Patients with depressive symptoms, often related to concerns about their health, relationships, or future, can become distressed. Care members refer distressed patients to psychiatry, but often, the wait for an appointment can make the distress worse and lessen the likelihood the patient will attend their appointment. Additionally, depression can contribute to a lack of medication adherence, self-care, and an increased risk of morbidity and mortality. Treating depression is essential for both patient’s depression and HIV care.
In the collaborative care model, the patient does not have to meet directly with the psychiatrist to receive the benefit of expert consultation. This process might not be familiar to the CP. Rather than one-on-one interactions, the CP is responsible for a caseload of patients and instead interacts with a Behavioral Health Care Manager (BHM) who relays valuable information to the CP. The CP provides mental health expertise and ensures safe and high-quality services, advising the BHM on patient care and entering recommendations into the Electronic Registry for the HIV physician.
The CP is responsible for promoting an environment where the BHM and HIV Physician receive training and acquire the knowledge and skills to diagnose and evaluate factors contributing to depression, and then make treatment recommendations.
A systematic approach to case consultation is highly recommended. For reference, MetroHealth has developed and refined a Case Consultation Formulation for the care team, addressing differential diagnosis and the appropriate treatment for each. It includes treatment goals and the processes for monitoring results. It also provides the HIV Physician with information on antidepressant dosing, side effects, and treatment considerations.
Also, the MIDUS Algorithm was created to allow HIV physicians and BHMs the ability to quickly identify the next steps to take for patients with different PHQ-9 scores to progress towards remission.
The CP meets weekly to review select cases with the BHM. These reviews focus on patients who are newly diagnosed or who are not improving as expected. History obtained from the BHM along with a review of the Electronic Medical Record help to formulate a diagnosis and make treatment recommendations. Treatment plans are adjusted based on information obtained or lack of response to previous intervention.
Consulting Psychiatrist Responsibilities:
- Provide case consultation review with the BHM. Reviews are best done at a dedicated time scheduled weekly for each BHM.
- Provide written recommendations in the EMR for the HIV physician.
- Provide direct support to the HIV physicians on challenging cases.