Impact of IBH on Chronic Disease Management and Healthcare Inequities

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The following is a summary of “Integrated Behavioral Health Implementation and Chronic Disease Management Inequities: An Exploratory Study of Statewide Data,” published in the August 2024 issue of Primary Care by Buchanan et al.

Chronic disease management presents significant challenges for individuals with diabetes, vascular disease, and asthma, especially those residing in rural areas, living in poverty, or belonging to racially or ethnically minoritized populations. These groups often face healthcare inequities, receiving fewer or lower-quality resources than others. Integrating behavioral healthcare (IBH) services into primary care is a promising approach to improving the management of these chronic conditions. However, the success of IBH integration varies among clinics, as evidenced by previous research from our team that identified four distinct patterns of IBH implementation: Low, Structural, Partial, and Strong. Despite the potential of IBH to enhance care, little is known about how differences in IBH integration impact chronic disease management and whether IBH could serve as a strategy to reduce healthcare inequities. This study investigates the relationships between variations in IBH implementation and chronic disease management within the context of healthcare disparities.

Building on a previously published latent class analysis of 102 primary care clinics in Minnesota, the researchers employed multiple regression analysis to establish the relationships between IBH latent class and healthcare inequities in chronic disease management. Investigators then used structural equation modeling to examine whether the level of IBH integration could moderate these healthcare inequities. Surprisingly, our findings contradicted our initial hypotheses and highlighted the issue’s complexity. Clinics with better chronic disease management were more likely to have low IBH integration than higher levels. Additionally, clinics with Strong and Structural IBH integration exhibited better chronic disease management as the racial composition of the clinic’s location became more homogenous (i.e., predominantly White).

These results suggest that while IBH may contribute to improved care, it alone may not be sufficient to effectively address healthcare inequities. The effectiveness of IBH appears to be more pronounced in environments with fewer social determinants of health challenges. Clinics with Low IBH integration may lack the motivation to engage in this practice change for chronic disease management and may require additional incentives. The findings underscore the urgent need for broader systemic and policy changes to specifically target the mechanisms underlying healthcare inequities beyond the scope of IBH integration alone.

Source: bmcprimcare.biomedcentral.com/articles/10.1186/s12875-024-02483-5