UVMMC Primary Care is transitioning to the Primary Care Mental Health Integration (PCMHI) model of care, in which behavioral health and/or psychiatric treatment is provided within a primary care setting via in-house consulting clinicians. There are currently no standardized informational materials to educate patients on the details of the PCMHI program, which is a new treatment model for most patients and clinicians involved. Development of educational materials, as well as broader public health implications of the PCMHI model of care, are addressed.https://scholarworks.uvm.edu/fmclerk/1798/thumbnail.jp

Stedman, Amy

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University of Vermont UVM ScholarWorks Family Medicine Clerkship Student Projects Family Medicine Community 2021 Implementation of the Primary Care Mental Health Integration (PCMHI) Model: Information for Patients Amy Stedman UVM Larner College of Medicine Follow this and additional works at: https://scholarworks.uvm.edu/fmclerk  Part of the Medical Education Commons, Primary Care Commons, and the Psychiatry and Psychology Commons Recommended Citation Stedman, Amy, "Implementation of the Primary Care Mental Health Integration (PCMHI) Model: Information for Patients" (2021). Family Medicine Clerkship Student Projects. 694. https://scholarworks.uvm.edu/fmclerk/694 This Book is brought to you for free and open access by the Family Medicine Community at UVM ScholarWorks. It has been accepted for inclusion in Family Medicine Clerkship Student Projects by an authorized administrator of UVM ScholarWorks. For more information, please contact donna.omalley@uvm.edu. Implementation of the Primary Care Mental Health Integration (PCMHI) Model: Information for PatientsAmy StedmanUVMMC Family Medicine – South BurlingtonJuly/August 2021Project Mentor: Clara Keegan, MDProblem Identification & Description of Needo UVMMC Primary Care is transitioning to the Primary Care Mental Health Integration (PCMHI) model of care, in which behavioral health and/or psychiatric treatment is provided within a primary care setting via in-house consulting clinicianso Implementation of the PCMHI model began in 2007 within the Veterans Health Administration, with the goal of improving access to mental health services via co-located collaborative care provided by mental health professionals1o UVMMC Family Medicine – South Burlington serves as the pilot site for the PCMHI program and has begun to refer patients for chart review-based psychiatric consultation and behavioral health serviceso There are currently no standardized informational materials being circulated within the South Burlington practice to educate patients on the details of the PCMHI program, which is a new treatment model for most patients and clinicians involvedPublic Health Cost & Cost Considerationso 60% of patients with psychiatric disorders are treated exclusively in a primary care setting.2o A cohort study of 4.4 million Medicare beneficiaries found that 4.2% of total Medicare spending went to mental health services and 8.5% went to additional medical spending associated with mental illness, for a total of 12.7% of total spending associated with mental health disorders.3o Among 5.4 million primary care patients in 396 VA clinics, 6.3% of patients saw a PCMHI provider. Each percentage-point increase in the proportion of clinic patients seen by these providers was associated with 11% more mental health visits and 40% more primary care visits, with 9% higher average total costs per patient per year.4o Implementation of PCMHI programs was associated with a pattern of increased identification and diagnosis of depression, anxiety, post-traumatic stress disorder, and alcohol abuse, which may enhance recognition of mental health needs among primary care patients.5o Greater clinic engagement in PCMHI services has been shown to increase accessibility to mental health care for primary care patients, without increasing acute care use or total healthcare costs, ultimately improving mental health care value at the patient population level.6Community Perspective & Support for ProjectCommunity Perspective & Support for ProjectHow/why did you get involved with implementation of the PCMHI program?“I was approached about the possibility of becoming the primary care physician champion for the program because of my interest in motivational interviewing and primary care management of mental health concerns…I believe that centralized mental health services (available through the medical home rather than only through outside referral) is more acceptable to many patients.”What do you see as the biggest advantage of the PCMHI model of care?“I feel like our PCMHI team gives us support and back-up in managing complex patients with mental health concerns. I really appreciate the rapid turnaround on the psychiatry chart reviews, which help guide me in medication adjustments. ”Are there certain patient populations you feel would benefit most from referral to the PCMHI program?“I am really excited to see more support for patients with chronic medical illness whose care is complicated by mood symptoms or anxiety. I think the behavioral activation strategies that Kerry Stanley provides can be helpful for managing medical conditions, not just mood disorders.”How do you feel that patients can benefit from your services as Behavioral Health Care Manager?“The Care Manager provides brief, evidence-based counseling through the medical home and…supports patients by breaking down problems in a more manageable way. As part of the larger clinical team, the Behavioral Health Care Manager directs the orchestra of patient and providers to make sure the patient’s quality of life is improving and to help access other levels of care when necessary.”What patient population do you feel can gain the most from the PCMHI program?