Integrating primary, behavioral and spiritual health care to improve patient outcomes

Background: Residents of Webb County, Texas, along the U.S.-Mexico border suffer from health disparities which stem from extreme poverty, lower levels of educational attainment, and inadequate access to basic health care. The scarcity of primary care and behavioral health service providers is a key factor influencing higher-than-average disease prevalence and unfavorable disease management in the region. In 2015 Mercy Ministries of Laredo became one of eight subgrantees of a grant awarded by the Social Innovation Fund to Methodist Healthcare Ministries of San Antonio to enhance/expand integrated primary care and behavioral health care services in medically underserved areas of South Texas.

Methods: Mercy’s project embodied a 3-dimensional model of health and healthcare, to include physical, behavioral and spiritual needs and interventions. With strong support from a research design and analysis group, this small clinic was able to demonstrate statistically significant improved health outcomes of several interventions. A non-randomized quasi experimental design (QED) was used and participants chose whether to participate in the intervention (207) or control (203) group. Common variables for all eight subgrantees included five overarching measures (HbA1C, blood pressure, BMI, PHQ-9 and quality of life score) and depression outcomes were used to statistically power all subgrantee studies.

Results: Intervention group participants had significantly greater improvements in quality of life and anxiety symptoms when compared with comparison group participants. Intervention participants had a Duke General Health score 4.01 points higher and a GAD-7 score 0.79 points lower than those in the comparison group. There were also significant improvements for intervention participants over time for these two outcomes as well as depression symptoms.

Conclusions: Grant funded resources enhanced health outcomes and prompted this small clinic to expand integrated primary and behavioral health services to serve the entire clinic population and promote integrated primary and behavioral health care for other underserved populations.

Abstract