Integration Between Primary Care Physicians, Psychologists Examined

A December 2017 issue of the Journal of Interprofessional Education and Practice focuses on the benefits of collaboration between primary care physicians (PCPs) and psychologists.

Two articles in particular, the first led by E. Farmanova, MSc, a doctoral candidate with the University of Ottawa's Interdisciplinary School of Health Sciences, and the second led by Carole Ivey, PhD, with the Department of Occupational Therapy at Virginia Commonwealth University, focus on gathered insights, challenges and successes of integrated/collaborative health.

Both articles point out integration between PCPs and mental health professionals increase access for underserved populations in particular, improves patient care by focusing on whole health, and identifies communication between care providers as key to providing optimal healthcare for patients.

Farmanova and colleagues reported the results of a 1-year demonstration project focused on the current inefficiencies of mental health delivery in primary care, and the benefits of collaboration/integration between PCPs and psychologists as a means of improving both efficiency and care for patients.

Farmanova's project observed the development of collaboration following the integration of 2 psychologists into 2 Eastern Ontario PCP practices — 1 rural clinic with 4 PCPs and 1 urban clinic with 10 PCPs — for a period of 12 months.

Through observation and focus group feedback from psychologists and PCPs at project months 3 and 6, and follow-up post-studies at months 13 and 16, researchers found participants saw referral/informal consultation as an ideal model of collaboration between mental health professionals and physicians in primary care settings.

Farmanova and colleagues are not alone in asserting patients, families, healthcare providers and researchers have identified the need for integrating mental health and primary care services. The provision and quality of primary mental healthcare is improved when PCPs work in close collaboration with mental health professionals.

Their qualitative study bolsters evidence of the benefit of interprofessional care while reporting on the collaborative process, and its perceived success.

Farmanova and colleagues reported at project completion, PCPs and psychologists felt they and their patients benefited through a mix of informal collaboration/corridor consultation and classic referral and consultation with a beneficial increase in 2-way dialog between PCPs and psychologists via messaging/emails and within electronic medical records (EMR) notes.

Upon returning to care as usual, PCPs and psychologists reported they felt they lost a vital resource and were increasingly interested in establishing other team-based approaches to care — even suggesting the addition of other allied health care professionals to expand care for patients.

A similar study lead by Carole Ivey (pictured) and colleagues took place over 12 months in an urban complex care clinic with 10 full time clinicians, including 2 PCPs and 2 clinical psychologists.

Rather than focusing soley on clinicians, Ivey and colleagues collected qualitative data from patients (n=13) and healthcare providers (n=10). Twenty-one hours of audio data was collected across a 4 month time frame at regular interprofessional team meetings, and clinicians were interviewed individually in private sessions. Patients were interviewed in 30-90 minute sessions on the medical campus and/or at the patients' homes.

Ivey reported several common themes during the course of analysis: decreased use of emergency rooms by patients, improved patient health, and an increased appreciation for interprofessional teamwork.

“Patients and clinicians described these health improvements being related to the clinic through development of trust and making a connection with the staff resulting in long term lifestyle change," Ivey noted.

"You get the most joy out of the ones where you can see them truly engage in their health and they begin to see that it works,” a physican reported. Improvements in patient health was seen as a positive factor benefiting both patient and clinician.

Both patients and clinicians reported the team approach to care in the clinic lead to increased access and use of resources that patients typically did not have access to, such as mental health care. Clinicians reported that an interprofessional approach also allowed for team-based discussions and joint problem solving.

In an MD Magazine interview, Ivey stated given the evidence that collaborative/integrated care is beneficial to management of mental illness within primary care services, professional programs recognize the need to prepare students to be collaborative practitioners, providing them with interprofessional education opportunities to build collaboration skills.

While this is an important starting point, Ivey feels current practitioners need to reach out and engage in shared models with other practitioners — engaging in continuing education on interprofessional processes of care and collaborating with other professionals.

Jodi Winship, PhD candidate, co-author of the study with Ivey, told MD Magazine that there are some obstacles to these collaborative care models.

“Collaborative care requires a cultural shift in our primary health care system,” Winship noted. “Effective dissemination to practitioners in the field regarding best practices and research translating collaborative models into practice can facilitate this shift."

“We need to look further at our view of traditional medical care and how that view is an obstacle to collaborative care,” said Ivey. "This [collaborative care] involves more than putting a PCP and a mental health practitioner together; it involves changing their way of practice."

Growing interest in interprofessional or collaborative healthcare models, particularly those between PCPs and mental health care professionals, seems to be motivated by the successes reported by recent studies like those by Farmanova and Ivey.

Both studies reported integrated health care models have the potential to improve patient care and address complex care needs in dramatic ways, but it will take concerted effort from the medical community to shift into collaborative care models.

The article by Farmanova et. al. "A demonstration study of collaboration in primary care: Insights from physicians and psychologists" and the article by Ivey, et. al. "Challenges and successes in an integrated behavioral complex care clinic" both appear in the December 2017 Journal of Interprofessional Education and Practice.