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Degree Name

PhD (Doctor of Philosophy)



Date of Award


Committee Chair or Co-Chairs

Peggy Cantrell

Committee Members

William T. Dalton III, Stacey Williams, Lisa Ousley


Integrated primary care (IPC) may help palliate the demand for mental health services and barriers to such care. There are varying degrees of integration (Blount, 2003; Doherty, 1995; Strosahl, 1998), with suppositions that certain patients may fare better in certain levels/models of IPC than in others (Doherty, McDaniel, & Baird, 1996; Mauer, 2006). No research to date has examined the interface between levels of care and patient behavioral and physical health demands, hence the aim of the current study. The current study utilized Mauer’s (2006) Four Quadrant Model to ascertain patient differences in behavioral and physical health demands and utilization across three levels of care: co-located, integrated, and a hybrid (receipt of both colocated and integrated care) for a general adult population within a community-based nurse practitioner-led FQHC. Total time spent in behavioral health treatment, total number of behavioral health sessions, number of presenting behavioral health concerns at baseline, and number of behavioral health no-shows and cancellations since baseline, differed significantly across the levels of integration. Number of past-year medical visits, number of chronic illnesses, and number of active medications at baseline did not differ significantly between groups, indicating that patient differences between levels of care were based more on behavioral health variations than physical variables. Moreover, patients were no more or less likely to be represented in one level/model of care over another based on patient quadrants, or combinations of high and low physical and behavioral health demands. This study is the first to our knowledge to examine the intersect of patient quadrants and levels/models of IPC. Future research should examine the intersect and impact of level/model of care and patient behavioral and physical health demands on outcome.

Document Type

Dissertation - restricted


Copyright by the authors.