Transcript INTERDISCIPLINARY MODELS OF INTEGRATED CARE

PATIENT CENTERED CARE
ALIGNING AND BUILDING COMPETENCE WITH
PRIMARY CARE PROVIDERS
RAY SOUSA, MAPC, LPC
WELCOME!
 INTRODUCTIONS
 WHAT DOES THE CLINICAL “LANDSCAPE” LOOK
LIKE IN YOUR CLINICAL SETTING?
 AN IMAGE?
“MENTAL HEALTH AND PHYSICAL HEALTH ARE
CLOSELY CONNECTED. MENTAL HEALTH PLAYS A
MAJOR ROLE IN PEOPLE’S ABILITY TO MAINTAIN
GOOD PHYSICAL HEALTH. MENTAL ILLNESS, SUCH
AS DEPRESSION AND ANXIETY, AFFECT PEOPLE’S
ABILITY TO PARTICIPATGE IN HEALTH-PROMOTING
BEHAVIORS. IN TURN PROBLEMS WITH PHYSICAL
HEALTH, SUCH AS CHRONIC DISEASES, CAN HAVE A
SERIOUS IMPACT ON MENTAL HEALTH AND
DECREASE ABILITY TO PARTICIPATE IN TREATMENT
AND RECOVERY”
HEALTHYPEOPLE.GOV
WILL IT BE A “SHOTGUN WEDDING A
BLESSING OR BOTH!?
 PATIENT CENTERED CARE IS THE GUIDING
PRINCIPLE OF COLLABORATION
 WHERE IS YOUR INSTITUTION ON THE
INTERDISCIPLIARY CONTINUIM?
 THE AFFORDABLE CARE ACT MANDATES SOME
FORM OF MENTAL HEALTH CARE.
CERTIFIED PATIENT-CENTERED
MEDICAL HOME NCQA
 ENHANCED ACCESS AFTER HOURS AND ONLINE
 LONG-TERM PATIENT AND PROVIDER RELATIONSHIPS
 SHARED DECISION MAKINGERTIFIED
 CASE MANAGER
 SUPPORT STAFF
 TEAM BASED CARE
 BETTER QUALITY AND EXPERIENCE
 LOWER COST FROM RFEDUCED EMERGANCY DEPARTMENT AND
HOSPITAL USE
A PHYSICIAN SPEAKS CANDIDLY
 “We are talking about a …malignant view of
physicianhood which ignores, indeed attacks, the
rights and needs of physicians themselves to be
sensitive, to feel pain, to be human beings. Doctors
are taught and then reinforced in countless ways that
they should hold feelings in, go it alone, never let their
vulnerability show”…
Medicine as a Human Experience, Reiser & Rosen, 1984
TALKING TO PRIMARYPROVIDERS: RULES
OF THE ROAD
 TREAT THEM EQUALLY – WITH YOURSELF AND EACH OTHER
 Read Medscape and other blogs
 Familiarize yourself with their changing world
 Don’t play the expert but you should know how your care impact the health issues of
their patients i.e.. Asthma, diabetes, hypertension, chronic pain.
 Get to know the benchmarks for treating these diseases
 Acknowledge referrals with a summary of your clinical impressions and plan.
 People with mental illness die much earlier than those without. Providers need your
help knowing how to identify them.
 Get them engaged in care and help keep them well
 Figure out where providers fit in the reimbursement hierarchy. That will explain many
of their frustrations.
 If your agency doesn’t have an EMR talk to your peers about what they are using. Take a
workshop.
 Paper notes are on their way out. Undocumented treatment is already out.
Clinical Experience
 PATIENTS OFTEN GO TO THEIR PRIMARY CARE PHYSICIAN FOR
ISSUES WHICH ARE REALLY BEHAVIOR HEALTH ISSUES
 IT IS CRITICAL THAT THE CARE TEAM SEES BEHAVIOR HEALTH
AS ESSENTIAL TO THE INTERDISCIPLINARY CARE TEAM
 ISSUES OF ADDICTION ARE OFTEN BEST FIRST ADDRESSED BY
BEHAVIOR HEALTH
 THE ELECTRONIC RECORD IS AN IDEAL WAY FOR YOU AND THE
PHYSICIAN TO COMMUNICATE AND ADJUST THE ONGOING
CARE PLAN
 OUR ENCOUNTERS WITH OUR CLIENTS DO AT LEAST
TWO VITAL THINGS: PROVISION OF CARE AND
ALWAYS PROMOTING AND PROVIDING NEEDED
EDUCATION FOR WELLNESS.
 WHEN DONE EFFECTIVELY, WE MAKE THE WORK OF
THE PHYSICIAN EASIER! DOCS LOVE THAT!
 ONSITE BEHAVIOR HEALTH REDUCES LACK OF
FOLLOW THROUGH BY PATIENTS.
 A SUPPORTIVE COMMUNITY FOR BEHAVIOR HEALTH
IS VERY IMPORTANT.
