|
March – April 2019
Guest column from Kevin Denlinger and Stacey Gedeon
How integrating behavioral health with primary care can benefit both you and your patients
It’s close to the end of the day’s schedule and you’re running about an hour behind. As you’re walking out of the exam room, your patient, who had made a same-day appointment due to a bad cold, asks:
Are you leaving? I know you’ve been telling me that I need to lose weight and quit smoking. I think I’m ready to start to work on that, but I need some help.
The 45-year-old female patient is obese, smokes more than one pack a day and was recently diagnosed with Type 2 diabetes.
You have two options:
Option 1: In an effort to make it home to your family in time for dinner, you tell the patient that you’re just leaving the office and will discuss her issues at her next scheduled visit, which is two months away. You may be able to share with her some flyers about weight loss and tobacco cessation, asking her to read them before your next visit.
Option 2: In an effort to leave at a reasonable time and provide high-quality primary care, you tell the patient that it’s great to hear she’s ready to take steps to improve her health, and you have a behavioral health specialist on staff who can meet with her today.
It’s easy to imagine how outcomes will differ depending on which option you choose. Let’s face it — most visits to a primary care doctor involve a behavioral component, and many patients are struggling to follow through on changes they know they need to make.
Issues such as depression and anxiety are likely what come to mind first when thinking about addressing behavioral health issues in a primary care setting, but the positive effect that behavioral health care can have on chronic condition management is equally important. Integrating behavioral health services with primary care has many advantages for primary care providers and their patients.
First and foremost, the help you provide to your patients can begin right away, especially if you have an in-house behavioral health expert. She arrives within minutes, you explain the situation and introduce her to the patient. While you see your next patient, the behavioral health expert performs an evaluation and initiates the first interventions with the patient. When you return to your desk, the behavioral health expert is ready discuss the findings with you and make recommendations.
Together, you formulate a plan and the patient is aware that the primary care team is communicating and working together. There’s no need to set up an outside referral or send the patient to another office and hope the patient shows for the appointment.
Additionally, both the primary care doctor and the behavioral health provider document the patient’s condition using the same electronic health record. Some might wonder if patients are bothered by shared record-keeping. In our experience, patients welcome the team approach to their care. The quality of their care improves and patient satisfaction and compliance rise.
While we consider having a behavioral health specialist on-site ideal, primary care doctors don’t have to bring a behavioral health specialist into their practice to offer good behavioral health integration. Many primary care doctors have several behavioral health specialists they refer to. They share medical records with them after receiving approval from the patient, discuss the patient’s condition and work together to develop a structured treatment plan.
Through case discussions, both the primary care doctor and the behavioral health expert can learn a great deal from each other — new ideas and new ways of approaching a health issue that can’t be learned from a textbook or lecture.
Many times, a behavioral health expert may suggest techniques other than medication to treat a condition. This can be a great approach, particularly when treating insomnia. Insomnia medications can have relative contraindications for people 65 and older, create dependency, lose effectiveness quickly and increase fall risk. Behavioral techniques are safer and become more effective over time.
When treating patients with common chronic medical problems, such as diabetes, collaboration between a behavioral health expert and a physician can lead to a more structured treatment program that not only improves care, but reduces the time it takes for the doctor to treat such conditions. In addition, patients who need to lose weight, exercise more or stop smoking can benefit greatly from working with a behavioral health specialist. Last but not least, behavioral health integration can improve overall health care quality — essential in today’s environment where there’s an increasing demand for quality metrics.
 |  |
| Kevin Denlinger, D.O. | Stacey Gedeon, Psy.D. |
Kevin Denlinger, D.O., is an osteopathic family physician at MidMichigan Community Health Services, and Stacey Gedeon, Psy.D., is a clinical health psychologist and director of behavioral health and integrated primary care at MidMichigan Community Health Services. MidMichigan Community Health Services is a federally qualified health center with its primary location in Houghton Lake.
|
