The Role of Care Managers in Collaborative Care Tasks and Effective Communication, Lecture notes of Nursing

Download The Role of Care Managers in Collaborative Care Tasks and Effective Communication and more Lecture notes Nursing in PDF only on Docsity! 4/21/2014 1 Care Manager Role Collaborative Team Approach PCP Patient Care Manager Psychiatric Consultant Other Behavioral Health Clinicians Core Program Additional Clinic Resources Outside Resources Substance Treatment, Vocational Rehabilitation, CMHC, Other Community Resources New Roles Care Manager is a ROLE • Most common MSW, LCSW, MA/MS Counselor, LMFT • Less common Clinical Psychologist, RN • All-in-one or split between licensed provider and unlicensed staff Who are Care Managers? 4/21/2014 2 Care Manager is a ROLE • Persistent • Flexible, open to new ways of practicing • Adaptable to primary care culture and workflows • Enjoys working in a collaborative team • Organized, able to track entire population of patients • Strong advocate for changing treatments until patient improved Characteristics of Effective Care Managers Collaborative Communication PCP Patient Care Manager Psychiatric Consultant Other Behavioral Health Clinicians Core Program Additional Clinic Resources Outside Resources Substance Treatment, Vocational Rehabilitation, CMHC, Other Community Resources New Roles Collaborative Care Tasks Indentify and Engage Patients Initiate and Provide Treatment Track Treatment Outcomes Proactively Adjust Treatments Other Care Tasks 4/21/2014 5 Attitudes & Beliefs • Patients may know little about depression – What they know may be inaccurate • May believe… – Depression is selfish, weakness – They should “handle it themselves” • Especially true for older adults, men Attitudes & Beliefs Culture can play important role – Cultural beliefs about causes, treatments – Stigma – Manifestation of symptoms can vary Know your own attitudes & beliefs – Do you believe psychotherapy is best treatment option for everyone? – How do you feel about medications? Your beliefs are communicated to patients Why Engage Caregivers / Family? • Family sees mood and behavior changes over time • Family can support treatment plan – Especially self-management plans • Patient chooses level of family involvement 4/21/2014 6 How to Engage Families/Caregivers Shared view of depression – Myths – Stigma – Cultural beliefs about causes of depression, treatments Provide resources to learn about depression – http://www.nimh.nih.gov/health/topics/depression/ – Existing resources in your clinic? Share treatment plans – Give family role in supporting treatment – Engage family in relapse prevention planning Collaborative Care Tasks Indentify and Engage Patients Initiate and Provide Treatment Track Treatment Outcomes Proactively Adjust Treatments Other Care Tasks Many Treatment Options • Brief Behavioral Interventions for Primary Care – Pleasant Event Scheduling / Behavioral Activation – Problem-Solving Treatment – Other Evidence- based Therapies • Medication Primer for Primary Care – Psychopharmacology for primary care – Supporting medication therapy as a team – Talking with patients about medication 4/21/2014 7 Why brief behavioral interventions? Feel Bad Do Less 3 Goals of Behavioral Activation Increase adaptive activities, preferably for mastery and pleasure Decrease activities that maintain depression Problem solve barriers to rewarding things Typically we think of acting from the “inside  out” (e.g., we wait to feel motivated before completing tasks) In BA, we ask people to act according to a plan or goal rather than a feeling or internal state Approach: Outside  In 4/21/2014 10 Communication: How and When? • Communication is key to team function! • Consider modality – In person – Staff (MA or nurse) – Phone – Fax – Email (careful with confidential info) – EMR • Frequency – Scheduled – As needed PCP Patient CM Psychiatric Consultant Other Behavioral Health Clinicians Core Program Additional Clinic Resources Outside ResourcesSubstance Treatment, Vocational Rehabilitation, CMHC, Other Community Resources Communication with PCPs • Communicate changes in patient’s clinical and functional status – Prioritize which changes need to be brought to the attention of the PCP – Maintain enough contact so that they remember who you are, but no so much that they see you as a pest Key Elements to Include When Talking to PCP • Baseline Clinical measures – e.g., PHQ-9 Score • Current Symptoms – Symptoms that aren’t improving • Current treatment(s) and length of time • Problematic side effects • Psychiatric consultant recommendations (if relevant) 4/21/2014 11 PCP Discussion Template Communicating with Psychiatric Consultant PCP Patient Care Manager Psychiatric Consultant Other Behavioral Health Clinicians Core Program Additional Clinic Resources Outside Resources Substance Treatment, Vocational Rehabilitation, CMHC, Other Community Resources New Roles Care Manager Psychiatric Consultant Communicating with Psychiatric Consultant Weekly consultation -review caseload -create recommendations -track outcomes Each ≥0.5 FTE care manager = 1 hour/week with consultant 4-6 patients per hour 4/21/2014 12 Consulting Psychiatrist Template Not Just Meds • Psychiatric consultant can help: – Clarify diagnosis – Suggest psychotherapeutic interventions – Brainstorm strategies when patient not improving – Provide emotional support to Care Mgr A Collaborative Care Plan • Shared by the whole team – Where will everyone be able to see it? • Include all treatment options – Behavioral interventions, Medications, Referrals • Clear goals and roles – A prioritized list, especially for complex patients – A clear “owner” for tracking goals 4/21/2014 15 Proactive Treatment Adjustment http://www.jhartfound.org/sif/ 43 • Identify patients that are not improving • Discuss with psychiatric consultant What if Patients Don’t Improve? • Is the patient adhering to treatment? – Behavioral interventions – Attending appointments • Is the medication dose high enough? – See max dose guidelines • Is the diagnosis correct? – ? Bipolar depression – ? Medical conditions (hypothyroidism, sleep apnea, pain) – ? Meds: steroids, interferon, hormones – ? Withdrawal: stimulants, anxiolytics • Are there untreated comorbid conditions / life stressors? Collaborative Care Tasks Indentify and Engage Patients Initiate and Provide Treatment Track Treatment Outcomes Proactively Adjust Treatments Other Care Tasks 4/21/2014 16 Other Collaborative Care Tasks • Caseload management • Referrals to care • Completion of treatment • Relapse prevention • Quality Improvement efforts Collaborative Team Approach PCP Patient Care Manager Psychiatric Consultant Other Behavioral Health Clinicians Core Program Additional Clinic Resources Outside Resources Substance Treatment, Vocational Rehabilitation, CMHC, Other Community Resources New Roles