Patient perspectives on factors that influence continued treatment engagement in Primary Care Behavioral Health: A qualitative exploration

Introduction: Primary care behavioral health (PCBH) is a service delivery model that embeds behavioral health consultants in primary care. PCBH has been implemented across several health care systems and has been shown to increase access to behavioral health services. Most of the patient access research in PCBH settings has focused on initial engagement with behavioral health services via the warm handoff, a process of referral where the primary care provider can connect the patient with an on-site behavioral health consultant the moment a need is identified. In contrast, fewer studies have examined factors that contribute to continued engagement with PCBH services beyond the first visit. Method: The present study aimed to address this gap by interviewing adult PCBH patients (n = 15, 93% White, 80% female) to learn about factors that influenced their intentions to attend planned follow-up visits. Results: Reflexive thematic analysis yielded four themes: (a) “Patient Factors” (e.g., high need and high motivation), (b) “Treatment Factors” (e.g., therapeutic alliance and treatment perceived as helpful), (c) “PCBH Factors” (e.g., convenience of receiving treatment in medical home), and (d) “Logistical Factors” (e.g., cost and insurance coverage). Discussion: These findings underscore the importance of psychotherapy common factors as they relate to treatment engagement, highlight unique strengths of PCBH that increase accessibility of care, and offer insights into how administrators can ensure the expectations of PCBH are clearly communicated to and understood by patients. Findings also demonstrate that even when patients are offered care in a setting that maximizes access, logistical challenges remain.