Who Should I Refer? VA Primary Care/Behavioral

Transcript:Who Should I Refer? VA Primary Care/Behavioral:
Who Should I Refer? VA Primary Care/Behavioral Health Integration in Practice David Hunsinger, MD, MSHA Medical Director Binghamton VA Outpatient Clinic Objective Over the course of this presentation, participants will begin to consider the broad range of clinical situations in which involvement of a Behavioral Health provider can prove helpful. Key Characteristics Co-located Collaborative Dedicated Behavioral Health (BH) Provider with schedule flexibility Warm Handoffs Benefits of the Model Timely patient evaluation and assistance There’s no time like the present…. Benefits of the Model Timely patient evaluation and assistance A continuation of the Primary Care encounter Eliminates the potential for ‘no show’ Benefits of the Model Face to face introduction Benefits of the Model Face to face introduction Lends legitimacy and credibility Reduces patient anxiety about the meeting More personal Benefits of the Model Face to face introduction Lends legitimacy and credibility Reduces patient anxiety about the meeting More personal Benefits of the Model Reinforces ‘whole person’ focus Mind body connection by John Hersey Tip #1 Referrals are not just for Urgent Problems Urgent Problems Major depression Anxiety Grief reaction Adjustment reaction ‘crying in the office’ Tip #2 Consider scripting your warm hand-off intro Warm Hand-Off “I work with someone whose job is to help patient’s in situations like this. If you have a few minutes, I’d like to introduce you.” “We have someone who is a great resource for these things. Let me introduce you and you can get his/her card if you want to talk to someone about it.” Warm Hand-Off “One of the members of your healthcare team is _________. If you have a few minutes, I’d like to introduce you so he/she can tell you a little bit about what kind of help he/she can provide you.” Tip #3 Refer all positive Clinical Reminder screens …….better yet, revise clinic flow to have these patients seen automatically Clinical reminders PHQ2/PHQ9 [depression] PTSD screen AUDIT-C [alcohol] ?TBI screen Tip #4 Think Patient needs not Diagnoses Needs not Diagnoses Establishing a healthy lifestyle Behavior change Tobacco and alcohol issues/concerns Relationship stress Job stress Establishing a healthy lifestyle Exercise Healthy Diet Sleep hygiene Exercise Cardiovascular conditioning affects many health conditions Promotes a sense of well-being Relieves stress/tension/anxiety Healthy Diet Weight loss Disease specific concerns Patients considering MOVE Patients unable to participate in MOVE Tobacco Use Individual coaching as an alternative to QuitSmart Relationship issues Spouse/significant other Children Boss Co-workers Tip #5