Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.


Date of Graduation

Fall 2017

Document Type


Degree Name

Doctor of Nursing Practice (DNP)


School of Nursing


Erika Metzler Sawin

Sharon Zook

Lynne Eggert


The increasing prevalence of mental illness in the United States presents significant challenges for primary care providers in low-income settings. Integrated Behavioral Health (IBH) programs have resulted in improved general health for low-income participants; however, managing appointment adherence, in which the patient attends appointment as scheduled, is particularly challenging. The purpose of this pilot project was to implement bundled interventions at a low-income primary care clinic to improve patient adherence to behavioral health treatment. The bundle of interventions included: 1) educational interventions emphasizing the benefits of IBH care 2) warm patient handoffs between the primary care provider to a behavioral health specialist at the primary care appointment, and 3) follow-up calls by behavioral health counselors for missed appointments. After the introduction of interventions, the average number of patients who no-showed for their appointment decreased by 60%, and the average number of patients who cancelled decreased by 15%. These differences were significant (x2 = 9.263, df = 2, p < 0.01). This pilot project showed that patients who were exposed to the bundle were more likely to keep their appointments and less likely to miss.



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