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Implementing Cognitive Behavioral
Therapy (CBT) Skills Group Medical
Visits within Primary Care
Dr. Bill Bullock, Dr. Erin...
The problem: Meet Mary
Mary is one of the 29% of people* struggling with the most common chronic
condition in Victoria: de...
3
Mary is feeling…
Afraid. Ashamed.
Overwhelmed. Uncertain.
Demoralized. Hopeless.
Stuck.
And all alone.
4
But Mary has many barriers to getting help…
42% of people no longer socialize with
someone with a mental health
problem....
5
Mary is courageous and finally
asks her family doctor for help.
*Canadian Mental Health Association, 2012
80% of people ...
6
And alone.
• Psychiatrist wait list
• Rejected: “not sick enough”
• Private services $$$
• GP has too little expertise,
...
7
Her relationships and family members are affected.
Mary and her family suffer.
Mary goes off work.
Society suffers.
She ...
Our Aim:
To create accessible and effective self-
management services for patients with
mild/moderate mental health proble...
Our Design
Cognitive Behavioural Therapy (CBT)
Skills Group Medical Visits
• Combine CBT & Acceptance-based
strategies
• A...
Strategies for Change:
1. Developing content
2. Enhancing family physicians’ skills
3. Establishing referral centre
4. Del...
Developing content
11
Referral Centre hosted by the
Victoria Division of Family Practice
• 480+ referrals
• 103 referring ...
Delivering the MH Service
12
Seven groups completed (Oct - Dec 2015)
• 91 patients; 72 completed (6/8 sessions)
Eleven gro...
Mary participates in a CBT
Skills Group
13
Self-Management Skills Tool Box
14
Effects of Change:
Patients
15
“Learning in the
group helped me
remember and
assimilate the skills.”
“I feel this course
w...
16
Effect Size:
CBT N=63 Waitlist Control N=140
PHQ-9 0.9 “Large effect”
GAD-7 1.2 “Very large effect”
WASA 0.7 “Moderate ...
Effect on Participating GPs:
17
“One of the
greatest learning
experiences of
my life”
“This is going to
help me with so
mu...
GMVs are a cost-effective model for the system
GROUP MEDICAL VISITS (GMV)
Fee Code Average # of
patients/group
Practice Ty...
Learning & Challenges
• Steep facilitator learning curve
• Enhancing family physicians’ skills
• Administrative & MOA func...
Sustainability and Spread
Crucial factors of sustainability
• Retention & expansion of physician champions
• GMV fee codes...
Questions?
21
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Implementing Cognitive Behavioural Therapy (CBT) Skills Group Medical Visits within Primary Care

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This presentation was delivered at the Quality Forum 2016 by Christine Tomori, Joanna Cheek, and Bill Bullock.

For more information, visit www.QualityForum.ca

Published in: Healthcare
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Implementing Cognitive Behavioural Therapy (CBT) Skills Group Medical Visits within Primary Care

