Collaborative Psychiatric Care in Palliative Care William Pirl, MD, - - PowerPoint PPT Presentation

Tele-consults and Models of Collaborative Psychiatric Care in Palliative Care

William Pirl, MD, MPH Director, Center for Psychiatric Oncology and Behavioral Sciences Past-President, American Psychosocial Oncology Society June 10, 2015

Objectives

➔Describe at least two different models of

collaborative psychiatric care

➔List the steps needed to implement a

collaborative psychiatric care model

➔Analyze the feasibility and appropriateness of

implementing a collaborative psychiatric care model at their own site

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Psychiatric Care in the U.S.

➔319 million people in U.S. ➔25,000 psychiatrists ➔> 50% of psychiatric care provided by non-

psychiatrists

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Lessons from Primary Care

➔Novel models of care ➔Collaborative with non-mental health

providers

➔Decreased barriers for patients

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Extension Models and Palliative Care

➔Palliative care clinicians assess psychosocial

well-being in all patients (screening)

➔Higher level of psychiatric skills in palliative

care

➔Experienced in working closely with other

services

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Psychiatry Expertise

➔Diagnosis of psychiatric disorders ➔Psychopharmacology ➔Mental health treatment planning ➔Neuropsychiatry ➔Recognizing limitations ➔Being suspicious

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Psychiatry Models

Separate Integrated Collaborative

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Patient Needs and Models

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Patient Needs and Models

Primary care

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Patient Needs and Models

Specialty psychiatry: Bipolar disorder Psychotic disorders’ Suicidal patients

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Patient Needs and Models

Palliative care with extension of specialty psychiatry: Depression Anxiety Sleep problems

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Patient Needs and Models

Palliative care with extension of specialty psychiatry: Can the patient be managed by palliative care? Treatment resistant disorders

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Extension Models

➔ Remote visits ➔ Supervision ➔ Tele-consults ➔ Integrated consults

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Remote Visits

➔ Psychiatrist provides

evaluations and treatment directly to patient via video or telephone

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Remote Visits

➔ Pros

– May be best option in rural settings – More thorough evaluation by psychiatrist – Billing – Convenient for patients

➔ Cons

– Same amount of psychiatrist time – Need for local responsible clinician (safety issues) – Patients’ ability to operate technology – Equipment and space

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Supervision

➔ Regular meeting, in

person or over phone, to discuss cases with psychiatrist and get recommendations and education

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Supervision

➔ Pros

– Might be easiest way to start – Efficient use of psychiatry time – Lower cost – May facilitate referrals

➔ Cons

– Not in real time – Coordinating staff

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Tele-consults

➔ Direct to patient (remote

visits)

➔ Clinician-to-psychiatrist

consults in which psychiatrist provides recommendations over phone to patient’s clinician

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Tele-consults

➔ Pros

– In real time – Efficient use of psychiatry time – No space needs – Value is back up, not number of consults – May be able to bill in rural areas

➔ Cons

– Set up – Face time still needed – Costs

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MGH Psychiatry Tele-consults for Primary Care Providers

➔Psychiatrist available by phone in real time

during clinic hours

➔Assist with diagnosis ➔Recommend treatments and referrals ➔Brief consult note

Stern and Worth, 2000

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MGH Psychiatric Oncology Tele-consult Service

➔Psychiatrist available by phone in real time

during clinic hours

➔Assist with diagnosis ➔Recommend treatments and referrals ➔Brief consult note

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MGH Psychiatric Oncology Tele-consult Service (cont.)

➔E-mail consults ➔Site visits ➔Psychosocial rounds ➔Educational programs

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Integrated Consults

➔ Psychiatrist provides

consults within the palliative care clinic with goal of palliative care clinicians managing

• ngoing psychiatric

care

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Integrated Consults

➔ Pros

– Face-to-face psychiatric evaluations – Clinician interactions with psychiatrist outside of appointments – Normalizes psychiatric care

➔ Cons

– Same amount of psychiatrist time – Space – No shows – Insurance issues – Costs

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Alternatives

➔One prescriber on team gets more training

– CME courses: MGH annual psychopharm update, etc.

➔Case manager to develop a local network

• f providers

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Getting Started

➔Supervision

– Team buy in – Finding someone

• Your institution first
• Psychiatrist who treated your patients
• Hook

– Payment

• $150-300/hr

– Mode

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Questions and Comments

➔Do you have questions for the presenter? ➔Click the hand-raise icon on your control

panel to ask a question out loud, or type your question into the chat box.

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CAPC Events and Webinar Recording

➔ Today’s webinar recording can be found in CAPC

Central under ‘Webinars’ – https://central.capc.org/eco_player.php?id=288

➔ For a calendar of CAPC events, including upcoming

webinars and office hours, visit

– https://www.capc.org/providers/webinars-and-virtual-office- hours/

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