Your SlideShare is downloading. ×
Behavioral Health Systems Lecture
Behavioral Health Systems Lecture
Behavioral Health Systems Lecture
Behavioral Health Systems Lecture
Behavioral Health Systems Lecture
Behavioral Health Systems Lecture
Behavioral Health Systems Lecture
Behavioral Health Systems Lecture
Behavioral Health Systems Lecture
Behavioral Health Systems Lecture
Behavioral Health Systems Lecture
Behavioral Health Systems Lecture
Behavioral Health Systems Lecture
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Behavioral Health Systems Lecture

288

Published on

Published in: Health & Medicine, Education
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
288
On Slideshare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
0
Comments
0
Likes
0
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. Behavioral Health and Primary Care David Eisenman MD and John Luo MD Departments of Medicine and Psychiatry
  • 2. Behavioral Health and Primary Care
    • Understand barriers to integration of behavioral health and primary care
    • Implications in caring for patients
    • Steps to improve care
  • 3. Barriers between Primary Care and Behavioral Health
    • Historical
    • Conceptual
    • Patient
    • Provider
    • Practice
    • Health Plan
    • Population/Community/Policy
  • 4. Conceptual Issues: Primary Care vs. Mental Health Specialties
    • Different perspectives
      • Majority of literature comes from specialty (and often tertiary) care settings
      • Diagnostic systems such as DSM-IV often seen as too complex and specialty-focused
    • Need to adapt strategies and approaches to the primary care setting (e.g., problem vs. DSM focus)
    • Linkages between and among various systems (SUD, social services, consumer directed) , etc.)
  • 5. Provider Barriers
    • Time
    • Interest
    • Tools
    • Training
  • 6. Practices Issues
    • Organization does not enhance patient-provider interactions & promote successful outcomes
      • Who is responsible for care?
        • Limited communication and teamwork between primary care and mental health specialties
      • How should care be provided?
        • Consultative? Collaborative? Integrated?
      • When should care be provided?
        • Lack of longitudinal focus
  • 7. WHO Responsibility for Care PCP BHS
    • Assessment/diagnosis
    • Evaluate preferences
    • Initiation of referral
    • Initiation of medication
    • Psychoeducaton/Counseling
    • Longitudinal follow-up/monitoring
    • Medication follow-up (including labs)
    • 2nd level or adjunctive medications
    • Link with community resources
  • 8. Referral Consultative Care Collaborative Care Integrated Team Independent Autonomous (PCP) Autonomous (MHS) How
  • 9. When Continuing Care Short-term Management Diagnosis/ Assessment Risk Factor Identification/ Prevention
  • 10. Plan Barriers
    • Separation by carve-out
    • Practitioner affiliation/communication/incentives
    • Confidentiality/HIPAA
  • 11. Health Plans Money Flow and and Communication No risk Health Plan A. Indemnity Model Mental Health Plan B. Carve-out Model No Shared Risk Primary Care Provider Mental Health Specialist Legend Primary Care Provider Mental Health Specialist High communication Low communication Money Flow
  • 12. Primary Care Tasks
    • Assessment/diagnosis
    • Intervention/management
    • Communication with patient
    • Communication with mental health specialist
    • Develop strategies that are:
      • Patient specific
      • Problem focused
      • Time phase sensitive
      • Sector/role relevant
      • Developmentally appropriate
  • 13. “ Systems of care that force the separation of “mental” from “physical” problems consign the clinicians in each area of this dichotomy to a misconceived and incomplete clinical reality that produces duplication of effort, data, and ensures that the patient cannot be completely understood” Institute of Medicine, 1996

×