successful integration of behavioral health into medical hypertension management
DESCRIPTION
Successful Integration of Behavioral Health into Medical Hypertension Management. Session I5 – Tapas Saturday, October 29, 2011. University Family Medicine—Denver Health Lowry Family Health Center Hypertension Clinic Verena Roberts, Ph.D. Learning Objectives. - PowerPoint PPT PresentationTRANSCRIPT
Successful Integration of Behavioral Successful Integration of Behavioral Health into Medical Hypertension Health into Medical Hypertension ManagementManagement
University Family Medicine—Denver University Family Medicine—Denver HealthHealth
Lowry Family Health Center Hypertension Lowry Family Health Center Hypertension ClinicClinic
Verena Roberts, Ph.D.Verena Roberts, Ph.D.
Session I5 – TapasSaturday, October 29, 2011
Learning ObjectivesLearning ObjectivesLearn how to successfully integrate
behavioral health into medical management of hypertension
Learn innovative approaches to management of patient health
Learn how to deliver brief evidence-based practices on hypertension in a time-limited
Learn how to adapt an integrated approach to your clinic structure
Denver Cares
Denver Cares
Correctional Care
Correctional Care
Denver Health
Medical Center
Denver Health
Medical Center911911
Community Health
Services (CHS)
Community Health
Services (CHS)
Regional Poison
Center & Nurseline
Regional Poison
Center & Nurseline
Denver Health
Medical Plan
Denver Health
Medical Plan
School-based Health Centers
School-based Health Centers
Rocky Mtn Center for
Medical Response to Terrorism
Rocky Mtn Center for
Medical Response to Terrorism
Public HealthPublic Health
Rocky Mtn Regional
Trauma Ctr
Rocky Mtn Regional
Trauma Ctr
Denver Health/CHSDenver Health/CHS
Lowry Family Health CenterLowry Family Health CenterMedical Director/Team Leader (MD)Program Manager (RN)3 FT/3 PT MD Attendings2 F-NPs2-2-2 Family Medicine Residents2 Behavioral Health Consultants (PsyD & PhD)2 RNsPT Patient Navigator6 Medical Assistants a/k/a Health Care Partners (HCPs)PT Pharmacy Dispensary TechnicianPT Family Planning Educator3 Laboratory Technicians Clerical Supervisor5 ClerksResidency Coordinator
From Idea to ImplementationFrom Idea to Implementation How we got started:
◦ PCHM project
◦ Clinic split into two teams
◦ Each team chose a “topic” Hypertension (HTN)
◦ Weekly “HTN Clinic” focused on medical HTN management of patients with HTN who were already diagnosed by their PCP, but blood pressure was uncontrolled
◦ 1 provider sees only HTN patients in 1 afternoon session Medication assessment Educational handout NO BEHAVIORAL HEALTH
Aim StatementAim Statement We aim to improve the identification and management of patients with
hypertension in Lowry Family Health Center. The process begins with the correct diagnoses of hypertension. The process ends with each patient having an individualized care plan. By working on the process, we expect:
- improved health- decreased visits for patients- improved outcomes- patient and employee satisfaction- medication compliance- increased access- decreased cost. It is important to work on this now due to: 1. Access issues 2. Expensive to health care system 3. Decrease mortality and morbidity in patients.
Behavioral Health IntegrationBehavioral Health Integration
Metamorphose of the Lowry HTN clinic◦Idea was introduced to team during monthly
PCMH meeting◦After initial “yes” – more detailed proposal
Logistics Content
◦Continued discussion with medical provider who was conducting the HTN clinic
◦Develop and research evidence-based treatments that can be adapted to short primary care visits
Integrated HypertensionIntegrated HypertensionClinic Key FeaturesClinic Key Features• Half-day scheduled with 8-10 HTN patients• Visit limited to hypertension issues• All patients seen by medical and behavioral health provider
• either together or one after another• Medication adjustment for hypertension• Self-management goal-setting/ Motivational Interviewing• Follow-up during HTN clinic only• Clinic is provider-driven
Clinic FlowClinic FlowPatient
navigator selects patients
from registry or PCPs refer patients
- Patients have to
have HTN dx -
appointment is made by navigator or
HCP
Clerk checks
patients in – HCP
gets vitals and blood pressure, rooms pt.
PCP and BH see patient together Or alone, but tag team,
so that each patient is
still seen by both, PCP and BH- Use
Vocera to communicate & manage
flow
Check out via HCP (if
non-English) or clerk and follow-up
appointment is made
Extending the Team WorkExtending the Team Work• Clerks and HCPs manage visit flow and assist with
check out and follow-up• Patient navigator finds patients via registry and
makes calls• Other PCP’s make referrals to HTN clinic• Remember – this is not a 2 person pony show, but a
team approach
Action Plan SheetAction Plan Sheet
Challenges to IntegrationChallenges to IntegrationData collection Clinic flowTurf protectionFollow-upProvider driven
Key Factors to IntegrationKey Factors to Integration Get your clinic on board!
◦ Talk to leadership
◦ Use PCMH as starting point Start small Be flexible Be persistent Show providers and patients how behavioral health can help Have a plan Do not take “no” for an answer, but come up with solutions – or
better – think of possible problems that may occur and have an answer
Build positive relationships with providers Regroup after each clinic – what works, what doesn’t? Give positive feedback and point out your successes! Involve the entire team as needed
AdaptationsAdaptationsTalk to PCP’s about behavioral health seeing patients
with significant HTN issues via integrated care visits (PCP & BH present at same visit)
Each day, scout out patients and huddle with PCPs regarding which patients are appropriate for BH integrated visits
Advertise how BH can help PCP’s with HTN patients If you happen to be unavailable, have patient see BH in
individual visit or schedule future integrated visit
Questions/DiscussionQuestions/Discussion