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- Journal of Health Psychology
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- International Journal of Clinical and Health Psychology
Various providers may have direct and indirect roles in patient treatment decisions and direct patient contact. The costs and savings related to specific providers in such systems can be hard to quantify. Second, even in more traditional consultation models, the patient typically continues to see the primary care provider, who may prescribe a treatment such as psychotropic medications.
As a result the specific factors behind patient outcomes can be hard to untangle. If the patient improves, is it a result of the antidepressant or the psychological intervention? Third, part of the anticipated benefit of involving health psychologists is the reduction in unnecessary medical evaluation or treatment, which can be very hard to measure objectively because it requires estimating a cost for each patient had they not received the psychological intervention. Forty years ago it looked as though the survival of psychotherapy depended upon how well it could incorporate the rapidly developing advances in neuroscience.
As drug therapy has expanded, the use of psychological treatments has contracted. Because of capitation contracts, managed care organizations had to pay for all of the psychotherapy their patients received but not all of the medications.
Health, Psychology and Social Studies | University of Cumbria
Primary care physicians who delivered an increasing percentage of mental health services were better trained in medication management than psychotherapy. Even if they feel competent in delivering talk therapy, the time constraints of their busy practices encourage prescribing psychotropic medications instead. Marketing to prescribing providers grew at an exponential rate, proportionate to their profits from the sale of psychotropic drugs.
Direct-to-consumer advertising also exploded during this time, and patients now often present to their physician asking to be prescribed a specific medication. It takes far less time to comply with medication requests than to convince patients to take a different course.
Although we do not have room here to discuss all the complex issues around psychotropic drugs in primary care, and their effects on health psychologists, they clearly seem to have threatened provision of nonpharmacological treatments. Recently the mainstream medical community has begun to recognize this problem. A recent commentary in the Journal of the American Medical Association expressed considerable skepticism about the use of psychotropic drugs.
Issues around psychotropic medications thus demand ongoing attention from health psychologists. We have attempted to provide a balanced assessment of recent developments in and challenges around health psychology in primary care. Our approach may seem somewhat pessimistic because it focused on challenges and absence of evidence rather than accomplishments. Yet we believe, based on our analysis of the literature, that both the perennial and novel challenges can be addressed, and that identifying them clearly is the first step. In the process of attending to system-level challenges and empirical data, we may have ignored the work of the many health psychologists who enact effective patient-centered care with every patient they see.
Because of bias towards publishing data-driven studies, their work and positive outcomes may seem invisible.
One should not interpret our findings, especially around lack of evidence of measurable benefit in some domains or in meta-analyses, as an attempt to detract from what health psychologists do in primary care. Rather they point out areas for further research and development, especially in demonstrating the effectiveness of health psychology within real-world clinic systems. In focusing on the role of health psychologists in clinical work, we may also have understated some of the broader and less tangible benefits that they bring to primary care.
Health psychologists have, through their ongoing activities, likely increased the awareness of mental health conditions among patients and providers, reduced the stigma of mental illness, challenged common assumptions about patients with mental health symptoms, and educated providers in various other disciplines. As described above, they have also worked to identify, understand, and treat the psychosocial factors involved in medical illness, and developed programs to encourage health-promoting lifestyle changes. Their work has also highlighted ethnic and psychological perspectives on illness, treatment methods, and the nature of outcomes, which can help providers understand the meanings patients ascribe to illness and health care.
Journal of Health Psychology
These sorts of contributions have not received much research attention recently, perhaps having been overshadowed by integrated care. For instance, a recent overview of training psychologists to work in primary care settings discusses only their clinical functions. Our synthesis of recent literature highlights some major gaps in knowledge, which can be addressed by future research. We suggest that researchers and policy makers focus on these questions, and that empirical evidence around them can help to improve the provision of mental health treatment in primary care.
Descriptive data on the prevalence of health psychology practices in primary care would greatly enhance the discussion. How many primary care clinics employ a health psychologist as part of their staff? How many have colocated health psychologists? How many use integrated care models? Once these data are collated, researchers can explore factors associated with uptake of various models of care, can evaluate outcomes, and can define regional variations or socioeconomic disparities.
Such information would help organize future service delivery and policy. These evaluations should apply current methodologically sound principles in trial design. The exact role of the health psychologist in integrated or collaborative care is at times nebulous, with some interventions using them in nontraditional roles, and others using agents besides psychologists to deliver therapy.
