Economic and Organisational Implications of Integrating Clinical Psychology into Primary Care

Background

Clinical Psychology (CP) has seen increasing integration into Primary Care (PC) in Spain in recent years, with marked regional differences in implementation, scope and service organisation. However, there is limited evidence on the economic and organisational implications of different models of integration. This study evaluates the economic impact and organisational consequences of consultation-liaison, collaborative, and replacement models incorporating CP professionals into PC teams.

Methods

Economic evidence was identified through an update of a previous review and additional searches in general and specialised economic databases (2010 to 2025). Economic evaluations and cost and resource use studies of organisational models incorporating CP in PC were included. Outcomes included cost-effectiveness, costs and health benefits (e.g. QALYs). Evidence was synthesised narratively.

Results

Six economic studies were included. Collaborative and mixed collaborative–replacement models increased service use and costs but showed favourable cost-effectiveness versus usual care, with substantial heterogeneity. Collaborative models required structured coordination, case management, symptom monitoring and planned communication between PC and CP professionals. Mixed collaborative–replacement models were more accessible and low-intensity, but involved less formal coordination. Consultation-liaison models were not cost-effective.

Conclusions

Economic evidence is limited and heterogeneous. Collaborative and mixed models appear most promising, although cost-effectiveness varies. Organisationally, implementation requires clear roles, structured referral pathways, coordination mechanisms and adequate resources. Integration of CP in PC alone is unlikely to improve care unless embedded in a structured service model.

Key messages

• Collaborative and mixed models integrating CP in Primary Care may improve outcomes but often increase costs, with variable cost-effectiveness.

• Effective implementation requires clear roles, coordination and resources; CP integration alone is insufficient without a structured care model.