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Collaborative Care Shows Results, But Remains Rare in Mental Health Care

February 27, 2018
Jon W. Draud, MS, MD

AUSTIN, Texas—Collaboration between primary and mental health care providers improves patient outcomes, but still happens in only a tiny fraction of cases, Jon W. Draud, MS, MD, said at an Elevate by Psych Congress talk on health care synergy.

The “latest estimates are fewer than 3% of psychiatrists and psychiatric nurse practitioners are in any way aligned with primary care,” said Dr. Draud, a Tennessee psychiatrist and medical director and a member of the Psych Congress Steering Committee. However, he expects collaborative care to become more common.

“We’re going to see this coming down the path more and more if you participate with insurance,” he said. “This is becoming a national kind of a thing and it’s going to be there whether we like it or not.”

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Data show that could be good news for patients with mental health disorders. A study published in Population Health Management in 2016 found that depression scores improved far more, and for a longer period of time, when primary and mental health care providers worked together. Another study published in 2016, in BMC Family Practice, suggests it could be a promising strategy for treatment of anxiety disorders as well.

Key Characteristics of Collaborative Care

A multiprofessional approach (general practitioner plus at least 1 other health professional)

A structured management plan

Scheduled patient follow-ups

Enhanced interprofessional communication

And, qualitative research published in General Hospital Psychiatry in 2014 illustrated the value of collaborative care in treating bipolar disorder patients. “These are usually difficult patients. A lot of them have major medical comorbidities, social issues, and need coordinated care,” Dr. Draud said. “It’s not just enough for them to come to us and get Latuda. They’re going to need a lot more usually.”

Collaboration can also help providers quickly establish a positive therapeutic alliance with a patient, which contributes to better outcomes, said Dr. Draud, whose practice has a collaborative care structure and integrated electronic medical records.

“Whenever I see a new patient I’m able to say ‘I have reviewed your entire medical record. I know Dr. Thompson, your primary care doctor, and I’ve known him for 22 years,’” he said. “You’re in. You don’t have to say anything else. … You have already established a therapeutic alliance, in one sentence, and everything else builds on that.”

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Psych Congress cochair and Elevate host Charles Raison, MD, praised the idea of medical providers working together.

“Any time you can communicate clinical issues, person to person, in a medical setting, it just is so much more effective,” said Dr. Raison, a former consulting psychiatrist. “You can get this complexity of interaction and agreement so quickly. You get all these nonverbal reads on what the situation is.”

“We do best when we’re actually in relationships with people and interconnected with them,” he added.

—Terri Airov

Reference

“Health care synergy: aligning outcomes across the health care spectrum.” Presented at Elevate by Psych Congress: Austin, TX; February 24, 2018.

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