Primary Care Challenge: Treating Mental Health and Chronic Disease

Added January 25, 2019

Psychiatric disorders, chronic illness, and substance use addictions all have a common connection known as the ‘highest burden of disease’ meaning most of the disease is directly related to neurological and substance use disorders.

These disorders account for high healthcare costs, frequent emergency department visits, hospital readmissions, and longer appointments with time-strapped physicians.

What can administrators, specialists and primary care providers do collectively to remedy these issues? What can be done to improve the delivery of patient care services that meet the needs of specific patient populations?

With the continuing abundance of cutting edge technology and medical advances, there is a clear-cut pathway that caters to the needs of both healthcare providers and their patients.

It All Begins with Primary Care

Primary care is the door through which patients have their first contact with a practitioner for managing chronic diseases including diabetes, multiple sclerosis, Parkinsons, cancer and heart disease to name a few. It is within these diseases the psychiatric condition is often undetected and, in most cases, left undiagnosed.

Major psychiatric disorders and multimorbidity diseases are frequently interconnected and significantly influence the underlying symptoms and care of other diseases. When a patient has more than one chronic disease including psychiatric conditions, the diseases and conditions, play tug-and-pull influencing the acuity and maintenance of each condition.

Relapse of a condition and a patient not adopting their care frequently occurs with patients who have multiple chronic conditions. These patients find themselves back inside the emergency room or readmitted post-discharge.

Effects of Multimorbidity and Mental Disorders

“Population-based studies have demonstrated a substantially increased risk of mortality for people with mental health and/or substance use issues compared to the general population that is three-fold for men and two-fold for women.”

The need for mental health treatment is expected to rise as the number of psychiatrists relative to the population continue to decline. Demand for mental health care is outstripping supply. In 6 years, there will be a deficit of psychiatrists and mental health providers to the tune of 15,600. This gap will affect the whole healthcare system. The problem is further complicated when you are trying to control costs.

When a patient has a chronic condition like diabetes, and it is comorbid with a psychiatric condition like depression, costs more than double. This financial burden can be managed by looking at the whole patient.

Case Study in Managing Multimorbidity Patients

PubMed NCBI details a study which took place at Colorado University with internal medicine physicians, they discussed primary care and the outcomes of complex multimorbidity patients with mental illness.

“Participants expressed a strong desire for increased integration of care through collaboration between primary care providers and mental health specialists. This approach could improve both comforts in treating mental illness and the delivery of care for complex patients.”

The treatment of patients with co-morbid medical and psychiatric illness has been negatively affected by insufficient access to mental health specialty care and the lack of additional support in primary care clinics. Lengthy protocol procedures also limit diagnosis time. Physicians agreed that these issues are a result of problems within the larger healthcare system in the US.

“Time is of the essence in primary care. You don’t have much time with patients but having screening tools embedded in your check-in sheets which then nurses and medical technicians can administer to the patient, allows you to spend more time with the patient instead of doing all the screenings yourself so you can focus on evaluating your patient.” Rodney Ho, PA.

Flag Patients Through Assessments and Questionnaires

Flagging patients through assessments and questionnaires in the primary care setting is like having an extra set of eyes and hands which will help enable early detection of depression. There are many mental health screenings which are available, the two most frequently accessed are the PHQ-2 and the PHQ-9. When determining which screening and assessment tool to use, several factors should be considered;

Reliability: Will it consistently produce dependable results?

Validity: Can the screening test differentiate between a patient with an issue that needs addressing and a patient that does not?

Sensitivity: How accurate is the test in identifying if a patient has a problem?

Specificity: Is the test precise enough to identify patients that do not have a depressive issue?

Sensitivity and specificity levels around 70% – 80% are acceptable developmental screenings for children presenting with anxiety, depression, inattention, impulsivity, disruptive behavior, aggression, substance abuse, learning difficulties and signs of social-emotional disturbance.

Time and cost are necessary considerations with every visit to primary care, screening tools embedded into check-in forms can be provided at every appointment. Mental illness accompanies all types of diseases. Physicians are limited in the treatment they provide due to financial and time constraints, insufficient training and lack of adequate resources. These issues are more intensified in minority and rural communities.

Psychiatric Collaborative Care Management Within Primary Care

Integrating a collaborative approach between primary physicians, behavioral healthcare managers and psychiatric consultants in the form of technology-based care management is the solution.

Care management provides high-touch care for patients while they are away from the care facility, encouraging them to stay engaged in their own care.

For example, CareAdopt’s care management technology offers a wide range of expertise consolidated into one application. CareAdopt provides real-time data and clarity concerning the patient’s’ condition which is all monitored by a care manager or behavioral healthcare manager who provides patient check-ins and additional services as needed.

Increasing the ability for a patient to communicate proactively enables stronger bonds of patient trust with the healthcare provider which in turn leads to more useful clinical information which can then be used to treat future patients.

The benefits of CareAdopt reach right back to the primary care physician. The primary care provider, now relieved of the burden of psychiatric care, can focus on supporting the patient with their treatment of diabetes, heart disease, and other chronic illnesses.

What many people do not know is that psychiatric collaborative care is reimbursable through Medicare and Medicaid as well as some private payers. It is an investment that keeps giving by making a positive impact in the lives of the patients and their care providers.

Ultimately, technology-based psychiatric care management is an integral part of the trending ‘open path’ modern healthcare ideology.