Access to mental health and substance use treatment improved with comprehensive primary care plus program

1. In a cohort of individuals, those diagnosed with an opioid use disorder (OUD), anxiety, or depression that were associated with a Comprehensive Primary Care Plus (CPC+) practice had increased utilization of mental health services and substance use treatment. 

2. Although CPC+ practices had higher utilization, the costs were not significantly different from non-CPC+ practices. 

Evidence Rating Level: 2 (Good)

Many individuals have been negatively affected by the COVID-19 pandemic, both those affected by the disease and the decline in mental health experienced secondary to lockdowns. Along with this increased struggle, there was a shortage of mental health professionals in the United States leading to more unmet therapy needs. The Comprehensive Primary Care Plus (CPC+), an advanced primary care model with behavioural integration, was used to improve the quality, access, and efficiency of primary care. To test the CPC+ model, 469 practices and a total of 102 733 patients (mean [SD] age, 49.5 [5.6] years, 57 531 women [56.4%] and 45 202 men [43.6%]) were placed into the 152 CPC+ practices, while 86 037 patients (mean [SD] age, 51.6 [6.6] years; 47 321 women [54.9%] and 38 716 men [45.1%] were attributed to 317 non-CPC+ practices. The CPC+ practices were greater in number overall while diagnosing fewer patients with chronic conditions. In patients diagnosed with an opioid use disorder (OUD), belonging to a CPC+ practice was associated with more prescriptions filled for buprenorphine (0.177 [95% CI, 0.037 to 0.196] prescriptions per patient per quarter) and anxiolytics (0.162 [95% CI, 0.005 to 0.319] prescriptions per patient per quarter). Similarly, in individuals diagnosed with anxiety or depression, those associated with a CPC+ clinic were associated with more prescriptions for buprenorphine (0.024 [95% CI, 0.006 to 0.041] prescriptions per patient per quarter). Although there were differences between health care usage in the CPC+ versus non-CPC+ clinics, there was no cost difference for patients between the practices. Overall, individuals diagnosed with an OUD that were associated with a CPC+ clinic filled more prescriptions for anxiolytics and buprenorphine compared to those at non-CPC+ clinics. 

Click to read the study in JAMA Network Open

Image: PD

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