Evaluating integrated care in primary care clinics in rural and frontier Colorado by uncovering barriers to behavioral health referrals: A mixed methods investigation

Healthcare reform is happening nationally at a rapid pace. A part of this rapid reform is the implementation of integrated care delivery systems. This mixed-methods study identified those clinical and practice barriers that affect referrals from primary care to behavioral health services. A triangulation mixed-method design was used; a type of design in which different but complementary data were collected on the same topic. In this study, a primary card study was used to collect quantitative data. Concurrent with this data collection, quantitative surveys explored the referral from the patient perspective and qualitative interviews were conducted with physical health providers. These combined results addressed the central question of what barriers exist in the referral process from primary care to behavioral health services. Barriers that were identified included lack of psychiatrists, patient motivation for seeking behavioral health, need for same day access, inability to exchange health record information, the stigma of being identified as a mental health patient, and communication between provider agencies. The study also concluded that behavioral and primary care integration/co-location efforts demonstrated a system of care that found statistical significance in both the identification of behavioral health symptoms and the number of referrals to behavioral health services compared to non-integrated facilities. Finally, significance was found in primary care provider type as it relates to making a behavioral health referral. The identification of these barriers can now assist with the implementation process of new integration efforts and strengthen the effectiveness of referrals in those sites that have already implemented integrated services.