Integrated Care

How can this help your primary care practice?

Common patient concerns in primary care

• The ten most common problems brought to adult primary medical care are: • chest pain, fatigue, dizziness, headache, swelling,

back pain, shortness of breath, insomnia, abdominal pain, and numbness.

• These ten complaints account for 40% of all visits. The doctor can identify a biological cause for the complaint in only 26% of these visits. The vast majority of patients coming to primary care have no discoverable organic disease. This is even more true for low income and underserved populations.

Collaborative Health Care Association, 2009

Common Patient Concerns

Major DepressionAnxiety DisorderSustance AbuseAdjustment Dis-orderOther

Collaborative Family Health Care Association, 2009

Integrated Care

• Integrated Primary Care (IPC) combines medical and behavioral health services to more fully address the spectrum of problems that patients bring to primary medical care.  (Collaborative Family Healthcare Association)

• IPC allows patients to feel that for any concern they bring in, they have come to the right place.

Integrated Care

• A majority of patients in primary care have…• A physical ailment that is affected by

stress, problems maintaining healthy lifestyles• A psychological disorder• Comorbid symptoms

• It is clinically effective and cost effective to make behavioral health providers part of  primary medical care.  (Collaborative Family Healthcare Association)

What is a psychosocial provider?

• A Mental Health Counselor (MSW, MHP, or MFT) that is trained and specializes in working collaboratively on patient concerns with their medical doctor and the medical team.

• Becomes a team member to help with patient concerns and offer aid in the psychological aspects a patient comes in with.

Why Integrative Care?

Why is it needed…why should it be considered?

• Between 25% and 30% of visits to primary care physicians have depression, anxiety, alcohol abuse, and somatoform disorders as part of the presenting issue (Gunn & Blount, 2009)

• Primary care medical professionals prescribe 60% to 70% of the psychotropic medications prescribed in the United States. (Gunn & Blount, 2009).• While the psychopharmacology aspect of psychological disorders is

covered by the MD, patients may also be in need of further care, like psychotherapy.

Benefits of Integrative Care?

• Shared goal of providing the patient with better care.

• Work together to attain the same goals as the primary provider

• Provider satisfaction• As a psychosocial provider we want to meet your treatment goals

for your patient.• We want relieve some of the burden.• We have a treatment focus• Reduction of somatic complaints; increased compliance; improved

doctor/patient relationship; stress reduction; meditation/relaxation for the management of chronic pain; couple, family, support system medical counseling for those impacted by chronic conditions or illnesses.

• You will have an increased compliance once their social emotional issues are addressed

Using an evidence based practice

• There is strong evidence to support collaborative primary mental health care for people with depression when linkages involve "direct collaborative activity", plus "agreed guidelines" and "communication systems". (BMC Health Services Research, 2011)• Thus, when behavioral and medical team are

on the same page, working towards the same goals for the patient.

How to integrate services…

• Offering an integrated practice will allow the patient to feel that any and all problems (medical and behavioral) can be addressed in the same place with the same office staff

• Integrating mental health services into primary care is one successful avenue for treating the health care of the whole person. (Collaborative Care Research Network)

Giving the patient what they want…• In this article, we use

“collaborative care” to describe the relationships (ways of interacting) between clinicians over time for the purpose of developing treatment plans, providing clinical services and coordinating care to meet the physical and behavioral health needs of patients. (Family, Systems and Health, 2010)

Journals of Positive Behavior Interventions, 2007

The Proposal…• Location of Services:

• Family Medicine Clinic

• Business Arrangement:• Incorporate a Psychosocial

provider as a necessary team member

• Starting at 1-2 days a week (working up to more)

• Questionnaires will be administered to patients to determine the effectiveness of adding a psychosocial provider to their services

• Communication: • The psychosocial provider will

be available for consultation with patients at time of office visit to establish rapport with patient

• Use of same electronic medical records

• Bi-weekly or monthly update reports regarding patient progress and progress towards treatment goals

Questionnaire

• Please fill out the questionnaire

• Once you have finished it, please hand it in…

• We will contact you with the appropriate information depending upon your responses.

Thank you for your time!

Buggey, T. (2007). A Picture Is Worth .... Journal of Positive Behavior Interventions, 9(3), 151-158. Retrieved December 14, 2007, from Academic Search Premier database.Collaborative Family Health Care Association, 2009)

Hunter, C., & Goodie, J. (2010). Operational and clinical components for integrated- collaborative behavioral healthcare in the patient-centered medical home. Families, Systems & Health: The Journal Of Collaborative Family Healthcare, 28(4), 308-321. Retrieved from EBSCOhost.

Gunn,, W. B., & Blount, A. (2009). Primary care mental health: a new frontier for

psychology. Journal of Clinical Psychology, 65(3), 235-252. doi: 10.1002/jclp.20499