Psychology in Primary Care
Interdisciplinary teams, which include psychologists, enable people to reduce their risk of developing a major chronic illness, receive more effective treatment, and lower health care costs. Providing mental and behavioral health services as part of a primary care model greatly increases access for underserved people. An integrated health care approach helps eliminate stigma as well as increases awareness of the psychosocial aspects of health. Psychologists play a key role in integrated health care by helping people modify their behavior to prevent and recover from health problems. Americans are better served when psychologists are included in primary care.
Psychological and Physical Aspects of Health Are Interrelated
Behavioral and social factors cause or contribute to nearly every cause of death, illness, and disability and directly cause approximately half of deaths each year (Journal of the American Medical Association, 2004).
Mental and behavioral health care plays a significant role in the prevention, diagnosis and/or treatment of the 15 leading causes of death in the United States. They are: heart disease, cancer, stroke, chronic lower respiratory disease, accidents, diabetes, Alzheimer’s disease, Influenza/Pneumonia, kidney disease, Septicemia, suicide, chronic liver disease, hypertension, Parkinson’s Disease, assault/homicide. (Center for Disease Control, 2005).
There have been more than 300 studies on stress and immunity in humans which show that psychological distress can have a negative impact on and is capable of modifying various features of the immune response (Miller & Segerstrom, 2004).
As much as 85% of physician visits are for problems that have a significant psychological and/or behavioral component, such as chronic illnesses. For example, research has shown a connection between depression and osteoporosis and even cancer (Stress Found to Weaken Resistance to Illness Washington Post, Dec. 22, 2003).
Thoughts, attitudes, and emotions can accelerate the onset of heart disease, as well as get in the way of taking positive steps to improve one’s health. (American Psychological Association, 2004)
Individuals with diabetes are twice as likely as individuals without diabetes to have serious psychological distress (McVeight, et al, 2003).
Depression is prevalent in approximately 20% of cancer patients and may impede treatment and recovery. Children and caregivers of cancer patients may also suffer with depression (NIH, 2009).
Psychological Services in Primary Care Increases Quality of Life
Participation in group psychotherapy is associated with better psychological adjustment, treatment, and compliance for women with breast cancer (Blue Cross-Blue Shield & American Psychological Association Demonstration Project, 1998).
A study of patients with heart disease found that psychological interventions can reduce the risk of further cardiac events by 75% compared to those given only medical care and medication (Sobel, 2000).
Psychological interventions centered around positive health behaviors are associated with lower cholesterol levels and healthier blood pressure and body weight in elderly patients (Fries et al., 1993).
Hospitals that integrated psychology into primary care showed a 27% reduction in hospital admissions and bed days over a twelve-year period (Health Partners Study, 1997).
Sixty percent (60%) of individuals with depression go undetected in primary care. It should be obvious that the role of primary care in detecting, treating and managing depression, the leading cause of disability, cannot be overemphasized. (Bland, 2007)
Psychologists help patients develop coping strategies and healthy behaviors, which are effective in reducing the factors associated with the development of illness. For instance, psychotherapy and/or behavioral interventions help individuals to change habits to reduce risks for cardiovascular disease, cancer, and HIV (APA Practice Organization 2001).
“In order to properly diagnose and manage patients with undifferentiated symptoms, as well to improve the outcome for patients with known chronic disease, the traditional medical model must be replaced by a more integrated, comprehensive, biopsychosocial model of illness in which the mind and body are no longer seen as separate.” (Epstein, Budd, & Cole, “Behavioral Disorders: An Unrecognized Epidemic with Implications for Providers” Behavioral Medicine Symposium (June, 1995).
Consumers Value the Role Psychologists Play in Primary Care
Eighty-eight percent (88%) of the public, in a national survey, believe that mental health services should be available to everyone and that their health care system should treat the entire person including one’s mental well-being. (W.K. Kellogg Foundation, 1999).
Ninety percent (90%) of those surveyed believe that good psychological health plays a role in maintaining good physical health (Penn & Schoen poll, May 1995).
Integrated Mental & Behavioral Health Care is Cost Effective
The provision of psychological services to high frequency Medicaid users resulted in a 36% reduction in their Medicaid utilization after one year (Pallak, et al., 1995).
Better identification of behavioral health needs and better targeting of care to those needs, particularly using interdisciplinary collaborative care, often leads to lowered overall medical cost and to more cost-effective treatment when properly designed. (Blount, et al, 2007)
When therapy was targeted toward the highest utilizers of medical care and focused on specific problem resolution, medical costs were reduced for all groups in the first year after the beginning of treatment, even when the cost of the mental health treatment was included. (Cost Effectiveness of Integrated Primary Care, taken on 4/29/2008 from integratedprimarycare.com)