The Role of Psychology in Integrated Primary Care for Complex Patients: Effects on Mental Health, Utilization of Medical Services, and Physiological Markers of Health

THE ROLE OF PSYCHOLOGY IN INTEGRATED PRIMARY CARE FOR COMPLEX PATIENTS: EFFECTS ON MENTAL HEALTH, UTILIZATION, AND PHYSIOLOGICAL MARKERS OF HEALTH By Danielle Christina Worthington, Ph.D. A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University. Virginia Commonwealth University, 2015. Major Director: Stephen Auerbach, Ph.D. Professor of Psychology Department of Psychology This study served as an initial evaluation of integrated psychology services within a clinic designed to serve uninsured patients with complex medical concerns and high utilization histories at the Medical College of Virginia in Richmond, Virginia. The current study evaluates patient outcomes, and more specifically, it further quantifies and describes the role that psychologists play in the primary care setting and their impact on utilization of medical care and in improved health outcomes. Additionally, the study evaluates psychologists’ success at treating mental and behavioral health conditions within the primary care model. The present study demonstrates that patients with complex medical and mental health needs can be effectively managed and treated in an integrated ambulatory care clinic. Care within this clinic resulted in significant improvements in depression, anxiety, HbA1c, cholesterol, and blood pressure. The findings suggested possible improvements in behavioral health outcomes such as insomnia as well, but more structured follow-up data are needed in future research to explore this relationship. Additionally it is possible that reductions in BMI may be significant if followed over a longer period of time. Utilization outcomes were more mixed, and contrary to the expectation that integrated services and improvements in health would be related to decreased utilization. Given the shift in health outcomes over the follow-up period, it is possible that early increases in utilization at the six-month mark, may shift to reductions in utilization and cost if the window of observation is expanded.