Patient Care Teams Lack Incorporation of Behavioral Health Specialists

In an attempt to broaden their scope of service, an increasing number of primary care physicians are incorporating nurse practitioners (NPs) and physicians’ assistants (PAs) into their patient care teams. However, the incorporation of certain other healthcare professions, such as behavioral specialists, psychiatrists, pharmacists, physical therapists, and occupational therapists, is still lacking, according to a recent policy brief published in the Journal of American Board of Family Medicine (ABFM)

Aiming to characterize which types of providers work most with family practitioners, researchers analyzed 2014 ABFM data and determined that more than 50% of family physicians report working with NPs at their practice site, 40% with PAs, 20% with behavioral specialists, and only 12% with psychiatrists.

“The high percentages reporting work with NPs and PAs may be related to their ability to more readily bill for clinical services, but they also highlight how frequently FPs, NPs, and PAs are working together in primary care practice,” Andrew Bazemore, MD, MPH, and colleagues wrote.

While this increase in NP and PA interaction is a promising indication of increased patient access and care, it also demonstrates that physician interaction with the other healthcare providers can be improved upon. After all, the “optimal balance of care teams for a given population remains unknown,” authors wrote.

Behavioral specialists work with and counsel patients with social or learning disabilities and psychiatrists specialize in the diagnosis and treatment of mental disorders. These professionals can work in clinical environments with patients whose extra needs may not be able to be covered by a physician, including patients with emotional or developmental issues, or deafness.

Other professionals, such as occupational therapists and pharmacists, can also contribute. A 2013 study found that occupational therapists could be integrated into primary healthcare teams with contributions in communication, trust, and understanding. A 2012 America Academy of Family Physicians paper called on pharmacists and physicians to work collaboratively "so that their combined expertise is used to optimize the therapeutic effect of pharmaceutical agents in patient care." The paper also discouraged fragmentation of care in general when it comes to healthcare.

Diversity of providers in family medicine is key. In order to improve patient health and reduce costs, primary care practitioners should have as varied of a provider team as possible. This may be difficult for smaller practices, but learning from high-functioning teams may facilitate the transition.

“With lots of federal and private investment in primary care transformation and behavioral health integration… it is an ideal time for family practitioners to enhance team-based delivery of care,” Dr Bazemore wrote.