Opinions on APA's stance on integrated care .

[softballtennis]

Thoughts , comments on APA's stance of integrated care. Does anyone think it would be beneficial for patients?

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[PikminOC]

http://alert.psychiatricnews.org/2014/04/apa-unveils-report-on-cost.html
http://psychnews.psychiatryonline.org/newsArticle.aspx?articleid=1867327
Of course it's helpful.
As a physician, this has always been important to me. And I integrate care every day for my patients.

 

[Bartelby]

My understanding of integration of primary and mental health care is not just coordination of care / talking to primary providers but rather a dedicated system designed to provide mental health care fully in the primary care office setting. The jist of it is hiring someone with training in mental health evaluations (such as a LICSW) who can see patients in the primary care office who are identified as needing more intensive mental health services by the PCP and having the PCP evaluate and initiate treatment as well. A designated psychiatrist would then review the caseload of patients being cared for under this model (without seeing most of them) and make recommendations about their treatment. The psychiatrist would only see a very small percentage of the reviewed individuals who need significantly more input, and typically just as a consultation.

I hope I am not butchering the general idea because I have only heard it presented at a conference and have not worked in any of these models, there is a lot of research coming out of UWash utilizing this (or a similar) model and showing better mental health outcomes in the primary populations served versus treatment as usual. It also seems that this model may actually save money. Personally I think based on the preliminary data that the model may make some sense. All of us going into our careers should know, though, that this is a radically reinvented practice model and not merely a statement that treating physicians should work together on their patient's care (which is a well-established ideal even if it does not always happen in real life).

 

[OldPsychDoc]

Radically reinvented?
Really?

Many multi-specialty group practices have been doing this kind of thing for years.

 

[notdeadyet]

VA too.

 

[Bartelby]

That's pretty interesting, I had never heard of those practice models before hearing about the research at UWash. At the VA and group practices are you referring to a system where:

1 - A hired evaluator (usually LICSW) assess all primary cases for the need for more psychiatric services and performs independent evaluations
2- The evaluator follows the patient and collects data on treatment response which is compiled into a spreadsheet
3- The psychiatrist is formally responsible for reviewing all of those cases and offering care recommendations (not at all a 'curbside,' the psychiatrist has responsibility for the patient's care sight unseen)
4- The psychiatrist and LICSW are explicitly hired and paid for these roles

Or are you just referring to physicians doing frequent curbside consults for each other and working really well together on the patients they share? When I first heard of this model it did not fit my mold of what a psychiatrist does (review tens to hundreds of primary care cases and offer treatment recommendations on patients you have never personally seen or evaluated), so it did seem pretty 'radical' in its divergence from the traditional doctor patient relationship to me. The researchers also presented it as a new model. How long have people been doing this already, and how has it worked out in the real world?

 

[clusterF]

Just changing one or 2 things doesn't make it a radical reinvention. It is at best a tweak.
One of the major hurdles, at least in california (not sure everywhere else) is the separation of church and state. Sharing mental health info here is a real obstacle.