Evaluations showing the effectiveness of integrated care programs should account for the material contributions of health psychologists in the interventions. The two main challenges described above greater financial accountability and increased prescription and marketing of psychotropic drugs have and will continue to influence the practice of health psychology in primary care, and some research has indicated that health psychologists are not well prepared to adapt to them.
Further exploration of approaches for adapting to these challenges is clearly warranted. For instance, reimbursement for the management of mental health problems by multiple providers eg, the primary care provider prescribing medications, the health psychologist providing psychotherapy, and possibly a care manager for integrating care may demand novel billing mechanisms. Ongoing advocacy efforts may be needed to promote psychotherapy as a viable and effective adjunct or alternative to psychotropic medications.
More research about the contributions of health psychologists to the practice improvement of other providers would help to characterize some of the apparently intangible benefits of this work, especially in the application of psychology research to common primary care conditions. It seems certain that health psychology, primary care, and the overall health care landscape will continue to change in the near future, with new demands, pressures, and opportunities. To understand, adapt to, and respond to these changes, health psychology professionals will need to continue to articulate the theories and techniques of health psychology and integrated care, to put their beliefs into practice, and measure the results of their efforts.
In summary, recent research has shown how health psychology contributes to health promotion in primary care settings, but work remains around demonstrating its effectiveness and cost-effectiveness across different systems of care, and adapting it to longstanding and novel challenges. National Center for Biotechnology Information , U. Psychol Res Behav Manag.
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Published online Jun 1. Author information Copyright and License information Disclaimer.
This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited. This article has been cited by other articles in PMC. Abstract Over the last decade, research about health psychology in primary care has reiterated its contributions to mental and physical health promotion, and its role in addressing gaps in mental health service delivery.
Keywords: health psychology, primary care, integrated care, collaborative care, referral, colocation. Introduction In this article we appraise recent research findings related to health psychology and mental health in primary care. Terminology and context There is no official definition for what a health psychologist is or does.
Past research It is impossible to summarize all the recent work about health psychology in primary care.
International Journal of Clinical and Health Psychology
Unchanged factors in the health care landscape Despite numerous innovative interventions that seek to improve mental health care, the basic process and context of care have been mainly unchanged over the last several decades. The effectiveness of health psychology interventions Health psychology, given its focus and setting, seems a natural solution to many of these persistent problems with mental health care delivery. Recent meta-analyses of outcomes The aforementioned evidence for the benefits derived from psychological interventions in primary care seems overwhelmingly positive, yet recent research has generated mixed results around effectiveness and cost-effectiveness.
Current and future challenges Beyond the absence of evidence-based outcomes in controlled research settings or real-world treatment settings, several additional key challenges remain to the practice of health psychology in primary care. What is the penetration of health psychology in primary care? Increased financial accountability Almost imperceptibly, medicine in the United States has changed to accommodate financial goals. Increased use of psychotropic drugs Forty years ago it looked as though the survival of psychotherapy depended upon how well it could incorporate the rapidly developing advances in neuroscience.
Discussion We have attempted to provide a balanced assessment of recent developments in and challenges around health psychology in primary care. Footnotes Disclosure No conflicts of interest were declared in relation to this paper. References 1. Matarazzo JD. Am Psychol. Health psychology: theory, research, and practice. London, UK: Sage Publications; Association AP. Becoming a health psychologist. Integrated primary care: an inclusive three-world view through process metrics and empirical discrimination.
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J Clin Psychol Med Settings. A web-based data management system to improve care for depression in a multicenter clinical trial. Psychiatr Serv. Glassock RJ. Health care reforms in America: perspectives, comparisons and realities. Primary care psychology.
Clinical health psychology and primary care: practical advice and clinical guidance for successful collaboration. The primary care toolkit: practical resources for the integrated behavioral care provider. New York: Springer; Integrated behavioral health in primary care: step-by-step guidance for assessment and intervention.
Haas LJ. Handbook of primary care psychology.
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Health Psychology owes its multidisciplinary feature to the diverse and cross-related influences from medicine, sociology, social, cognitive, developmental psychology and neuroscience. Despite its Part of the challenge to disseminate theoretical innovations is finding a suitable publication platform. This results in numerous innovations first being presented in book chapters, limiting their dissemination and exploration.