Penetration Rates of Behavioral Health Consultants Targeting Cardiovascular Disease and Associated Modifiable Risk Factors Among Military Health Care Beneficiaries

Introduction: Targeting cardiovascular disease (CVD) and its associated risk factors is important not only in the general population, but also among those served by the military health care system. The primary care behavioral health model of integrating behavioral health consultants (BHCs) into a primary care setting is one method for enhancing how these modifiable risk factors are addressed; however, it is unknown how often BHCs are used to target those with biopsychosocial factors contributing to CVD and those with diagnosed CVD. Method: The present study evaluated what percentage of primary care patients with diagnosed CVD risk factors (i.e., tobacco use, obesity, and depression) or diagnosed CVD were referred to BHCs. Data were drawn from electronic health records of U.S. military primary care clinics over the 3-year period from January 2017 to December 2019. Results: A total of 1,321,072 unique individuals were included. Among the sample, 37.1% were active duty, 40.6% were married, 43.8% were female, and 30.9% were between 45 and 64 years old. The study revealed penetration rates of 1.5% (8,577 of 583,659 patients) for patients diagnosed with CVD, 5.3% (10,286 of 192,566 patients) of those demonstrating tobacco use, 3.4% (8,765 of 256,852 patients) of those demonstrating obesity, and 20.0% (31,125 of 155,656 patients) of those diagnosed with depression. Discussion: These findings suggest that BHCs are underutilized for targeting CVD and some associated risk factors in military primary care clinics. Research should explore whether these findings replicate in other health care systems and implement methods to improve BHC utilization.