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Who Should I Refer? VA Primary Care/Behavioral Health Integration in Practice. David Hunsinger , MD, MSHA Medical Director Binghamton VA Outpatient Clini c. Objective. - PowerPoint PPT Presentation
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Who Should I Refer?VA Primary Care/Behavioral
Health Integration in Practice
David Hunsinger, MD, MSHAMedical Director
Binghamton VA Outpatient Clinic
OBJECTIVE
Over the course of this presentation, participants will begin to consider the
broad range of clinical situations in which involvement of a Behavioral Health
provider can prove helpful.
KEY CHARACTERISTICS
• Co-located• Collaborative• Dedicated Behavioral Health (BH)
Provider with schedule flexibility• Warm Handoffs
BENEFITS OF THE MODEL
Timely patient evaluation and assistance
THERE’S NO TIME LIKE THE PRESENT….
BENEFITS OF THE MODEL
Timely patient evaluation and assistance
• A continuation of the Primary Care encounter• Eliminates the potential for ‘no show’
BENEFITS OF THE MODEL
Face to face introduction
BENEFITS OF THE MODEL
Face to face introduction• Lends legitimacy and credibility• Reduces patient anxiety about the meeting• More personal
BENEFITS OF THE MODEL
Face to face introduction• Lends legitimacy and credibility• Reduces patient anxiety about the meeting• More personal
BENEFITS OF THE MODEL
Reinforces ‘whole person’ focus
Mind body connection by John Hersey
TIP #1
Referrals are not just for Urgent Problems
URGENT PROBLEMS • Major depression• Anxiety• Grief reaction• Adjustment reaction• ‘crying in the office’
TIP #2
Consider scripting your warm hand-off
intro
WARM HAND-OFF • “I work with someone whose job is to help
patient’s in situations like this. If you have a few minutes, I’d like to introduce you.”
• “We have someone who is a great resource for these things. Let me introduce you and you can get his/her card if you want to talk to someone about it.”
WARM HAND-OFF • “One of the members of your healthcare team
is _________. If you have a few minutes, I’d like to introduce you so he/she can tell you a little bit about what kind of help he/she can provide you.”
TIP #3
Refer all positive Clinical Reminder
screens…….better yet, revise clinic flow to have
these patients seen automatically
CLINICAL REMINDERS • PHQ2/PHQ9 [depression]• PTSD screen• AUDIT-C [alcohol]• ?TBI screen
TIP #4
Think PATIENT NEEDS not DIAGNOSES
NEEDS NOT DIAGNOSES • Establishing a healthy lifestyle• Behavior change• Tobacco and alcohol issues/concerns• Relationship stress• Job stress
Establishing a healthy lifestyle
• Exercise• Healthy Diet• Sleep hygiene
Exercise
• Cardiovascular conditioning affects many
health conditions• Promotes a sense of well-being• Relieves stress/tension/anxiety
Healthy Diet
• Weight loss• Disease specific concerns• Patients considering MOVE• Patients unable to participate in MOVE
Tobacco Use
• Individual coaching as an alternative to
QuitSmart
Relationship issues
• Spouse/significant other• Children• Boss• Co-workers
TIP #5
Healthcare is a team sport [especially in a PACT
environment]
TEAM
• Talk to your PCMHI provider• Ask for suggestions about referrals• Invite him/her to huddles and team meeting
where patients are discussed
TIP #6
Most people’s lives are impacted far more by
psychological, psychosocial, and behavioral issues than by
physical issues
CONCLUSION
So………… refer early refer often!
CONCLUSION
So………… warm hand-off early
warm hand-off often!