>There is no clinically logical way to improve health care if we can't >integrate behavioral & mental health with physiological health at the >gatekeeper level. The divide between these fields is fluid. A good >medical gatekeeper should be fairly paid to make all proper referrals, >without regard for outmoded clinical categories that treat patients with >chemical overdoses as separate from patients with depressions, patients >with liver cirrhosis as separate from patients with alcohol dependency. > >-- Tony West
Neighbors, I was going to ignore West, but the issue is too important. Using a multi-disciplinary approach in a primary care setting has many potential benefits. No one has suggested that doctor's can't now address underlying causes of major disease, as West suggests. And it's a ridiculous distraction to assert that doctors wouldn't refer an alcoholic to treatment or not order a psych evaluation after a suicide attempt. Tony is just being Tony. (By the way, viral hepatitis is a leading cause of cirrhosis and other liver disease. Not all OD's are suicide attempts by depressed individuals.) The article only touches on brief interventions in what is generally called, "behavioral health." There are huge gaps in the relevant delivery systems (either a major mental health diagnosis and formal treatment or nothing at all for the individual). These brief interventions are a great example to introduce the concept of a multi-discplinary approach in the article. But having a social worker on site, where many real problems are easily identified, has many more potential benefits. If a pediatrician prescribes medicine for a child to parents with literacy troubles, you can imagine how this might negatively impact compliance with medical advice. Literacy is a big barrier to compliance, which is recognized. This is not an issue in the domain of the physician to address. It is an issue that the social worker can initially address on site. Referrals work much better if they are done properly! This concept is important for those individuals to consider, who wish to see the quality of care improved while using proven strategies that are cost effective. Here again is the link to the article. http://www.philly.com/inquirer/health_science/A_side_of_behavioral_counseling_with_your_visit.html -----Original Message----- >From: Anthony West <[email protected]> >Sent: Sep 28, 2009 6:29 PM >To: UnivCity listserv <[email protected]> >Subject: Re: [UC] Report on integrated care > >There is no clinically logical way to improve health care if we can't >integrate behavioral & mental health with physiological health at the >gatekeeper level. The divide between these fields is fluid. A good >medical gatekeeper should be fairly paid to make all proper referrals, >without regard for outmoded clinical categories that treat patients with >chemical overdoses as separate from patients with depressions, patients >with liver cirrhosis as separate from patients with alcohol dependency. > >-- Tony West > > >> Here is a local report about integrating brief behavioral health care >> interventions with primary care. The benefit to individuals and society, >> when patient needs are identified and addressed in a coordinated system, is >> tremendous. Even brief interventions are extremely cost effective and help >> with problem identification that is otherwise overlooked and untreated. >> >> Thankfully, the report notes this coordination of care as another gap in >> the current for profit billing system for health care delivery! We could >> truly help people much less expensively with such coordination within >> systems. >> >> I developed a similar brief follow-up process for high risk behavioral care >> patients referred to employment. With great success, I showed that brief >> intervention (often via phone) could help individuals maintain employment. >> (It is what employers want much more than tax credits in order to hire the >> formerly incarcerated- the current emphasis of the city program) The >> benefits of treating the needs of the whole person is much greater than >> expensive treatments for individual problem areas. It should make sense >> intuitively to most people! >> >> http://www.philly.com/inquirer/health_science/A_side_of_behavioral_counseling_with_your_visit.html >> >> >> Glenn > >---- >You are receiving this because you are subscribed to the >list named "UnivCity." To unsubscribe or for archive information, see ><http://www.purple.com/list.html>. ---- You are receiving this because you are subscribed to the list named "UnivCity." To unsubscribe or for archive information, see <http://www.purple.com/list.html>.
