MENTAL HEALTH INTEGRATION PROJECT ENHANCING MENTAL HEALTH PRACTICE
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MENTAL HEALTH INTEGRATION PROJECT ENHANCING MENTAL HEALTH PRACTICE IN PRIMARY CARE… through improved education and communication. Dr. Ken Casimir MD Affinity Medical Group Dr. Mark Marnocha Ph. D UW-SMPH Family Medicine Dr. John Mielke MD Appleton Cardiology/Community Foundation Dr. Doug Moard MD Thedacare Family Medicine Dr. Mark Rovick DO Fox Valley Children’s Psychiatric/MCW
Setting Fox Valley region: Third largest urban population area in Wisconsin n Larger Cities: Oshkosh, Neenah, Menasha, Appleton. n [Green Bay] n Smaller Towns: Chilton, New London, Shawano, Hortonvlle, Kimberly, Kaukauna, Little Chute, Freedom…. Limited Scope: contiguous communities, and those with linkage via health systems x 2. n Region/Community/Practice driven rather than state-level or discipline-specific. n
Weaknesses/Threats Serious shortage of Pediatric Psychiatry n Inadequate Adult Psychiatry Access n Nation-wide shortage of psychiatry n Strong Family Medicine practices, though majority not full-scope. (no inpatient medicine or Ob) n Family Medicine forced to assume wider scope of MH practice. n
Strengths/Opportunities Community interests in compassion, education, health-care, and youth services. n Community Foundation w/physician voice. n Connections with MCW and UW-SMPH Medical residency and consultation programs. n Involved psychiatrists with community, primary care, and youth expertise. n Community aim to improve MH access, align pediatric MH resources, and upgrade MH prevention. n
Relevant Literature Diverse studies of upgrading MH care skills among primary care physicians. n No clear ‘gold standard’ as far as methods with well-documented and replicated results. n Recent statewide initiatives to bolster primary care MH care skills, notably New York, Massachusetts, Nebraska. n Pediatric MH concerns increasing, eg, ADHD overdiagnosis, proper use of atypicals, suicide prevention, emerging n
MHIP Task Force 630 am meetings begun in 2011 n Coffee stat and prn n Prior history of diverse connections among MHIP group members. n Ongoing alignments with health systems, community initiatives, educational resources. n Initial literature review. n Questions about regional needs & physician interest? n Development of mixed Quantitative/ n
Interview Format 11 Likert or other numeric items. n 5 yes-no or other forced choice items. n 4 open-ended questions. n Comments solicited after all items. n Interview responses transcribed by interviewers. n Numeric and content summaries by 1 st author. n
Physician Survey Information MHIP n n n 21 semi-structured face-to-face interviews 12 female / 9 male regional physicians Snowball/Convenience Sample MD/DO mix Most Early-Middle career (3 -20 years post residency) n n n 17 Family Medicine, 3 Pediatrics, 1 Internal Medicine 8 Affinity; 7 Thedacare; 2 Kaukauna Clinic; 1 each FCCHC, PCA, UW, Independent From Appleton, Chilton, Greenville, Kaukauna, New London, Oshkosh,
General Numerical Findings n 57% do not feel proficient caring for MH problems. n 67% do not feel counseling is sufficiently accessible. n Only 29% identify an MD partner w/special interests in MH care. n Only 20% find MH care reimbursement to be a problem.
Physician Views about MH Changes BAD NEWS = “More Psychiatrists” is most needed change, but least practical. n GOOD NEWS = “More PCP training” is 2 nd most needed change, and the most practical. “More Counseling” is moderate in need and practicality. “Reimbursement Change” is least needed, and 2 nd least practical. n
Need for MH Changes 5 change areas rated from 4 = ‘Great Need’ to 1 = ‘Minimal Need’
Practicality of MH Changes 5 change areas rated from 4 = ‘Highly’ to 1 = ‘Minimally’ Practical
Physician Interest in MH Training 95% indicated they are either “Very amenable - Sign me up” or else “Interested-Have some questions. ” n Only 1 MD (later career) not interested! n Only 24% (5 Physicians) said they need any compensation for such training. n EXTENSIVE ideas from physicians for training content, AND for in-depth group training face-to-face with primary care peers and psychiatry / MH resource people. n
Interview Content Summaries Mental Health Care Concerns: Lack of communication w/psychiatry; poor access to general MH resources; access to psychiatry; resources unfamiliarity. n Suggested Training Areas: Refractory depression; Younger children; Bipolar; Schizophrenia; Suicide; ADHD; Managing meds; Algorithms for treatment, diagnosis; Listening/counseling. n
Initial MHIP Conclusions Additional psychiatric training is clearly identified by PCPs as both necessary and practical n 95% of surveyed PCPs were either “interested” or “very interested” in structured psychiatry CME training n Only 24% of surveyed PCPs identified a need for reimbursement for CME time n
Conclusions (continued) PCPs identify their relationships with psychiatrists as less than satisfactory n Communication regarding available mental health resources is inadequate n Improvement of MD-MD relationships, along with readily accessible network re: available resources is essential n
Current status of project n n n n Community Funding Initial curriculum per ASCP, with augmentation prn 9 monthly evening sessions Emphasis on complex cases, minimal basic review, and current evidence/practice updates 2. 5 hours with dinner ~50 registrants; including NPs and students/residents. Future iterations may include office staff involved in MH case management Session eval forms; pretest and posttest
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