  1. 1. Implementing Cognitive Behavioral Therapy (CBT) Skills Group Medical Visits within Primary Care Dr. Bill Bullock, Dr. Erin Burrell, Dr. Joanna Cheek, and Christine Tomori
  2. 2. The problem: Meet Mary Mary is one of the 29% of people* struggling with the most common chronic condition in Victoria: depression and/or anxiety. 2 *VIHA,2013
  3. 3. 3 Mary is feeling… Afraid. Ashamed. Overwhelmed. Uncertain. Demoralized. Hopeless. Stuck. And all alone.
  4. 4. 4 But Mary has many barriers to getting help… 42% of people no longer socialize with someone with a mental health problem. 55% wouldn’t marry someone with a mental health problem. 50% wouldn’t tell friends or colleagues about family member with a mental health problem.* *Canadian Medical Association. (2008). Eighth Annual National Report Card on Health Care. STIGMA It’s a sign of weakness to be depressed and anxious. I should just get over it. No one else understands this. I don’t want people to know I’m struggling.
  5. 5. 5 Mary is courageous and finally asks her family doctor for help. *Canadian Mental Health Association, 2012 80% of people with mental health issues in Canada receive care exclusively within the primary care system.*
  6. 6. 6 And alone. • Psychiatrist wait list • Rejected: “not sick enough” • Private services $$$ • GP has too little expertise, confidence, & time for self- management strategies Is no one going to help me with this patient in need? I can’t do this all alone. She needs more support than I can give in the office! But eventually he, too, feels stuck.
  7. 7. 7 Her relationships and family members are affected. Mary and her family suffer. Mary goes off work. Society suffers. She stops exercising, eats poorly and her mental & physical health deteriorates. The healthcare system pays the bill.
  8. 8. Our Aim: To create accessible and effective self- management services for patients with mild/moderate mental health problems within primary care. So patients and doctors feel less stuck and alone when managing mental health problems. 8
  9. 9. Our Design Cognitive Behavioural Therapy (CBT) Skills Group Medical Visits • Combine CBT & Acceptance-based strategies • Adult patients suffering with mild- moderate anxiety or depression • Groups of 15 patients led by family physicians/psychiatrists • 90 min groups for 8 consecutive wks 9
  10. 10. Strategies for Change: 1. Developing content 2. Enhancing family physicians’ skills 3. Establishing referral centre 4. Delivering group medical visits o Part 1: psychiatrists and family physicians co- facilitating patient groups o Part 2: family physicians facilitating their own patient groups 5. Evaluation 6. Sustainability and spread 10
  11. 11. Developing content 11 Referral Centre hosted by the Victoria Division of Family Practice • 480+ referrals • 103 referring family physicians 0 20 40 60 80 100 120 Aug Sep Oct Nov Dec Jan Feb #ofreferrals Month Enhancing family physicians’ skills
  12. 12. Delivering the MH Service 12 Seven groups completed (Oct - Dec 2015) • 91 patients; 72 completed (6/8 sessions) Eleven groups in progress (Jan – Mar 2016) • 166 patients being served • 3 groups solo-facilitated by family physician Two “Booster” groups planned (Feb – Mar 2016) • 30 patients Seventeen CBT and four “booster” groups planned (April – June 2016) • 315 patients 91 257 602
  13. 13. Mary participates in a CBT Skills Group 13
  14. 14. Self-Management Skills Tool Box 14
  15. 15. Effects of Change: Patients 15 “Learning in the group helped me remember and assimilate the skills.” “I feel this course would be valuable for a lot of people”. “A doctor tells you to take a pill to feel better but this same person is telling you to practice skills gives credibility” “The peer support was truly invaluable. Knowing others with shared experiences helped.” “I know I’m not alone”.
  16. 16. 16 Effect Size: CBT N=63 Waitlist Control N=140 PHQ-9 0.9 “Large effect” GAD-7 1.2 “Very large effect” WASA 0.7 “Moderate effect”
  17. 17. Effect on Participating GPs: 17 “One of the greatest learning experiences of my life” “This is going to help me with so much of my clinical work with patients” “This is protective against physician burn-out” “The group has changed the way I relate to myself—personally and professionally”.
  18. 18. GMVs are a cost-effective model for the system GROUP MEDICAL VISITS (GMV) Fee Code Average # of patients/group Practice Type Cost/per person Cost of 1.5 hours/per person Cost of 6 sessions/ per person Cost of 8 sessions/ per person G78773 13 Psych $ 16.71 $ 50.13 $ 300.78 $ 401.04 P13773 13 GP $ 8.74 $ 26.22 $ 157.32 $ 209.76 INDIVIDUAL VISITS Fee Code Average age of patients/group Practice Type Cost of 1.5 hours/ per person Cost for 6 sessions/ per person Cost of 8 sessions/ per person 00630/00632 n/a Psych $ 261.24 $ 1,567.44 $ 2,089.92 00120 43 GP $ 52.76 $ 316.56 $ 422.08 18 $209.76 is equivalent to 4 GP 20 min visits Plus huge savings with prevention of disability, downstream health care spending & ripple effects in communities.
  19. 19. Learning & Challenges • Steep facilitator learning curve • Enhancing family physicians’ skills • Administrative & MOA functions • Appropriate space & times to run GMVs 19
  20. 20. Sustainability and Spread Crucial factors of sustainability • Retention & expansion of physician champions • GMV fee codes stable & adequate • Victoria Division of Family Practice • Island Health partnership • On-going program adaptation Opportunities for spread • New physicians within the same community • New physicians in other communities • Modified CBT Skills Groups for other patient populations 20
  21. 21. Questions? 21

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