diabetes 101 and depression screening and treatment...apr 25, 2017 · interactions of depression...
TRANSCRIPT
4/25/2017
1
Integrating Healthcare
Through Population
Health Management
Joseph Parks, M.D.
National Council Behavioral Health Medical Director
Today’s Moderators
Madhana Pandian
Coordinator
Deann Jepson, M.S.
Co-facilitator
Slides for today’s webinar will be
available on the CIHS website:
www.integration.samhsa.gov
In the About Us/Innovation Communities 2017 tab
To participate
Use the chat box to communicate with other attendees
Use the question box to send a question directly to presenters.
Disclaimer: The views, opinions, and content
expressed in this presentation do not
necessarily reflect the views, opinions, or
policies of the Center for Mental Health
Services (CMHS), the Substance Abuse and
Mental Health Services Administration
(SAMHSA), the Health Resources and
Services Administration (HRSA), or the U.S.
Department of Health and Human Services
(HHS).
Setting the Stage
Dr. Joe Parks
National Council Behavioral Health Medical Director
4/25/2017
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Setting the Stage
John Kern, MD
Clinical Professor of Psychiatry and Behavioral Sciences at
University of Washington
Diabetes 101 and
Depression Screening
and Treatment
John S. Kern MD
April 2017
Behavior Change is not easyKaton on relationship between DM and
depression
Collaborative Care as approach to
depression in primary care
Basic principles
Population-Based Care
Measurement-Based Treatment to Target
Patient-Centered Collaboration
Evidence-Based Care
COLLABORATIVE CARE TEAM
New Roles
PCP
Psychiatric
Consultant
BHP/
Care
Manager
Patient
© University of Washington
4/25/2017
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Primary Care Provider
New Roles
PCP
Psychiatric
Consultant
BHP/
Care
Manager
Patient
© University of Washington
Behavioral Health Provider / Care Manager
has two functions
New Roles
PCP
Psychiatric
Consultant
BHP/
Care
Manager
Patient
© University of Washington
CARE
MANAGER
MSW
LCISW
RN
PsyD, PhD
Psychiatric Consultant Role
New Roles
PCP
Psychiatric
Consultant
BHP/
Care
Manager
Patient
© University of
Washington
Screening processes
PHQ-9
GAD
MDQ / CIDI
AUDIT – CAGE
DAST
PST-PC
Getting
buy-in
from staff PHQ-9 above 10
AIM for remission
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Biopsychosocial treatment
Evidence-based meds
Don’t wait to start meds if they are indicated – clinical inertia
can really delay access to effective treatment.
Evidence based psychosocial treatment
Behavioral Activation
Problem-solving therapy
Treatment protocol – this is an
EXAMPLE, not the Gospel!
Use of registry
Who is not getting better
Who is slipping through cracks
Don’t obsess waiting for the perfect tool
Should also be used for physical monitoring
Depression Registry
TEAMcare
The TEAMcare Program
TRAINING WORKBOOK
A Program for Managing Depression, Diabetes
and Coronary Heart Disease
in Primary Care
TEAMcare Research Group:
PC in MH registry
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Training behavioral health staff in
Collaborative Care – sources of material:
AIMS center website: aims.uw.edu
Center for Integrated Health Solutions web page
Establishing Policies and Procedures
Starts with buy-in from the top
Systematizing:
Screening – front desk has to be involved
Flow to get screening result to the PCP in a digestible form
Double entry into registry – has to be done by someone.
Registry review and outreach – has to be done by someone.
PCP involvement – may require persuasion / engagement –
they need to know when hired.
Money for psychiatric consultation.
An example from AIMS:
An instrument for
Assessing Gaps in care process:
© 2016 American Psychiatric Association. All rights reserved.28
ENGAGING THE PCP: ”WHY AM I DOING
THIS?”
These patients are already your patients.
They are not going away.
We can help with everyday workflow, shorten long appointments, reduce arguments about controlled substances... We have your back!
Can help with chronic disease outcomes, IMPROVE YOUR METRICS!
© 2016 American Psychiatric Association. All rights reserved.29
SECRET SAUCE
Frequent early contactBao, Y., Druss, B.G., Jung, H.Y., Chan, Y.F. & Unützer, J. (2015).
Unpacking Collaborative Care for Depression:
Examining Two Essential Tasks for Implementation.
Psychiatric Services in Advance, doi: 10.1176/appi.ps.201400577
Treatment to target Unutzer et al,American Journal of Public Health Vol. 102, No. 6,
pp. e41-e45, 2012
0.0
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50.5
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0
Estim
ate
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um
ula
tive P
rob
ab
lility
0 8 16 24 32 40 48 56 64 72 80 88 96 104 112 120 128 136
Weeks
Before P4P After P4P
Questions?
4/25/2017
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Learning Sessions
May 23, 12 noon – 1 p.m. ET
Presenter: Joseph Parks, M.D.
Interactions of Depression and Diabetes –
Impacts on Treatment and Outcomes
June 15, 2 – 3 p.m. ET
Presenter: Katie Stuckmeyer
Metabolic/Diabetic Screening and Strategies
to Improve Treatment Adherance
July 28, 2 – 3 p.m. ET
Presenter: Jeff Capobianco, Ph.D., LLP
Strategies to Maintain Gains, Support Momentum, and
Sustain Adoption of the Innovation
Report Out
August 15
2 – 3:30 p.m. ET
5 x 5 presentations
Learn how Innovations Community participants are: Progressing toward goals
Sustaining momentum, improving interventions, and garnering
positive gains
Establishing best practice models across the organization
Next Steps:
Continue to:
work on your plan’s action steps with your team,
meet with your coach on a regular basis, and
provide status updates.
If you haven’t done so already...
schedule a call with your coach, and
send a copy of your workplan to your coach.
ResourcesDiabetes Management
• http://www.integration.samhsa.gov/health-wellness/wellness-
strategies#diabetes
• http://www.integration.samhsa.gov/about-
us/5_21_2015_Best_Practiecs_in_Diabetes_Management.pdf
Collaboration & Teamwork
• http://www.integration.samhsa.gov/workforce/collaboration-and-teamwork
Depression Screening Tools
• http://www.integration.samhsa.gov/clinical-practice/screening-
tools#depression
Depression and Diabetes in Marginalized Communities: Spotlight Hispanic
Community
• http://www.integration.samhsa.gov/workforce/Diabetes__Depression_in_the_HispanicLatino_Community.pdf
Benefits of Integrating Diabetes and Depression Care Study
• http://www.integration.samhsa.gov/news/articles/2016/09/23/treating-diabetes-
and-depression
Thank you for joining us today.
Please take a moment to provide
your feedback by completing the
survey at the end of today’s
webinar.
If you have additional questions/comments, please send them to:
Joe Parks – [email protected]
Deann Jepson – [email protected]
Madhana Pandian – [email protected]