Resident Rotation: Collaborative Care Consultation Psychiatry

Size: px

Start display at page:

Download "Resident Rotation: Collaborative Care Consultation Psychiatry"

Harvey Harris
5 years ago
Views:

1 Resident Rotation: Collaborative Care Consultation Psychiatry Anna Ratzliff, MD, PhD James Basinski, MD With contributions from: Jurgen Unutzer, MD, MPH, MA Jennifer Sexton, MD, Catherine Howe, MD, PhD Deborah Cowley, MD 1

2 Module 3: Collaborative Care Teams 2

3 Learning Objectives: Module 3 By the end of this module, the participant will be able to: Understand in more depth the typical role responsibilities for PCP s, care managers, and psychiatrists in collaborative care. Relate collaborative care processes and roles to a typical primary care work flow and practice environment. Use telephone/telepsychiatry p y to perform psychiatric consultation. Demonstrate increased comfort in communications with both care managers and primary care providers. Consider personally implanting strategies t for improving i communication with care managers and PCPs. 3

4 Collaborative Team Approach PCP Core Program Patient BHP/Care Manager Consulting Psychiatrist Other Behavioral Health Clinicians Additional Clinic Substance Treatment, Vocational Rehabilitation, CMHC, Other Community Outside 4

5 Team Roles 5

6 Primary Care Provider PCP Core Program Patient BHP/Care Manager Consulting Psychiatrist Other Behavioral Health Clinicians Additional Clinic Substance Treatment, Vocational Rehabilitation, CMHC, Other Community Outside 6

Life of a Busy PCP Challenges: Ways to cope: Large patient panels (1,500 2,500) Fast paced:

serious? What is practical to accomplish today?

problems Acute care, chronic care, prevention Everything comes at me and dib batt att the th

7 Life of a Busy PCP Challenges: Ways to cope: Large patient panels (1,500 2,500) Fast paced: encounters / day Huge range of problems / responsibilities Focus: What is the most serious? What is practical to accomplish today? g and treat over Diagnose time Get help TEAMWORK Full range of medical, behavioral, social problems Acute care, chronic care, prevention Everything comes at me and dib batt att the th problem bl before me hard to keep track of what happens once treatments started Need practical solutions & effective communication COLLABORATIVE CARE 7

8 Primary Care Provider Oversees all aspects of patient s t care Diagnoses common mental disorders Starts & prescribes pharmacotherapy Introduces collaborative care team Ideally with warm hand-off Makes treatment adjustment in consultation with care manager, team psychiatrists, and other behavioral health providers. 8

9 BHP/ Care Manger PCP Core Program Patient BHP/Care Manager Consulting Psychiatrist Other Behavioral Health Clinicians Additional Clinic Substance Treatment, Vocational Rehabilitation, CMHC, Other Community Outside 9

10 Behavioral Health Professional (BHP) / Care Manager - I Facilitates t patient t engagement and education Works closely with PCP and helps manage a caseload of patients in primary care Performs systematic initial and follow-up assessments. Systematically tracks treatment response Supports medication management by PCPs Where will patient get medications? Planning for medication adherence Facilitating PCP visit to discuss side effects 10

11 BHP/Care Manager II Provides brief, evidence-based counseling or refers to other providers for counseling services Reviews challenging patients t with the consulting psychiatrist weekly Facilitates referrals to other services (e.g., substance abuse treatment, specialty care and community resources) as needed Prepares client for relapse prevention 11

Behavioral Health Clinicians Additional Clinic

12 Consulting Psychiatrist PCP Core Program Patient BHP/Care Manager Consulting Psychiatrist Other Behavioral Health Clinicians Additional Clinic Substance Treatment, Vocational Rehabilitation, CMHC, Other Community Outside 12

13 Consulting Psychiatrist Supports BHPs/care managers and PCPs Provides regular (weekly) and as needed consultation on a caseload of patients followed in primary care Module 3 Focus on patients who are not improving clinically intensification of treatment In person or telemedicine consultation or referral for complex patients Provides education and training for primary care based providers care-based providers 13

14 Other Behavioral Health Clinicians PCP Core Program Patient BHP/Care Manager Consulting Psychiatrist Other Behavioral Health Clinicians Additional Clinic Substance Treatment, Vocational Rehabilitation, CMHC, Other Community Outside 14

