Defining the Value: What is the Value of the MIDUS Approach?

MIDUS_HIV_collective-care-defining-value

 

It’s important for healthcare providers to consider all the ways that collaborative care models can contribute to your patients’ health and your practice. A quality collaborative care model will ensure sustainability and value to your organization. Here are some benefits to consider:

Access

With the collaborative care model, mental health care and treatment improves access as patients can receive psychiatric care much sooner than they would in another model where they are referred for direct psychiatric evaluation and management.

Patient satisfaction

Behavioral health Managers (BHMs) can effectively establish rapport with patients, creating higher satisfaction with the care and treatment, decreasing stigma surrounding mental health, and improving quality of life. Patients found that when they participated in the collaborative care model, they felt more supported throughout their care experience.

Patient engagement

Because of increased satisfaction with their treatment process, some patients who are initially skeptical of a psychiatric diagnosis, when provided with education, support, and resources, become accepting of their diagnosis and engaged in their care over time. They become more comfortable opening up and less embarrassed discussing their mental health problems, especially those related to trauma and substance abuse.

Provider decision support

Many HIV providers recognize the burden of psychiatric illnesses in their patients; however, they may not have the training or skills to treat psychiatric disorders. Providers receive decision support for the psychiatric consultant. In addition, a list of antidepressants that are unlikely to interact with HIV medications, their starting doses, titration schedule, and side effects are made available to the providers.

Additionally, each staff member had a good understanding of their own level of expertise and limitations, as well as their colleagues’ expertise and limitations.

For example, because of their experience treating the social determinants of health, social workers have a unique perspective on the ways in which support groups, self-management strategies, and other social components can help in treating a patient’s depression.

A physician’s expertise, on the other hand, is primarily in medical-based treatments, and are therefore more likely to recommend an evidence-based antidepressant, to identify biological contributors to depression symptoms, or to refer the patient to psychiatry.

Either option may be appropriate for a patient, but more importantly, both the doctors and social workers know their own limitations and can count on the others’ expertise if necessary. Open discussion and communication between providers is always better for patient care, especially in treating challenging mental health cases that may be multifactorial in nature and require a multi-disciplinary approach.

Increased diagnostic accuracy

The use of a structured diagnostic assessment helps identify comorbidities among patients. Additionally, when measurement-based care (use of a regular tool to assess response to symptoms) is used and patients do not have symptom remission, the diagnosis can be reconsidered. Through this approach, clinic providers can identify many comorbidities such as post-traumatic stress disorder (PTSD) and substance use disorders, which can mediate depression outcomes. For example: some patients who were initially diagnosed with major depressive disorder may later be re-diagnosed as having bipolar disorder.

The collaborative care model can be adapted to provide treatment for a complex neuropsychiatric population such as people living with HIV. A number of psychiatric disorders occur at high rates in people living with HIV. Our adaptation of collaborative care model for people with HIV involves a detailed and structured diagnostic assessment for all commonly occurring psychiatric disorders. Neuropsychiatric causes of symptoms due to HIV or other related conditions are considered on the differential diagnosis when making a recommendation. We utilize screens for neurocognitive disorders such as the Modified HIV Dementia Scale and the Montreal Cognitive Assessment (MoCA) to identify neurocognitive impairment. Information obtained from these screenings can then be utilized to formulate a differential diagnosis and guide management. Sensitivity to and awareness of lesbian, gay, and transgender issues are integrated into the delivery of care.

Team support

It is common for providers to spend a disproportionate amount of time providing care for a small fraction of their patient panel who have complex care needs and usually have psychiatric comorbidities. In the collaborative care model, providers can work with a team, decreasing feelings of isolation and burnout that often result in turnover of staff.

Coordinated care: It is necessary in collaborative care to ensure effective communication between all members of the team and involve other relevant staff members (e.g., medical case workers or nurses) when necessary. Effective communication, combined with leveraging the use of electronic health records, helps clinics achieve coordinated care to best address the needs of patients.


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