TY - JOUR
AU - G. J. R. Buchanan
AU - J. M. Berge
AU - Piehler T
A1 - 
AB - BACKGROUND: People with diabetes, vascular disease, and asthma often struggle to maintain stability in their chronic health conditions, particularly those in rural areas, living in poverty, or racially or ethnically minoritized populations. These groups can experience inequities in healthcare, where one group of people has fewer or lower-quality resources than others. Integrating behavioral healthcare services into primary care holds promise in helping the primary care team better manage patients' conditions, but it involves changing the way care is delivered in a clinic in multiple ways. Some clinics are more successful than others in fully integrating behavioral health models as shown by previous research conducted by our team identifying four patterns of implementation: Low, Structural, Partial, and Strong. Little is known about how this variation in integration may be related to chronic disease management and if IBH could be a strategy to reduce healthcare inequities. This study explores potential relationships between IBH implementation variation and chronic disease management in the context of healthcare inequities. METHODS: Building on a previously published latent class analysis of 102 primary care clinics in Minnesota, we used multiple regression to establish relationships between IBH latent class and healthcare inequities in chronic disease management, and then structural equation modeling to examine how IBH latent class may moderate those healthcare inequities. RESULTS: Contrary to our hypotheses, and demonstrating the complexity of the research question, clinics with better chronic disease management were more likely to be Low IBH rather than any other level of integration. Strong and Structural IBH clinics demonstrated better chronic disease management as race in the clinic's location became more White. CONCLUSIONS: IBH may result in improved care, though it may not be sufficient to resolve healthcare inequities; it appears that IBH may be more effective when fewer social determinants of health are present. Clinics with Low IBH may not be motivated to engage in this practice change for chronic disease management and may need to be provided other reasons to do so. Larger systemic and policy changes are likely required that specifically target the mechanisms of healthcare inequities.
AD - Redleaf Center for Family Healing, Hennepin Healthcare Research Institute, 701 Park Ave., Suite S3, Minneapolis, MN, 55415, USA. gretchen.buchanan@hcmed.org.; Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA. gretchen.buchanan@hcmed.org.; Department of Family Medicine and Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, Aurora, CO, USA.; Department of Family Social Science, University of Minnesota, St. Paul, MN, USA.
AN - 39143518
BT - BMC Prim Care
C5 - Healthcare Disparities
CP - 1
DA - Aug 14
DO - 10.1186/s12875-024-02483-5
DP - NLM
ET - 20240814
IS - 1
JF - BMC Prim Care
LA - eng
N2 - BACKGROUND: People with diabetes, vascular disease, and asthma often struggle to maintain stability in their chronic health conditions, particularly those in rural areas, living in poverty, or racially or ethnically minoritized populations. These groups can experience inequities in healthcare, where one group of people has fewer or lower-quality resources than others. Integrating behavioral healthcare services into primary care holds promise in helping the primary care team better manage patients' conditions, but it involves changing the way care is delivered in a clinic in multiple ways. Some clinics are more successful than others in fully integrating behavioral health models as shown by previous research conducted by our team identifying four patterns of implementation: Low, Structural, Partial, and Strong. Little is known about how this variation in integration may be related to chronic disease management and if IBH could be a strategy to reduce healthcare inequities. This study explores potential relationships between IBH implementation variation and chronic disease management in the context of healthcare inequities. METHODS: Building on a previously published latent class analysis of 102 primary care clinics in Minnesota, we used multiple regression to establish relationships between IBH latent class and healthcare inequities in chronic disease management, and then structural equation modeling to examine how IBH latent class may moderate those healthcare inequities. RESULTS: Contrary to our hypotheses, and demonstrating the complexity of the research question, clinics with better chronic disease management were more likely to be Low IBH rather than any other level of integration. Strong and Structural IBH clinics demonstrated better chronic disease management as race in the clinic's location became more White. CONCLUSIONS: IBH may result in improved care, though it may not be sufficient to resolve healthcare inequities; it appears that IBH may be more effective when fewer social determinants of health are present. Clinics with Low IBH may not be motivated to engage in this practice change for chronic disease management and may need to be provided other reasons to do so. Larger systemic and policy changes are likely required that specifically target the mechanisms of healthcare inequities.
PY - 2024
SN - 2731-4553
SP - 302
ST - Integrated behavioral health implementation and chronic disease management inequities: an exploratory study of statewide data
T1 - Integrated behavioral health implementation and chronic disease management inequities: an exploratory study of statewide data
T2 - BMC Prim Care
TI - Integrated behavioral health implementation and chronic disease management inequities: an exploratory study of statewide data
U1 - Healthcare Disparities
U3 - 10.1186/s12875-024-02483-5
VL - 25
VO - 2731-4553
Y1 - 2024
ER -