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Who Should I Refer? VA Primary Care/Behavioral Health Integration in Practice. David Hunsinger , MD, MSHA Medical Director Binghamton VA Outpatient Clini c. Objective.

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who should i refer va primary care behavioral health integration in practice

Who Should I Refer?VA Primary Care/Behavioral Health Integration in Practice

David Hunsinger, MD, MSHA

Medical Director

Binghamton VA Outpatient Clinic

objective
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
Key Characteristics
  • Co-located
  • Collaborative
  • Dedicated Behavioral Health (BH) Provider with schedule flexibility
  • Warm Handoffs
benefits of the model
Benefits of the Model

Timely patient evaluation and assistance

benefits of the model1
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 model2
Benefits of the Model

Face to face introduction

benefits of the model3
Benefits of the Model

Face to face introduction

  • Lends legitimacy and credibility
  • Reduces patient anxiety about the meeting
  • More personal
benefits of the model4
Benefits of the Model

Face to face introduction

  • Lends legitimacy and credibility
  • Reduces patient anxiety about the meeting
  • More personal
benefits of the model5
Benefits of the Model

Reinforces ‘whole person’ focus

tip 1
Tip #1

Referrals are not just for

Urgent Problems

urgent problems
Urgent Problems
  • Major depression
  • Anxiety
  • Grief reaction
  • Adjustment reaction
  • ‘crying in the office’
tip 2
Tip #2

Consider scripting your warm hand-off

intro

warm hand off
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 off1
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
Tip #3

Refer all positive

Clinical Reminder

screens

…….better yet, revise clinic flow to have these patients seen automatically

clinical reminders
Clinical reminders
  • PHQ2/PHQ9 [depression]
  • PTSD screen
  • AUDIT-C [alcohol]
  • ?TBI screen
tip 4
Tip #4

Think Patient needs

not Diagnoses

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
Establishing a healthy lifestyle
  • Exercise
  • Healthy Diet
  • Sleep hygiene
exercise
Exercise
  • Cardiovascular conditioning affects many health conditions
  • Promotes a sense of well-being
  • Relieves stress/tension/anxiety
healthy diet
Healthy Diet
  • Weight loss
  • Disease specific concerns
  • Patients considering MOVE
  • Patients unable to participate in MOVE
tobacco use
Tobacco Use
  • Individual coaching as an alternative to QuitSmart
relationship issues
Relationship issues
  • Spouse/significant other
  • Children
  • Boss
  • Co-workers
tip 5
Tip #5

Healthcare is a team sport [especially in a PACT environment]

slide33
Team
  • Talk to your PCMHI provider
  • Ask for suggestions about referrals
  • Invite him/her to huddles and team meeting where patients are discussed
tip 6
Tip #6

Most people’s lives are impacted far more by psychological, psychosocial, and behavioral issues than by physical issues

conclusion
Conclusion

So…………

refer early

refer often!

conclusion1
Conclusion

So…………

warm hand-off early

warm hand-off often!