BEING A CLINICIAN AND SPIRITUAL CARE
 WE ARE MOVING TO NEEDING TO BE BOTH A LICENSED CLINICAN AND
HAVE CHAPLAIN EXPERTISE
 POLLS SHOW THAT PATIENTS WANT TO INCOARPORATE SPIRITUALITY
IN THEIR CARE IN A WAY THAT INCLUDES THE PHYSICIAN
 THE OPPOSITE OF PLACEBO – “NOCEBO”
 GOOD MEDICINE IS ALL ABOUT RELATIONSHIP
 Unfortunately, if that relationship is one of insensitivity, or neglect, the
relationship becomes the Nocebo* as described by Nicholas Wade:
“Much less attention has been paid to the inverse of the placebo effect,
the creation of expectancies that make people worse.” (The Spin
Doctors by Nicholas Wade Pg.16
(The New York Times Magazine)
ACCESS COMMUNITY HEALTH NETWORK
INFECTIOUS DISEASE CLINIC STRUCTURE
 THERE ARE 34 “HUB SITES” WITHIN THE NETWORK
 ALL ARE LOCATED IN NEIGHBORHOODS WHERE
THERE IS HEALTH CARE DISPARITY
 EXTENSIVE OUTREACH TO AT RISK POPULATIONS
 CONSUMER ADVISORY BOARD
 PATIENT ADVOCATES
CARING FOR OUR HIV+ CLIENTS
The Team
 THE INFECTIOUS DISEASE PHYSICIAN
 SUPPORTING MEDICAL STAFF:
 NURSES, PHYSICIAN ASSISTANT, MEDICAL,
BEHAVIOR HEALTH CONSULTANTS, PSYCHIATRY,
CHAPLAINS, ASSISTANTS, CASE MANGERS, PATIENT
ADVOCATES, ADDICTION SPECIALISTS.
HIV ISSUESS FOR BEHAVIOR HEALTH
 BEHAVIOR HEALTH IS AN ESSENTAL PART OF THE CARE OF OUR
HIV PATIENTS.
 REGULAR ASSESSMENT BY OUR “BHC”
 REFERRRAL BY THE TREATING DOCTOR.
 CONSULTATION WITH THE DOCTOR CONCERNING ABOUT
HOW THE PATIENT IS COPING AND WHAT THE CARE PLAN WILL
BE.
FREQUENTLY OCCURING CLINICAL ISSUES
 THE MANNER IN WHICH THE INFECTION WAS CONTRACTED
 HOW LONG HAS THE PATIENT BEEN UNTREATED?
 WHAT IS THE EXTENT OF THEIR DISCLOSURE OF THEIR HIV
STATUS?
 IS THERE A SUPPORT NETWORK IN PLACE?
 HOW MUCH DOES THE PATIENT KNOW ABOUT HIV?
ADDRESSING STIGMA AND
DISCRIMINATION
 STIGMA IS AN ATTITUDE
 DISCRIMINATION IS A BEHAVIOR WHICH FLOWS FROM STIGMA.
 “I AM MORE RELIGIOUS THAN GAY!”
 THE DEMOGRAPHIC SHIFT LINKING HIV MORE TO POVERTY,
RACE AND MINORITIES.
 CALLS FOR ONGOING CULTURAL SENSITIVITY
 THE ROLE OF FAITH COMMUNITIES
FAITH BASED COMMUNITY CLINICS
 PHYSICIAN INVOLVEMENT FROM THE VERY BEGINNING
 THEY BRING WITH THEM MEDICAL STAFF, EQUIPMENT ETC. THAT YOU
CANT PROVIDE.
 THE CONGREGATION KNOWS THE COMMUNITY AND ITS NEEDS.
 ESTABLISHING AND MAINTAINING GOOD RELATIONSHIPS WITH
LOCAL ALDERMEN AND OTHER PERTINENT LOCAL OFFICIALS.
 STRONG LEADERSHIP IS NEEDED IN ORDER TO MAINTAIN
RELATIONSHIPS BETWEEN MEDICAL STAFF AND CONGREGATIONAL
COMMITTEES WHO HAVE THEIR OWN RYTHMN WHICH MAY SEM
SLOWER.
KNOW YOUR TARGET POPULATION
 What is their insurance status?
 Do Good Samaritan laws apply for the protection of the medical and
behavior health staff?
 Is their a billing process? Sliding scale?
 Identified local resources: local food pantries and other pertinent
social services.
 Avoid the “Lone Ranger” syndrome!
 It first and last a community enterprise!
 Identify your spiritual understand of suffering and healing and social
justice.
“MENTAL HEALTH AND PHYSICAL HEALTH ARE
CLOSELY CONNECTED. MENTAL HEALTH PLAYS
A MAJOR ROLE IN PEOPLE’S ABILITY TO
MAINTAIN GOOD PHYSICAL HEALTH. MENTAL
ILLNESS, SUCH AS DEPRESSION AND ANXIETY,
AFFECT PEOPLE’S ABILITY TO PARTICIPATGE
IN HEALTH-PROMOTING BEHAVIORS. IN
TURN PROBLEMS WITH PHYSICAL HEALTH,
SUCH AS CHRONIC DISEASES, CAN HAVE A
SERIOUS IMPACT ON MENTAL HEALTH AND
DECREASE ABILITY TO PARTICIPATE IN
TREATMENT AND RECOVERY”
HEALTHYPEOPLE.GOV