Integrating Addiction and Mental Health Care into the Primary Care Practice
Providing addiction and other mental health care in the primary care setting has been demonstrated to reduce health care costs, improve function and symptom outcomes for patients, and improve provider satisfaction. We have developed tools to facilitate the training of providers and an electronic record to drive care. Foundations for Integrated Care is a training program developed by the Department of Veteran Affairs for mental health providers who work in the primary care setting. The program was based on years of experience and the available research evidence. While developed by the Department of Veteran Affairs, the program has wide application to medical homes, accountable care organizations and community practice.
The BHL software tool was created to provide the critical informatics support needed to be successful in this model of care. The software is a user friendly tool that facilitates the delivery of evidence and measurement based health care for a variety of mental health conditions including depression, anxiety disorders and addiction. The software tool provides a registry of patients being managed, collects and tracks outcome data, provides automated decision support for the patient and provider, allows ease of scheduling, and allows direct patient entry of self assessments.
Key Features of the Software
- Patient tracking and panel management
- Progress note generation
- Clinical triage with adaptable decision support
- Structured follow-up assessment for tracking and symptom monitoring of depression, anxiety, PTSD, pain, alcohol use, addiction, as well as medication monitoring
- Patient level feedback
- Letters with brief psychoeducation
- Patient feedback reports on treatment progress
- Administrative reports including workload and clinical outcome data
There were several principles used in designing the training program and accompanying software:
The program provides support for depression, alcohol and anxiety problems. Within each disorder, the program addresses a broad spectrum of severity, from watchful waiting for subsyndromal symptoms to treatment for mild to moderate symptoms to referral management for the most complex or severely affected individuals.
The program provides assessment, monitoring, early intervention, treatment for depression, anxiety and alcohol misuse, and referral management; thus, the program can be tailored by each center to their available resources.
The program allows for multiple methods of case finding (screening, direct referral, pharmacy-based referrals for new antidepressants, self-referral, etc).
The program can target individual patients for specific programs or research projects. The software offers decision support which operationalizes the program algorithm and can be further tailored to account for primary care provider or clinic preferences.
Assessments can be conducted either by telephone or face-to-face. The program can also be based at individual clinics or medical centers, or at central settings such as regional or VISN level centers.
The Foundations for Integrated Care manuals are attached as PDF documents. These are available free of charge. If you decide to use them please make sure you let us know and appropriately acknowledge the training materials in any publications or publicity. We do offer training - either at Penn or at your site. The training is broken into modules each lasting 4 hours. You pick and choose what you want to be trained on.
The BHL software is available for licensure.
David Oslin, MD
Foundation manual links