Depression, anxiety and other behavioral health issues can be common companions to the physical illnesses that patients present in primary care offices, but too many primary care private practices lack the training and resources to effectively treat them all collectively.
Is referral—which often involves a lengthy delay and additional costs—the only way to get patients the mental health care they need? A new treatment guide can provide resources to speed up and simplify treatment for primary care physicians in private practice.
“Treating behavioral illnesses in a primary care setting is difficult,” explained Ryan Laschober, MD, associate program director of the Waco Family Medicine Residency and editor-in-chief of The Waco Guide to Psychopharmacology Care, which is available at no charge in the Google and Apple app stores.
Dr. Laschober recently took part in a webinar on the challenge of providing psychopharmacological care in a private practice primary care setting with colleague Zachary Sartor, MD, who is curriculum director of the Waco Family Medicine Residency and associate editor of The Waco Guide to Pharmacology in Primary Care.
They presented their work in the latest session that is part of the AMA Private Practice Simple Solutions series of free, open-access rapid-learning cycles that provide opportunities to implement actionable changes that can immediately increase efficiency in private practices.
The session is available to view on demand, as are all previous sessions in the AMA Private Practice Simple Solutions series (registration required).
Together, the two family physicians covered topics such as how to determine the need for psychopharmacological intervention, available tools and resources, and key steps to integrating into a private practice setting.
“A majority of people who seek care for behavioral health disorders do so through the primary care context,” noted Dr. Sartor, “which can be challenging for primary care clinicians. There’s poor specialty support in many areas around the country and many primary care clinicians say they don’t have any specialty support in their area.”
About two-thirds of primary care physicians say they have no specialty support in their area, Dr. Sartor noted, “and this trended worse in areas that are underserved or rural.”
Building a scaffolding of care
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However, primary care physicians can offset that problem with “scaffolding” of behavioral care that includes measurement-based care, decision-support tools—specifically to support psychopharmacological treatment—and team-based care, which Dr. Sartor called “the three pillars” of behavioral care.
The use of these tools improves the patient-physician relationship, Dr. Laschober said.
“We use psychometric tools to inform our treatment decisions,” he said. That involves the use of patient- or clinician-reported symptoms according to a behavioral rating scale. These scales can be used to inform treatment decisions and engage patients in their treatment decisions, according to Dr. Laschober.
With these measures in mind, private practice primary care physicians can use decision-support tools to direct them to “case-specific” advice derived from current medical knowledge and the patient case data. The Waco Guide to Psychopharmacology in Primary Care was designed to provide a searchable resource to direct primary care physicians to the relevant treatment protocol based on patient psychometrics, he said.
Details on dosage and more
The Waco Guide to Psychopharmacology in Primary Care also includes treatment options, dosage and other psychopharmacological information relevant to treatment needs, “including high-level side effects that we want to share with the patient in the exam room,” Dr. Laschober said.
When the psychopharmacological intervention has some success, Dr. Sartor recommends team-based brief, nonpsychopharmacological interventions as needed, such as exercise for depression, provided by other members of your care team to open the schedule of the primary care physician but continue the interventions as diagnosed.
It takes astute clinical judgment as well as a commitment to collaboration and solving challenging problems to succeed in independent settings that are often fluid, and the AMA offers the resources and support physicians need to both start and sustain success in private practice.
Learn more with the AMA about behavioral health integration in physician practices and explore the AMA Private Practice Physicians Section, which seeks to preserve the freedom, independence and integrity of private practice.
