ERICA SKAGIUS RUIZ: Primary Care Behavior Health (PCBH) in Swedish Primary Care – Implementation and Effects

Project description

Background
Mental and behavioral health issues represent significant public health challenges, with primary care playing a crucial role in prevention and treatment (1). Many primary care patients benefit from psychological interventions (2–4), but limited resources and high demand often lead to barriers such as long waiting times.

The Primary Care Behavioral Health (PCBH) model, known in Sweden as Integrated Behavioral Health (IBH), is a promising approach for integrating psychological care into primary care settings (5–8). The model aims to improve population health through team-based care and high accessibility to psychological expertise for both patients and staff (9).

In the PCBH-model, behavioral health providers work closely with medical staff, offering brief, evidence-based interventions and same-day availability. Additionally, they provide education for primary care teams on behavioral health and psychological approaches (9,10).
PCBH has gained significant interest in primary care organizations worldwide. However, robust scientific evidence remains scarce, and further research is needed to examine its effects at multiple levels as well as its implementation within primary care settings (7,8,10).

In 2019, the regional health authority of Östergötland launched the implementation of PCBH, led by a regional team of psychologists in collaboration with local implementation teams at the primary care centers. The implementation includes education, training, and follow-up over 18 months, followed by at least 24 months of support. To date, 24 clinics have participated.

Aim
The doctoral project investigates a large-scale implementation and application of the PCBH-model in primary care in Sweden and aims to examine the effectiveness and implementation in terms of outcomes on patient, staff and organizational levels.

Method
The doctoral project is part of the RÖ research initiative The Effects of Primary Care Behavioral Health: A Pragmatic Multicenter Clinical Trial, designed as a pragmatic stepped-wedge cluster trial.

• Study 1: Aims to explore staff experiences and perceptions of working with PCBH in clinical practice. Interviews were conducted with nurses, physicians, behavioral health clinicians, and managers (n=19), analyzed using qualitative content analysis (11).
  
  
• Study 2: Aims to investigate behavioral health clinicians’ experiences of working with PCBH in Swedish primary care. Interviews were conducted with behavioral health clinicians (n=17), analyzed using qualitative content analysis (11).
  
  
• Study 3: Aims to examine care accessibility (i.e., waiting times, reach, and patient visits) by comparing 24 PCBH centers in RÖ with 48 control centers from three other regions. Quantitative data from registries and surveys are analyzed.
  
  
• Study 4: Aims to evaluate the implementation of PCBH from a health economics perspective (under planning).

Relevance
The doctoral project is expected to provide a deeper understanding of the PCBH-model, which has the potential to improve access to care, quality of care, and psychological well-being. It also aims to highlight PCBH from a staff perspective and contribute to principles for successful implementation in a Swedish context. The findings will hold clinical and organizational significance for patients, healthcare staff, and policymakers, while also contributing to international research on integrated care models.