Date of Graduation

12-2017

Document Type

Dissertation

Degree Name

Doctor of Philosophy in Psychology (PhD)

Degree Level

Graduate

Department

Psychological Science

Advisor/Mentor

Bridges, Ana J.

Committee Member

Leen-Feldner, Ellen W.

Second Committee Member

Cavell, Timothy A.

Keywords

Integrated Behavioral Health Care; Long-term Outcomes; Primary Care

Abstract

Although increasingly studies show brief behavioral health services are effective for primary care patients (Bridges et al., 2013; Bryan, Morrow, & Appolonio, 2009; Corso et al., 2012; Gomez et al., 2014), there is a paucity of research exploring the long-term effects of these interventions (e.g., Ray-Sannerud, 2012). The primary aim of the current study was to explore long-term effectiveness. Specifically, the current study 1) examined whether reductions in patient global distress following brief behavioral health care services were maintained long-term, 2) evaluated whether improvements were reliable and not due to regression to the mean effects, and 3) explored medical cost offset via reductions in medical visits. A secondary aim was to gather qualitative information about patient recall of their visits. Participants were 83 adults (Mage = 42.55 years, 79.5% female, 61.4% White) who were recruited from a pool of 454 patients seen at three integrated care clinics between August 2014 and June 2016. Patients were seen for a variety of presenting concerns such as anxiety, depression, sleep, and health related conditions. Results demonstrated that, on average, participants evidenced statistically significant declines in global distress at long-term follow up as compared to global distress following their first visit. Over half of the sample evidenced reliable change above and beyond what was expected due to measurement error and regression to the mean effects. Patients did not illustrate significant reductions in medical cost offset, such that they did not have a reduction in medical service utilization in the 12 months following receipt of BH services as compared to the 12 months prior. Qualitative data revealed that a majority of patients remembered detailed information about their BH visits (e.g., recommendations received) and were largely satisfied with BH services. Interpretations, limitations, and future directions are also discussed.

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