Clinicians Say Integrated Care Is Highly Satisfying

Working in an integrated care setting that allows psychiatrists to reach a larger number of patients in a variety of practice settings is highly satisfying, according to a survey of 52 clinicians published in Psychiatric Services in Advance on December 15, 2015.

Integrated care enables clinicians to reach “patients with mental health issues that without an integrated care approach would go undetected and untreated,” said one psychiatrist, in comments reflective of the overwhelmingly positive response.

Lori Raney, M.D., chair of the APA Work Group on Integrated Care, and colleagues from the University of Washington School of Medicine recruited psychiatrists for the survey from two sources: an online e-list developed to increase connections among clinicians working in integrated care and participants in previous national training sessions in integrated care implementation. The survey was available electronically to this group of psychiatrists, who self-identified as working in integrated care.

Sixty-seven respondents completed the survey between November 2011 and January 2012. The sample represented psychiatrists distributed across the United States, including the Northeast, South, Midwest, and West. Only psychiatrists working in integrated care settings at least five hours a week were included in the analysis. A total of 15 respondents were excluded because they were psychiatry residents or psychiatrists without direct patient care responsibilities.

The survey was composed of 36 multiple-choice questions addressing integrated care practice characteristics, team composition, common consultation questions, and systems issues. Six open-ended questions assessed the psychiatrists’ opinions and experiences.

Nearly all respondents reported that they provided consultation regarding medication recommendations (n=51) and diagnostic clarification (n=50). Forty-four respondents reported requests for consultation on behavioral interventions, and the same number reported requests for education on a specific topic. The most common diagnoses associated with consultation were anxiety, depression, and substance use disorders.

Responses to open-ended questions about the experience of working in integrated care were almost unanimously positive. The analysis highlighted four themes in respondents’ subjective experiences: working in a patient-centered care model, working with a team, the psychiatrist’s role as educator, and opportunities for growth and innovation. Some strengths of the model highlighted by those surveyed were that it fosters patient-centered care and offers benefits of working in a team—for example, “mutual support and efforts when helping patients who have a complex clinical presentation.”

Many comments revealed positive effects of the education provided by psychiatrists. “I enjoy educating and feeling like my efforts are reaching so many more people than they do in the traditional model of care,” one psychiatrist wrote.

Some challenges were reflected in survey responses, especially around the “culture change” required in a transition to integrated care. For instance, one respondent noted that “team members ... feel threatened by expanding their scope of practice or by allowing others to enter into an arena previously reserved just for them.”

Cultural change also emerged as a challenge when training new team members: “You get this well-designed functioning team and then someone leaves and the new person is hesitant/resistant for a while until you get the person in the groove.” Respondents also reported financial challenges, including “always fighting for resources and reimbursement systems that tend to encourage nonintegration.”

In remarks to Psychiatric News, Raney said the survey is the first to look at psychiatrists’ practice in integrated settings. “Core tasks including curbside consultation, education of team members, working with team dynamics, and providing leadership in primary care settings were reported by psychiatrists who participated in the survey,” she said. “The ability to reach more people in need of behavioral health treatment through the psychiatrist-supported approach in the collaborative care model was viewed as a very rewarding experience.” 

Raney urges APA members to take advantage of training in integrated care that APA will be providing as part of the Transforming Clinical Practice Initiative, a grant program for which APA is receiving $2.9 million over four years to train 3,500 psychiatrists in the clinical and leadership skills needed to support primary care practices that are implementing behavioral health programs (see page 1). APA is one of just 39 health care organizations selected by the Centers for Medicare and Medicaid Services to participate.

Raney said, “Continued efforts to engage more psychiatrists in this work are needed, and this study provides the first report of the core tasks and satisfaction experienced working in this exciting new area of psychiatric practice.” ■