Randall Reitz: "Three Articles"

Imgaining being transformed into Sandy Bount for a day.  Geez.  I have never flown that fast.  What articles would I choose?  Hmm.  How about Don't Bloch's piece on the Dual Optic; CJ Peeks on the three world view and something about team work and transdisciplinary care like the the one by Ruddy in Journ of Health Care for the Poor and Underserved in 2005.

Larry Mauksch

Well, frankly I have no idea how to approach this seminar in the way Sandy might do so. I am a talk therapist and that would be my approach.

My first thought stems from my recent research that primary care physicians are more likely to prescribe psychotropic medication for patients who have mental or emotional distress rather than refer them to talk therapy. Why? One of the pieces that surfaced is that the majority of physicians do not know the distinctions between the five fields of talk therapy and these fields are very different in their approaches. Choosing an inappropriate talk therapist for an identified problem is like taking your Mercedes to a Chevy dealership for repair--bound to result in frustration. So, my primary focus would be to make a simplified introduction of the five different talk therapies for these physicians.

Of written works, I might pick something out of Anatomy of an Illness or The Body Speaks explaining the interconnectedness of all humans' minds and bodies--thus the need for holistic approach in the healthcare arena. Of course, I would like to mention the incredible benefit for a patient's recuperation/maximized health by understanding the role that family plays and harnessing this powerful accomplice. There's vast data on that.

But my curiosity would lead me to give these attendees a questionnaire--what ways could they see themselves working collaboratively with talk therapists right now in their day-to-day practice?

My three picks:

Blount's 2003 "Integrated primary care: Organzing the evidence" from FSH 21, 121-133

  Despite being 6 years old this is a solid summary of the evidence.  Sandy would likely be too modest to select his own article... I am not constrained by this convention.

Engel's 1977 "The need for a new medical model: A challenge for biomedicine" from Science 196, 129-136

  You could make a strong argument that this is where it all began.  It would be nice to believe that medicine has changed substantially in the past 30 years.  Unfortunately this article is needed as much today as it was then.  There have been many attempts to modify and ammend Engel's biopsychosocial model, but it has with stood test of time.  The biopsychosocial model should be the first paragraph of any answer to the question, "Why should we have collaborative care?"  There is no need to replicate this argument when we have Engle's own words.

Strosahl's 1997 "Building primary care behavioral health systems that work: A compass and a horizon" a chapter in Cummings book of that year

  This may not be the best book chapter on integrated care, but it was my first.  For that reason it is special to me.  It also serves as a starting point for trying to evaluate and compare different collaborative programs.  It does a very nice job of starting the conversation on how we should approach the evaluation of collaborative care.  The methods introduced here point directly to the efforts of the CCRN.

- Dan

I couldn't do just three so I added one more:

Butler, M., Kane, R. L., McAlpin, D., Kathol, R. G., Fu, S. S., Hagedorn, H., et al. (2008). Integration of Mental Health/Substance Abuse and Primary Care No. 173 (Prepared by the Minnesota Evidence-based Practice Center under Contract No. 290-02-0009.)AHRQ Publication No. 09-E003. Rockville, MD: Agency for Healthcare Research and Quality.

deGruy, F. (1996). Mental health care in the primary care setting. In M. S. Donaldson, K. D. Yordy, K. N. Lohr & N. A. Vanselow (Eds.), Primary Care: America's Health in a New Era. Washington, D.C.: Institute of Medicine.

Peek, C. J. (2008). Planning care in the clinical, operational, and financial worlds. In R. Kessler & D. Stafford (Eds.), Collaborative Medicine Case Studies: Evidence in Practice. New York: Springer.

Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, D.C.: National Academy Press.

The assumption I would make is that, as Sandy for a day, I would have enthralling presentation skills at my disposal.  For once in my life I would be "very clear". Given that, I don't think I would want to give articles that explain the "how" of collaborative family healthcare, but rather, the "why".  As physicians typically privilege EBM, I would go with the best publications of RCT research.  Unfortunately, the pickings are still slim but do include:

Unützer J, Katon WJ, Callahan CM, Williams JW, Hunkeler E, Harpole L, Hoffing M, Della Penna RD, Hitchcock-Noël P, Lin EHB, Areán PA, Hegel M, Tang L, Belin T, Oishi S, Langston, C, The IMPACT Investigators. Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. Journal of the American Medical Association, 2002; 288:2836-2845.

Sadur CN, Moline N, Costa M, Michalik D, Mendlowitz D, Roller S, Watson R, Swain BE, Selby JV, Javorski WC.  Diabetes management in a health maintenance organization. Efficacy of care management using cluster visits. Diabetes Care, 1999 22:2011-7.

Bauer MS, McBride L, Williford WO, Glick H, Kinosian B, Altshuler,  Beresford T, Kilbourne AM, Sajatovic M. Collaborative Care for Bipolar Disorder: Part II. Impact on Clinical Outcome, Function, and Costs. Psychiatr Serv, 2006; 57: 937 - 945.

None of these articles gives a good sense of what is commonly considered collaborative care (i.e. fully integrating a licensed mental health professional into a primary care team), but I don't believe that research has been published yet, has it?

I would add a clinical article that has been very helpful in understanding what it BH clinicians would actually be doing while they are in the exam room. Iverson, Chris. Solution-Focused brief therapy,Advances in Psychiatric Treatment (2002) 8: 149-156© 2002 The Royal College of Psychiatrists 

One more to add that may provide the PCP some insight into the perspective of the BHS:  Behavioral Consultation and Primary Care:  A Guide to Integrating Services by P. Robinson and J Reiter--chapters 1 and 5. 

Thinking of the challenges ahead, may be not for the introductory session, here are some other readings:

Mullan, F. & Ficklen, E. (2006). Narrative matters: The power of the personal essay in health policy. John Hopkins University Press. 

A great collection of personal stories that inform and are informed by health policies. In puts systemic and larger systems ideas in the policy and political context. Something where patients, families, and health practitioners can find common grounds for collaboration and advocacy.

Any of the texts available about Appreciative Inquiry, a tool and way of thinking that busy professionals working in complex institutions, could definitely use. Similarly, learning about positive deviance would also be great.