“This program is meant to be proactive in nature, meaning that we are not strictly waiting for a patient to present to their primary care provider to share their concerns…In this way, PCMHI is exciting because it benefits a population of patients who may feel they don’t need or deserve counseling, who might feel stigmatized going into a regular counseling setting or who need coordinated medication support.”What do you see as the biggest advantage of the PCMHI model of care?“…One of the most significant is the routine use of screening and tracking tools to make sure the services patients are receiving are effective. If we are not seeing the changes we expect, it allows us to reassess the plan of care and make needed adjustments…We know one plan of care doesn’t fit all and PCMHI allows for a tailored approach to patient care.”Interview with Clara Keegan, MD“Primary Care Champion” for the PCMHI programInterview with Kerry Stanley, LICSWBehavioral Health Care Manager for South Burlington PCMHIo Development of patient education materials to enable patients to better understand the PCMHI program, including referral process, structure/purpose of the program, and roles of clinicians involved in their careo Worked closely with Clara Keegan, MD and the South Burlington PCMHI clinicians to determine high-yield program information and how to best convey this to patientso Created a dot phrase for PCPs to put in a patient’s after visit summary when they first refer the patient to the PCMHI teamo Will initially utilize the dot phrase at South Burlington with the intent that it will be customized for use at other practices as they implement the PCMHI programIntervention & MethodologyResponseo Creation of patient information sheet with pertinent FAQs following initial referral to the PCMHI programo Available in EPIC as a dot phrase for PCPs to put in their after-visit summaryEvaluation of Effectiveness & Limitationso The primary aim of the project has been development of patient education materials that have not yet been implemented into clinical practice. As such, effectiveness of these materials with regard to patient understanding of the PCMHI program has not yet been established. This would be an area that could benefit from future community projects.o Limitations are largely due to the individualized nature of the PCMHI program and referral process. The program offers multiple different services, with patients utilizing different aspects. This info sheet for the after visit summary serves as a broad, introductory overview of the program, though additional, more specialized information may be required depending on a patient’s level of involvement with the PCMHI services.o Survey of patients who have been referred to PCMHI in order to assess understanding of the program and satisfaction with care receivedo Creation of an algorithm to help providers determine when to refer patients to PCMHI and which patients would benefit most from the program’s serviceso Existing studies have evaluated clinicians’ utilization of their PCMHI program via the Primary Care Behavioral Health Provider Adherence Questionnaire (PPAQ)7, which could be administered at UVMMC Primary Care in the future to better inform clinical practice o Referral to PCMHI can also occur via patient identification by various population health measures; development of further patient education materials could be beneficial for this arm of the PCMHIRecommendations for Future ProjectsReferences1. Post, E. P., Metzger, M., Dumas, P., & Lehmann, L. (2010). Integrating mental health into primary care within the Veterans Health Administration. Families, Systems, & Health, 28(2), 83.2. Butler, D. J., Fons, D., Fisher, T., Sanders, J., Bodenhamer, S., Owen, J. R., & Gunderson, M. (2018). A review of the benefits and limitations of a primary care-embedded psychiatric consultation service in a medically underserved setting. The International Journal of Psychiatry in Medicine, 53(5-6), 415-426.3. Figueroa, J. F., Phelan, J., Orav, E. J., Patel, V., & Jha, A. K. (2020). Association of mental health disorders with health care spending in the Medicare population. JAMA Network Open, 3(3), e201210-e201210.4. Leung, L. B., Rubenstein, L. V., Yoon, J., Post, E. P., Jaske, E., Wells, K. B., & Trivedi, R. B. (2019). Veterans health administration investments in primary care and mental health integration improved care access. Health Affairs, 38(8), 1281-1288.5. Zivin, K., Pfeiffer, P. N., Szymanski, B. R., Valenstein, M., Post, E. P., Miller, E. M., & McCarthy, J. F. (2010). Initiation of Primary Care—Mental Health Integration programs in the VA Health System: Associations with psychiatric diagnoses in primary care. Medical Care, 843-851.6. Leung, L. B., Yoon, J., Rubenstein, L. V., Post, E. P., Metzger, M. E., Wells, K. B., Sugar, K. A., & Escarce, J. J. (2018). Changing patterns of mental health care use: the role of integrated mental health services in veteran affairs primary care. The Journal of the American Board of Family Medicine, 31(1), 38-48.7. Possis, E., Skroch, B., Hintz, S., Bronars, C., Mallen, M., Crowl, H., Moore, K., Bemmels, H., & Olson, D. (2020). Examining and Improving Provider Adherence to the Primary Care Mental Health Integration Model. Military Medicine, 185(9-10), e1411-e1416.

Implementation of the Primary Care Mental Health Integration (PCMHI) Model: Information for Patients

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Implementation of the Primary Care Mental Health Integration (PCMHI) Model: Information for Patients

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