Primary Care Consultation Flashcards
What’s the Triple Aim in working with Primary Care Consultation?
The Goal is to improve overall health systems outcomes by…
1) Improve Patient experience to Care
2) Reduce the Cost
3) Improve health of the populations
How is health management defined?
Broadly defined as systemic and integrated approach to improving the health of a given population by changing the policies and systems that impact health care ACCESS, QUALITY, and OUTCOMES.
The principles of PATIENT CENTERED MEDICAL HOME (PCMH)
- Each patient has a personal PCP
- Team focused on biopsychosocial aspects of patient’s health. BHP may be part of team or connected via medical neighborhood.
- Whole person orientation - behavioral and physical
- Shared: registries, medical records, decision making, revenue streams, responsiblity
- Care plans developed in partnership, patient, fam, PCP, BHP
- Enhanced access to BH care
- Payment recognizes the added value of BH care.
What are the models of Collaborative Care?
Coordinated Care, Colocated Care, Integrative Care (primary care Behavioral Health (PCBH) model
What’s the key Difference btwn Behavioral Health Consultation & Specialty Mental Health?
- The gaol of a primary care behavioral health consultative service is to provide the behavioral health provider in the second tier of the primary care system.
- Second-tier providers support the primary care provider (physician, PA, NP), bringing more specialized knowledge to bear on problems that the med provider believes require additional support (or identified through screening).
What do Behavioral Health Consultants do (BHC)?
A) Operates in a consultative role w/in primary care treatment team and w/in primary care
B) offers recommendations and care delivery regarding behavioral interventions or psychotropic medications.
What’s the purpose of BHC?
- Consultant’s interventions are always designed and delivered to support the medical provider’s impact on the patient’s overall health.
- The BHC is working on behalf of the medical provider, support medical care w/ specialized knowledge and skills in behavioral health.
What are the differences in primary goals between PRIMARY CARE BEH HEALTH CONSULTATION (pcbhc) and Specialty Mental Health Care (smhc).
This is a long fucking answer…
The PCBHC: performs appropriate clinical assessments, supports primary care provider decision making, build on primary care provider intervention, teachers primary care provider core mental health skills, educates patients in self management skills through exposure, improves primary care provider-patient working relationship, monitors w/ primary care provider, manages chronic patients w/ primary care provider in primary provider role, and assists in team building.
The SMHC: delivers primary treatment to resolve condition, coordinates w/ primary care provider by phone, teaches patient core self management skills, manages more serious mental disorders over time as primary provider, deliver primary treatment to resolve condition, coordinates w/ primary care provider by phone, teachers patient core self management skills, and managers more serious mental disorders over time as primary provider.
What’s the Difference in Appointment structure btwn Primary Care Behavioral Health Consultation (PCBHC) and Specialty Mental Health Care (SMHC)?
PCBHC: limited to ONE to THREE visits in typical case, 15-30 minute visits.
SMHC: Session number variable, related to patient condition, and 50 minute visits typical.
Differences in intervention structure btwn PCBHM and SMHC?
PCBHC: informal, revolves around primary care provider assessment and goals, less intense: between session interval longer, relationship generally not the primary focus, visit times around primary care provider shifts, and long term follow up is rare; reserved for high risk cases.
SMHC: formal, requires intake assessment and treatment planning, higher intensity, involving more concentrated care, relationship built to last over time, visit structure are not related to medical visits, longer term follow up encouraged for most clients.
Diff in intervention methods btwn PCBHC and SMHC
PCBHC: limited face to face contact, use patient education as primary model, consultation is a technical resource to patient, emphasis is on home based practice to promote change, may involve primary care provider in visits with patients.
SMHC: Face to face contact is primary treatment vehicle, education model ancillary, home practice linked back to treatment, primary care provider rarely involved in visits with patient.
Diff in termination and followup btwn PCBHC and SMHC
PCBHC: responsibility returned to primary care provider, primary care provider gives relapse prevention or maintenance treatment.
SMHC: therapist remains person to contact if in need, therapist provides any relapse prevention or maintenance treatment.
Diff in referral structure and primary info products btwn PCBHC and SMHC?
PCBHC: patient referred by PCP ONLY, consultation report goes to PCP, Notes made in medical record only
SMHC: patient self-refers or is referred by others, specialty treatment notes (i.e., intake and progress notes), and part of a separate mental health record w/ minimal notation in medical records.
Benefits of Integrated Behavioral Health Care
Immediate access to behavioral health care, improved recognition of behavioral health needs, improved collaborative care and management of patients w/ psychosocial issues in primary cares, immediate and internal resource for primary care providers to help assess a patient’s psychosocial concerns or beh health
*issues, without referring the patient to a speciality mental health clinic
*provisions of rapid feedback to medical provider (PCP)
improved fit btwn the care paitients seeks in primary care and the service offered.
*prevention of more serious mental disorders through early recognition and intervention, triage into more intensive speciality mental health care by the BHC, improved efficiency in delivery of empirically supported treatments, and facilitation of the transfer of empirically supported treatments into primary care.
