Rural Health Disparities Addressed by PCMH with Integrated Behavioral Health Care

Rural integrated primary care settings face unique needs and requirements when striving to provide the highest level of care possible. Rural Health Group (RHG) is a federally qualified health center that provides integrated health care to several rural counties in North Carolina. This rural setting has numerous challenges faced by both providers and patients alike. Many communities in North Carolina have experienced upheaval in local specialty mental health services, which have become more and more privatized and fragmented. This type of discontinuity of care can lead to poorer health outcomes. RHG has worked to combat these challenges.

RHG has adopted a whole-person care treatment paradigm, and patients are treated with the mindset that illness is illness, regardless of whether it is physical or mental.   At RHG, there are 25 medical providers, and five full-time behavioral health providers. Each clinic has an onsite BH provider who’s there at least part of every week, and BH providers are always available by instant message or phone if they’re not physically at the clinic. Visits with BH providers generally occur at the same time as the patient’s primary care appointment, as well as in the same room. This makes it easier on the patient and reinforces the team-based approach. BH providers offer assessments, brief interventions, and referrals for more intensive treatment of BH issues, as needed. RHG is able to be fully responsive to patients presenting with chronic and acute medical conditions, as well as with many behavioral health issues, but they are not equipped to deal with severe mental illness.

RHG uses a patient-centered medical home model (PCMH), which is responsible for drawing an overall picture of a person’s health, and helping where is seen fit.  Because the whole team is involved, a patient will be more likely to follow up on their treatments and return for care. The team must be able to assess the patient’s readiness to change and take an active role in their own health care. Responsibility lies with the providers to give realistic options to patients. Providers must connect patients to services and lay out realistic options for their health. PCMH integrated care is about providing team-based whole-person care to patients. RHG cannot be all things to all people, but hopes to model what they teach and be aware of their strengths as well as their limitations.

RHG’s capacities are like those of any PCMH, and are aptly summed up by the author, Jan Sweet Freeman, PsyD director of integrated care, Rural Health Group, Roanoke Rapids, North Carolina.

”Integrated primary care in a patient-centered medical home is the best way to invite patients to engage in better self-care, to move from provider-based care to team-based care, and to address whole-person needs. However, primary care—whether rural or urban, public or private—cannot become the default mental health system for North Carolinians with severe mental illness.”

Read the related article: Providing Whole-Person Care: Integrating Behavioral Health Into Primary Care (PDF - 68.18 KB)

Posted April 2015