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Finding treatment for mental and behavioral health conditions can be daunting, even under the best circumstances. A patient may have to navigate a maze of preferred providers and clinic locations through their insurance plans, which usually means multiple phone calls, paperwork, and long waits for appointments.
That’s the last thing someone needs when they’re already suffering from depression, anxiety or substance abuse, so there is growing support for integrating behavioral care into primary care clinics. That way if a patient’s primary care doctor diagnoses a behavioral health condition, they can refer them to a psychiatrist or psychologist right away, help schedule the appointments, or maybe even arrange an initial session that same day in the same clinic.
“For patients, that setup is great because it decreases barriers,” said Neda Laiteerapong, MD, a primary care physician at UChicago Medicine. “It’s challenging to ask a patient who is suffering from an active mental health issue to go back home, make phone calls and advocate for themselves.”
In 2015, she and her colleagues from internal medicine and psychiatry (Lisa Vinci, MD, Daniel Yohanna, MD, and Nancy Beckman, PhD) launched a behavioral medicine clinic that was integrated into the primary care clinic. Staffed with physicians and health psychologists working together in the same space to offer same-day consultations and therapy sessions, the clinic is designed to help patients with behavior change, chronic disease management, depression, anxiety and other emotional and behavioral problems.From a patient perspective, this is the right way to go. They're getting the care they need right when they need it, and feeling the support they need when coming to their primary care doctor.
The collaboration provides obvious benefits for patients, but providers benefit from working together too. As part of the primary care-behavioral health integration program (PC-BHIP), general internists, health psychologists and psychiatrists work together to develop clinical decision support tools, guidelines for diagnosis and prescribing medications, educational materials and other resources for patients. This improves primary care providers’ ability to provide first-line care for behavioral health issues.
For example, if a medical assistant or nurse who sees the patient first flags them for signs of depression, the primary care provider can finish the screening, provide counseling, start medications and, if necessary, refer them to a psychologist immediately. This creates an opportunity for a “warm handoff,” when the physician introduces the patient to a psychologist in person, instead of asking them to make additional calls or schedule more appointments.
As the new clinic got up and running, Laiteerapong and her colleagues conducted two surveys of the staff to get their feedback on how well the different services were being integrated. As expected, things were a bit rocky at first, as staff got used to new schedules and routines. The team took this feedback to start making fixes and adding tools to make things run more smoothly, from making flowcharts to help everyone understand the new processes to updating the electronic medical record system to make it easier for providers to bill for mental health screenings.
The team published the survey results in a recent paper in the American Journal of Medical Quality. Seven months after the initial survey, general impressions of the clinic’s integration already improved as the team implemented more fixes.
At UChicago Medicine, other departments like the Kovler Diabetes Center, Comprehensive Cancer Center and Pain Medicine Clinic, provide similar arrangements to give patients easy access to a variety of services. This kind of one-stop shopping for patients with complex care needs is becoming more common nationwide as health systems and accountable care organizations try to integrate services and improve quality of care.
“As a primary care doctor, I’ve had patients who have suffered from not having easy access to psychiatry or psychology care,” Vinci said. “From a patient perspective, this is the right way to go. They're getting the care they need right when they need it, and feeling the support they need when coming to their primary care doctor.”
Neda Laiteerapong is a practicing general internist and researcher in the Department of Medicine at the University of Chicago. Dr. Laiteerapong’s work focuses on improving the understanding of how the quality of life in older adults with diabetes is affected by geriatric syndromes, hypoglycemia and macrovascular and microvascular complications of diabetes.Read more about Dr. Laiteerapong