As a guy who visits the doctor as infrequently as possible, I am perhaps not the best choice to author a paper on integrated care from the patient perspective. My last visit to a medical professional was a couple of weeks ago, when poor decision making on my part led to a spill from my bicycle on a set of railroad tracks. I came away from the accident with road rash on my ankle and calf, a significant gash on my knee, and, most painful of all, a bruised ego. Like any good American male, I took a picture when I got home and immediately posted it on Facebook, blood and all. One of my friends, who also happens to be a nurse, implored me to seek medical attention. I resisted visiting a medical professional until the next morning, when I finally relented and went to a clinic close to my home. The doctor cleaned me up, bandaged my wounds, gave me a tetanus shot (my last tetanus shot was in 1995), and sent me home with oral and topical antibiotics.
Why is all of this important? I don’t know. Maybe it isn’t. However, while the clinic nurse was taking my medical history, I revealed that I take Lexapro, an antidepressant, and that I am a recovering alcoholic with over eighteen years of sobriety. These are both behavioral health issues. Why does my medical provider need to know about this stuff? Okay, I can see needing to know about what medications I am taking. But why the other stuff?
That got me thinking about work. I work as a grant writer for Aspire Indiana, Inc., a community mental health center. As an organization, we are in the process of transforming from a behavioral healthcare provider to healthcare provider. We have opened a medical clinic on our campus in Anderson, Indiana, staffed with several medical professionals, including a nurse practitioner. We are in the process of becoming a Federally Qualified Health Center Look Alike, a designation which will allow us to tap into federal funding streams.
So what? As a patient, as a consumer of medical services, what does all of this have to do with me? Honestly, absolutely nothing. My only concerns are the quality of the provider and whether or not they accept my insurance.
However, eighteen years ago when I first got sober, I went to see my primary care physician, who thought that I may be depressed, and suggested that I try taking an antidepressant. As miserable as I was, I was willing to try anything. And that was it – a pill and a pat on the back. Eighteen years and several different antidepressants later, I wonder if things would have been different had my physician suggested that I talk to a mental health professional during that visit when I was prescribed an antidepressant.
That’s where the concept of integrated care comes in. You see, in an integrated care environment, when a primary care physician suspects that a patient has a behavioral health issue, he/she administers a behavioral health screening tool, and, if indicated, he/she can do what is called a “warm hand-off” or introduction to the behaviorist on staff. The behaviorist will talk with the patient about what prevents them from achieving their health goals, including behavioral health issues (e.g., depression, substance abuse). I don’t know about you, but I know I’d feel more comfortable seeing a behaviorist if I’d had the opportunity to meet them in my doctor’s office versus being referred to a mental health clinician in the community and not knowing what to expect.
On the flip side, consider someone who has a severe and persistent mental illness such as schizophrenia. Often, these people experience barriers to getting the healthcare they need – barriers such as transportation, money, and lack of motivation – barriers that are removed when primary care services are located in the same facility where they receive their behavioral healthcare. People with severe and persistent mental illness die 20 to 25 years earlier than those without mental illness. Why? It isn’t due to suicide. It’s because they don’t get the healthcare they need to deal with issues that are common with people who have mental illness, issues such as diabetes, obesity, and heart disease. Having a “one-stop shop” for these patients dramatically increases the odds that they will get their medical health issues addressed in a timely and effective manner.
According to an article published in Family Practice Management, studies have shown that there are numerous benefits to integrated care:
- “Increased efficiency. Chronically ill patients with co-occurring somatic or mental health issues can be quickly sent to an in-house behavioral health specialist without a referral or scheduling a separate appointment. All the while, the physician is able to remain on schedule.
- Increased patient and physician satisfaction. Both patients and physicians report that they prefer the convenience, efficacy and support of on-site behavioral health specialists.
- Improved health outcomes. Working as a team, the physician and behavioral health specialist assist the patient in managing chronic illnesses that often require changes in lifestyle and behaviors.
- Improved mental health outcomes. Research shows that patients with mental health conditions achieve greater symptom relief and have less need for costly emergent services when treated by an interdisciplinary team.”
Seems like a win-win situation, right? From my perspective as a patient, I wish that I would have had access to on-site behavioral healthcare eighteen years ago. Perhaps I wouldn’t have struggled so much in the early years of my sobriety. Perhaps I would have addressed some of my unhealthy coping mechanisms early enough that I wouldn’t still be struggling with them today.
Source: Reitz, Randall, PhD, Peter Fifield, MS, and Patrice Whistler, MD, MPH, FAAP. “Integrating a Behavioral Health Specialist Into Your Practice.” Family Practice Management 18.1 (2011): 18-21. Family Practice Management. 2011. Web. 17 June 2015.
About the Author: Mark Combs, MBA, is a grant writer with Aspire Indiana, and is an aspiring cyclist. You can learn more about Aspire Indiana at https://www.facebook.com/AspireIndiana. You can follow Mr. Combs on Twitter @MarkCombs1968.