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.
NEWS
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.
RESEARCH
·
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.