Integrated Care (Lippolis) Flashcards
the 20/20 problem
Of the 20 percent of kids struggling with mental health issues – only 20 percent receive mental health services at all.
Colorado rates of depression
In Colorado, our rates of depression are higher than the national average. And we can see that 1 in every 10 Colorado teens suffered from a major depressive episode in the past year alone!
teens and suicide
Over 22% of U.S. high school girls think seriously about killing themselves.
Over 10% of high school boys plan their own suicide
And over 10% of these girls actually do try to kill themselves – along with over 5 % of our high school boys.
THAT EQUALS 1,000 teen suicide attempts each day in the USA!
integrated care
1.) Nearly half of all pediatric office visits involve behavioral, psychosocial, and/or educational concerns.
2.)Primary care is an ideal place for identification of childhood mental illness.
3.) In fact, the American Academy of Pediatrics: Formed the Task Force on Mental Health Stated that -
primary care clinicians (PCCs) can and should be able to provide mental health services to children and adolescents in the primary care setting,
specifically – THE MEDICAL HOME.
Coordinated care
has the patient has the central player and typically a “go-between” individual to help the providers communicate. The role of “care navigator” is often used in this way. Someone to help the family practice doc and the specialist communicate and ensure the patient actually does get to the specialist and the information from the specialist gets back to the PCP.
Co-location model
Providers working in the same office – or even in the same building - are MUCH more likely to communicate.
This can really improve care coordination. I mean it is easy to ask while you are both walking down the hall, “Have you had a chance to see Suzy yet?” Close proximity generally allows for more communication
Of course Location alone does not necessarily mean there will be collaboration – or even much communication…
I have certainly worked in clinics where we said good morning when we got there – worked our tails off seeing one patient after another with lunch in our offices, or away from the clinic, and then said good night when it was time to go…
So – even if you are co-located, if you want coordination – you need to plan communication in some way.
Collaborative/Integrative Model
A true “health home”
This is the SYNCHRONIZED SWIMMING OF MEDICINE
Mental health specialists and PCPs co-manage the patient
Mental health specialists and PCPs have a shared medical record
two primary types of consult
Informal “curbside” consult – Primary Care Provider to Specialist communication with no patient present, no personal patient info need be given. This can be done over the phone, in person or via televideo or even via e-mail. For instance, I participate in a program where primary care providers can call for a telephone consult with a child psychiatrist. We discuss the case over the phone and I help provide some guidance on the case they have in their clinic.
Formal consult – Specialist with patient seen directly. PCP can be present or not. PCP receives communication from specialist. This can also be done in person or via telemedicine. PCP or specialist can prescribe. Typical is PCP remains the prescriber with recommendations from specialist.
Utilization of Limited Resources (i.e. Child Psychiatrist or other specialist)
The smallest part is direct patient care – that can be ongoing Patient Care. These are kids who see me regularly and I am there permanent psychiatrist. OR direct consultation – I see the kiddo and coordinate with their PCP around my recommendations.
Indirect Care – Specific case consultation - This is the curbside consultation, I don’t see the kid, but we talk about the case in an informal way.
Consultation on General presentations - this is case-based discussions that are focused on a topic area of interest, like ADHD or depression.
Education – Starting with Care Providers, this education can be very informal, like a lunch and learn in the breakroom, to a very formal, ongoing didactic training with CME attached.
Community Education has the largest potential impact overall. This type of education can be to groups, organizations, really anyone. On any topic related to children’s mental health.
Increasing Specialty Services
Extension of Services = Increased access to direct care
- Direct Care Models
- – Psychiatric Provided Ongoing Care to Patient
- – Consultation directly with patient
Expansion of Services = Increased training and support of direct care providers
- Indirect Care
- – Consultation to Direct Care Providers
- Education
- — Train the people already providing the care how to do it well and feel comfortable
If you combine telemedicine and Integrated Care you GET
VIRTUAL INTEGRATED CARE!
This is a work flow illustration of what Virtual Integrated Care looks like.
PCP identifies case to discuss 2. Curbside consultation 3. Decision if needs CAP direct consult…
PCP REMAINS PRESCRIBER!!!!
integrated care in the medical home- Benefits for patients and families
- ) Better access to care.
- ) Reduced stigma.
- ) Increased consultation, referral and collaboration because of regular contact between mental health and primary care providers.
- ) Deceased use of unneeded medical and emergency services.
- ) Improved adherence to treatment.
- ) Greater convenience and satisfaction for families.
- ) Increased likelihood that families follow through with referral for mental health services and supports.
- ) Decreased wait times between mental health referrals and initial appointments.
ALL OF THIS MEANS - BETTER ACCESS TO BETTER CARE!!!
BIGGEST BENEFIT
of Integrated Care?
EARLY DETECTION AND TREATMENT OF IMPAIRING MENTAL HEALTH ISSUES!
This means LESS SUFFERING and more years of good health!
Even for the really scary diagnoses
Treatment and Intervention in Psychosis (TIPS) early detection study
designed to intervene earlier in psychosis and study the effects of this on patient outcomes.
- ) Patients from a health care area practicing intensive and comprehensive early detection of psychosis were compared with those of patients from a comparison area practicing the usual methods of detection.
- ) In the early-detection AND TEATMENT area, the duration of untreated psychosis was reduced significantly and Patients from the early detection area had fewer positive and negative symptoms at presentation, at 2 years, and at 5 years, and they had fewer negative, cognitive, and depressive symptoms at 2 and 5 years.
- ) I will point out that LESS were living independently – which can actually be a bad thing. More patients in the usual-detection area lived independently (78% compared with 62%); however, living independently does not imply recovery. Only 17.9% of the patients living independently in the usual-detection area were fully recovered, compared with 48.4% for early detection patients. VERY SIGNIFICANT OUTCOMES IN A VERY DEBILITATING DISEASE.