15 Incorporate Other Behavioral Health Clinicians i i Can provide valuable services such as: Comprehensive assessment Evidence-based counseling / psychotherapy Individual id or Group Behavioral health interventions focused on health behaviors Chemical dependency counseling / treatment Social work services 15

16 Silent Silent Partners PCP Other staff and managers BHP/Care Manager Patient Other Behavioral Health Clinicians Substance Treatment, Vocational Rehabilitation, CMHC, Other Community Core Program Consulting Psychiatrist Additional Clinic Outside 16

17 Silent Partners Who are they? Receptionists/Front Desk Staff Medical Assistants CEOs, Administrators Can be crucial in supporting the integrated care effort Important to nurture champions here too! 17

18 Working as a Team 18

19 Working with BHPs/Care Managers Who are the BHPs/CMs? Typically y MSW, LCSW, MA, RN, PhD, PsyD Variable clinical experience What makes a good BHP/CM? Organization Persistence Creativity and flexibility Enthusiasm for learning Strong patient advocate Willingness to be interrupted Ability to work in a team 19

20 BHP/Care Manager Skills Clinical Skills Basic assessment skills with use of common screening tools Concise, organized written and oral presentations Behavioral Medicine & Brief Psychotherapy Engage patient in developing a therapeutic alliance around mutually agreed goals and expectations of the treatment plan Support medication management by PCP Provide brief evidence-based psychotherapies (see module 5) Other Skills Referrals to other behavioral health providers and community e e a s to ot e be a o a ea t p o de s a d co u ty Excellent communication skills in their key liasion role 20

21 Tips for Working with BHPs/Care Managers Maintain relationship based on collaborative consultation between professional rather caseload supervision with different educational goals and less even power differential Knowing their strengths and limitations Helpful to learn (and rely) on existing training and strengths of BHP/CM Be ready to build on limitations for consultation hour as well as local and centralized resources or work around with systemic aids,e.g. structured symptoms rating scale for psychiatric symptoms reviews. Monitor for various sources of Burnout Local clinical issues, patient populations, etc. 21

22 Psychiatrist and BHP/Case Manger Consultation ti Goals -Discuss overall caseload (with balance of new versus old cases) -Specific p case reviews - Diagnostic clarification - Treatment planning - Medication recommendation 22

23 Psychiatrist and BHP/Case Manager Consultation ti Variables in the Structure and Process of Consultation Hours Length and schedule of consultation Amount of preparation before hour by psychiatrist In-person or skype connection vs phone alone Active structuring of presentations by psychiatrist Availability of co-scheduled psychiatric evaluation 23

24 Collaborative Team Approach PCP Core Program Patient BHP/Care Manager Consulting Psychiatrist Other Behavioral Health Clinicians Additional Clinic Substance Treatment, Vocational Rehabilitation, CMHC, Other Community Outside 24

25 Tips for Working with PCPs Availability and Accessibility Easy access for PCP Same day for curbside questions Typically by pager, , cell phone Not utilized as much as would expect! Promoting integrated care Expect questions and possible skepticism / resistance Promote yourself as a resource Teach the model BHP/Care manager will assess patient first New role for psychiatrist to support the BHP/Care manager and support team treatment 25

26 Communication with PCPs Recommendations By default brief and focused, but also tailored the individualized interests and needs of the PCP Provisional diagnosis and next steps for assessment and diagnostic clarification Treatment: Both medication recommendations and psychotherapuetic interventions and referrals Provide Education Through patient-focused recommendations Webinar or in person at provider meetings 26

27 Reflection Questions 1) What have been your experiences working as a psychiatrist in multidisciplinary care teams? Has sharing patient care, communication, teaching been enjoyable and frustrating? 2) To date, have you had any experience (e.g. telepsychiatry, curbside consultations with medical colleagues or non- medical acquaintances) with providing indirect consulting in psychiatry? 3) How do you feel about a psychiatry consulting process that stresses iterative and longitudinal approaches to patient diagnosis and treatment? 27

Resident Rotation: Collaborative Care Consultation Psychiatry

Resident Rotation: Collaborative Care Consultation Psychiatry Anna Ratzliff, MD, PhD Ramanpreet Toor, MD James Basinski, MD With contributions from: Jürgen Unützer, MD, MPH, MA Jennifer Sexton, MD, Catherine