Psychiatrists for Medically Complex Patients: Bringing Value at the Physical Health and Mental Health/Substance-Use Disorder Interface

Kathol, Roger G.; Kunkel, E; Weiner, J. S.; McCarron, Robert M.; Worley, Linda L.M.; Yates, William R.; Summergrad, Paul; Huyse, Frits J.

doi:10.1176/appi.psy.50.2.93

Cited by 68 publications

(51 citation statements)

References 79 publications

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“…(8)(9)(10)(11) The profile of the elderly investigated in this study showed a mean age of 72.3 years, females predominated, with a socioeconomic income in the range of three times the minimum wage, a profile that was similar to that observed in the literature. (12)(13)(14)(15) The increase in longevity was a response to the evolution of medical science, however, the quality of life of the elderly was one of the greatest challenges in developing countries, where poverty and social inequality were highlighted.…”

Section: Discussionsupporting

confidence: 72%

“…(7) In this study, patients were classified through INTERMED as "complex" and "non-complex" based on a cutoff point of 20 representing the need for integrated treatment. (10,11) The INTERMED had advantages over other instruments because it was quick to administer, with an average duration between 15 and 20 minutes. It explored many pieces of patient data, providing knowledge and current, historical, and future assessment of four aspects -biological, psychological, social and health system -and enabled the collection of data by others involved in patient care, such as family members and caregivers, in cases in which the patient was unable to answer questions due to severe cognitive impairment or other disorders.…”

Section: Methodsmentioning

confidence: 99%

“…(7) The validity of this instrument is documented for the care of several types of patients. (8)(9)(10) Compared with usual care, targeted nursing interventions based on the INTERMED scores resulted in improvements in quality of life, at the time of admission and discharge in patients in general practice and in elderly patients requiring interdisciplinary care. (6,(8)(9)(10)(11) Assuming the importance of providing comprehensive care to the hospitalized elderly, this study aims to investigate biopsychosocial aspects of hospitalized elderly, and aspects of the health system, and to classify their degree of care complexity.…”

Section: Introductionmentioning

confidence: 99%

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Biopsychosocial aspects and the complexity of care of hospitalized elderly

Gutierrez

Silva

Shimizu³

2014

Acta paul. enferm.

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Objective: To investigate the biopsychosocial aspects and aspects of the health system of hospitalized elderly and to classify their degree of care complexity. Methods: This was a quantitative study whose convenience sample consisted of 279 elderly. The Interdisciplinary Medicine Instrument (INTERMED) method was used, a tool that identified biopsychosocial aspects and conditions of the health system and classified the complexity of the patient. The data were submitted to descriptive analysis. Results: The prevailing profile was of elderly women, retired, white, with low educational levels, married and satisfied with their life conditions. The mean age was 72.3 years. The biological domain was the most compromised. As for the complexity of care, 34.8% of the patients required multiprofessional care. Conclusion: The elderly had high care complexity, with the biological and health system domains being the most compromised. ResumoObjetivos: Conhecer os aspectos biopsicossociais e as condições do sistema de saúde de idosos hospitalizados e classificar o grau de complexidade assistencial. Métodos: Trata-se de estudo quantitativo, cuja amostra por conveniência foi constituída por 279 idosos. Utilizou-se o método Interdisciplinary Medicine Instrument (INTERMED), ferramenta que identifica aspectos biopsicossociais e condições do sistema de saúde e classifica a complexidade do paciente. Os dados foram submetidos à análise descritiva. Resultados: Predominou idosos do gênero feminino, aposentados, de cor branca, baixa escolaridade, casados e satisfeitos com as condições de saúde. A média de idade foi 72,3 anos. O domínio biológico foi o mais comprometido. Quanto à complexidade assistencial, 34,8 % dos pacientes requerem assistência multiprofissional. Conclusão: Os idosos apresentaram elevada complexidade assistencial, com maior comprometimento nos domínios biológico e sistema de saúde.

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Section: Discussionsupporting

confidence: 72%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Biopsychosocial aspects and the complexity of care of hospitalized elderly

Gutierrez

Silva

Shimizu³

2014

Acta paul. enferm.

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“…[7][8][9] Yet, the addition of integrated behavioral health care, when evidence-based and appropriately configured, can improve health and decrease the total cost of care, ie, can reverse these negative outcomes. 10 Presently, most primary care clinics include neither systematic approaches nor specialty personnel to address the behavioral health care needs of their patients. Clinics cannot afford onsite mental health professionals, yet are overwhelmed with just meeting patients' medical needs.…”

Section: The Problemmentioning

confidence: 99%

Value-Based Financially Sustainable Behavioral Health Components in Patient-Centered Medical Homes

Kathol

deGruy

Rollman

2014

The Annals of Family Medicine

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Because a high percentage of primary care patients have behavioral problems, patient-centered medical homes (PCMHs) that wish to attain true comprehensive whole-person care will find ways to integrate behavioral health services into their structure. Yet in today's health care environment, the incorporation of behavioral services into primary care is exceptional rather than usual practice. In this article, we discuss the components considered necessary to provide sustainable, valueadded integrated behavioral health care in the PCMH. These components are to: (1) combine medical and behavioral benefits into one payment pool; (2) target complex patients for priority behavioral health care; (3) use proactive onsite behavioral "teams;" (4) match behavioral professional expertise to the need for treatment escalation inherent in stepped care; (5) define, measure, and systematically pursue desired outcomes; (6) apply evidence-based behavioral treatments; and (7) use cross-disciplinary care managers in assisting the most complicated and vulnerable. By adopting these 7 components, PCHMs will augment their ability to achieve improved health in their patients at lower cost in a setting that enhances ease of access to commonly needed services. INTRODUCTIONT he Affordable Care Act is centered on making health care less expensive and more effective. A cornerstone of this effort is an overhaul of primary care.1 Since over 40% of patients seen in primary care settings have behavioral health conditions, which include mental health and substance use disorders, disabling psychological symptoms and psychosocial stress, and unhealthy behaviors, 2 comprehensive primary care must necessarily address behavioral health issues.As the redesign of primary care takes place, insufficient attention to the critical behavioral elements of comprehensiveness will compromise the gains that are otherwise possible. And gains are possible: behavioral comorbidity, especially in patients with chronic and complex medical conditions, is associated with an estimated $350 billion per year spent on unnecessary medical and surgical services when behavioral conditions remain ineffectively treated.3 Unfortunately, two-thirds of patients with significant behavioral conditions receive no treatment at all, 4 and most of those who do, receive their care in the medical and not the behavioral care sector. 5,6 Moreover, this percentage does not change even for patients with severe mental disorders.While financial support for services delivered to patients seen in behavioral health settings remains important, this paper is focused on improving behavioral health care in the primary care setting, where the majority of patients with such problems are encountered. Today, hospitals, clinic systems, groups of primary care physicians, payors, and other stakeholders are seeking economically feasible ways to include behavioral health services that will add value, ie, improve health at equivalent or reduced cost, for patients seen in patient-centered medical homes (PCMHs...

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“…Psychiatric acuity capabilities appeared most distinctive for these high acuity clusters, while medical acuity capabilities are comparable. Both clusters can be classified as CIUs because of their medium to high medical and psychiatric acuity capabilities [8]. Supplementary Appendix C provides a complete overview of their differences and commonalities.…”

mentioning

confidence: 99%