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News & Research Column

Posted By Matthew P. Martin, Thursday, March 10, 2016

Welcome to the second edition of the CFHA News and Research Column, a new series of posts that highlight recent developments in the field of collaborative and integrated care. Check back each month for additional reports.


Privacy Rules on Medical Records for Substance Use Treatment

The U.S. Department of Health and Human Services (HHS) and the Substance Abuse and Mental Health Services Administration (SAMHSA) are seeking to make it easier to access and share substance use treatment records.


The confidentiality rules for substance use records (42 CFR Part 2) were developed in the mid-1980s to give patients confidence to seek substance abuse treatment without fearing disclosure of the treatment. Under the current rules, identifiable information can be released only with the affected individual’s consent.

The rule differs markedly from the Health Insurance Portability and Accountability Act, which does not require patients' consent for a provider to disclose their records for treatment, payment or other healthcare operations.

According to the proposal, "Significant changes have occurred within the U.S. healthcare system that were not envisioned by the current regulations, including new models of integrated care that are built on a foundation of information sharing to support coordination of patient care, the development of an electronic infrastructure for managing and exchanging patient information, and a new focus on performance measurement within the healthcare systems.”


The modifications would allow the federal government, and subsequently the Centers for Medicare and Medicaid Services, to develop a new infrastructure for managing and exchanging patient information, with an increased focus on performance measurement and quality improvement. The modifications would also help to decrease stigma toward substance use treatment and make it easier to integrate behavioral health services.


Public comment on the proposed rule is open until April 11. Click here for an opinion article.


New Depression Screening Guidelines

The U.S. Preventive Services Task Force (USPSTF) recently published recommendations for depression and autism screening. For the general adult population, including pregnant and postpartum women, the USPSTF recommends screening for depression "with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up”.


For adolescents, 12 to 18 years of age, the USPSTF recommends screening for major depressive disorder with the same care systems mentioned for the adult population.


Finally, for autism spectrum screening in children aged 18 to 30 months, the USPSTF "concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for autism spectrum disorder (ASD) in young children for whom no concerns of ASD have been raised by their parents or a clinician”.


For a blog commentary, click here.


Call for Social Work to Move Toward Integrated Care

Educators at the Silver School of Social Work at New York University are encouraging their discipline to embrace and move toward integrated care. They argue that the Patient Protection and Affordable Care Act centers on the promotion of integrated health, thus creating a timely opportunity. The authors argue that traditional social work roles of care coordinator, case manager, and community organizer fit well within collaborative care and disease management models. They call for more leadership roles from social work in the growing integrated care field as well as a focus on workforce development for future social workers.



· New data suggests that depression management in primary care can help older adults with depression and diabetes. Researchers examined the mortality risk of 1,226 patients from multiple practices who received algorithm-based depression management for 98 months (2006-2008) from a depression care manager. They found that patients with depression and diabetes who received the intervention treatment were less likely to die post-2008. For heart disease, persons with major depression were at greater risk of death, whether in usual-care or intervention practices. The study is part of the Prevention of Suicide in Primary Care Elderly: Collaborative Trial.

· Collaborative care has a modest benefit (effect size 0.3) over usual care, says data from the University of Manchester. Nineteen general practices in northwest England were randomized to collaborative care and twenty to usual care. Collaborative care included patient preference for behavioral activation, cognitive restructuring, graded exposure, and/or lifestyle advice, management of drug treatment, and prevention of relapse. Mental health professionals provided up to eight sessions of psychotherapy, with two sessions attended by a practice nurse. Patients in the intervention arm reported being better self managers, rated their care as more patient-centered, and were more satisfied with their care. Michael Sharpe wrote commentary on the study saying we know integrated care works but we still don’t know much about which interventions work best. He also believes there were several limitations to the study (e.g., care was not integrated with medical care, treatment was psychiatry-directed). He also believes we need more intensive treatment for co-morbid patients.

· Data from one study at the University of Southern California suggests that patients are generally accepting of automated remote monitoring of their depression. From 2010 to 2013, the Diabetes-Depression Care-management Adoption Trial (DCAT)-a quasi-experimental comparative effectiveness research trial aimed at accelerating the adoption of collaborative depression care in a safety-net health care system-tested a fully automated telephonic assessment (ATA) depression monitoring system serving low-income patients with diabetes. They found that the vast majority of participants would participate in the future and found the technology useful and secure.


· Does integrated behavioral health services in primary care work for patients with serious mental illness? Researchers in one study compared minimally enhanced usual care with collaborative care for 404 patients with PTSD enrolled in Federally Qualified Health Centers. They found no difference in effectiveness between the two care models. In a similar study examining patients with bipolar disorder, researchers found that collaborative care was superior to usual care. James Phelps recently wrote a blog post on this topic for CFHA.


· Representatives from SAMHSA are calling for integrated care services to meet the mental health needs of children and adolescents. They state, "What may be needed is not a health home as currently conceptualized for adults, nor a traditional medical home, but a family- and child-centered coordinated care and support delivery system supported by health homes or other arrangements.”

· Qualitative data from 59 interviews suggests that collaborative care helps clinicians to see patients more holistically, gives patients space to talk about their mental health, and decreases stigma toward mental health care. Interestingly, patients also reported a desire to "discussing emotional health problems in a separate therapeutic space away from the” medical staff. Patients saw medical staff members as insiders who managed their medical care and behavioral health staff members as outsiders "which paradoxically granted patients freedom to talk emotionally about their life circumstances and medical conditions in ways that were not possible with” medical staff.

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