on patient care. Our goal in this pilot evaluation is to assess the acceptability and feasibility of such an approach. To do so, we are collecting information on the number and types of consults initiated by primary care providers, as well as providers’ opinions about the program. The insights we glean from this evaluation will help serve to inform the next phases of psychiatry eReferral dissemination and implementation efforts across the San Francisco Health Network.

UCSF-Fresno Collaborative Care Pilot
PI: Shawn Hersevoort
Health Delivery System Partner: UCSF Fresno

Between May 2013 and November 2014 the UCSF-Fresno department of psychiatry developed and implemented an integrated mental health service based on the highly successful University of Washington I.M.P.A.C.T. model of collaborative care. This developing interface between specialties is becoming increasingly important in the era of affordable and accountable care. Our application is unique in that we are working in four separate resident run clinics, internal medicine, family practice, OBGYN, and pediatrics, as well as with a severely socioeconomically disadvantaged patient population. The teaching program includes a didactic series geared to primary care residents, weekly supervision, and ongoing as needed on-call consultation. Our initial goals were to demonstrate participation from primary care by showing increased screening frequency, as well as program effectiveness by a positive trend in population-based improvement in depression scores.