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Significant evidence supports the need to increase primary care services for persons with serious mental illness. Mental health consumers are challenged by navigating the traditional primary care system, have higher rates of uncontrolled chronic comorbidities, and more frequently visit hospital emergency departments for benign acute illnesses. Managing primary care needs in an accessible health setting allows persons with serious mental illnesses to delay, prevent or reduce complications from common chronic health conditions and reduce the costs and time in managing acute illnesses. Additionally, improvement in physical health has the potential to positively influence mental health status. Collaboration between a community behavioral health center, a local hospital and a university school of nursing created a venue to provide whole-person primary care services for patients with serious mental illnesses. The output of that collaborative effort was the establishment of a primary care clinic embedded within the community mental health center.
Background
Objec0ves
Primary Care • Well person examinations • Chronic disease management • Acute illness care Mental Health Care • Medication Services • Individual therapy • Alcohol and Drug Detox/Treatment Phlebotomy services • Tuesdays & Thursdays Pharmacy • Free medication delivery • “Dispill” packaging
Co-‐Located Services All Scheduled Appointments: • New patient/Well woman visits: 29% • Follow-up/Office Visits/Walk-in: 33% • No Show/No Call: 29% • Cancelled: 9%
Results Conclusions • Co-located behavioral health and primary
care services encouraged mental health consumer utilization
• Multiple exam rooms increase efficiency • Decreased wait time increases show rates • On-site laboratory services improve test
adherence • On-site pharmacy improved medication
adhrenece
References DeHert, M., Correll, C. U., Bobes, J., Cetkovich-Bakmas, M., Cohen, D., Asai, I., ... Leucht, S. (2011). Physical illness in patients with severe mental disorders: Prevelence, impact of medications and disparities in health care. World Psychiatry, 10, 52-77. Kaufman, E. A., McDonnell, M. G., Cristofalo, M. A., & Ries, R. K. (2012). Exploring barriers to primary care for patients with severe mental illness: Frontline patient and provider accounts. Issues in Mental Health Nursing, 33, 172-180. Knapik, G. P., & Heifner Graor, C. (2013). Engaging persons with severe persistent mental illness into primary care. The Journal of Nurse Practitioners, 9, 283-287. Lawrence, D., & Kisely, S. (2010). Inequalities in healthcare provision for people with severe mental illness. Journal of Psychopharmacology, 24(11), 61-68. Parks, J., Svendsen, D., Singer, P., & Foti, M. E. (2006). Morbidity and mortality in people with serious mental illness. Alexandria: National Association of State Mental Health Progarm Directors (NASHMPD) Medical Directors Council.
Contact Informa0on .Valeo Behaviroal Health [email protected] 785-2331730, et 3560 Puala Ellis, DNP, CARN, NEA-BC St. Francis Health Systems [email protected] 785-295-8384
Special thanks to: Dr. Monica Scheibmeier Dean, Washburn University School of Nursing Stacy Forgy Development Director, Valeo Behavioral Health
• Compare models of integrating primary care and mental health care
• Illustrate how modifications to clinic principles improve patient engagement
• Evaluate data supporting embedding primary within a community mental health center
Valeo Behavioral Health and St. Francis Health Systems Laura Sidlinger, DNP, APRN-‐C and Paula Ellis, DNP, CARN, NEA-‐BC
Primary Care within a Community Mental Health Center: An InnovaGve Approach to Whole-‐Person Care
56%
44%
Type of Completed Visits
Follow-‐up
New PaGent
0
10
20
30
40
50
60
70
80
Age in Years
Pa0ents Seen in the Clinic Year One
Age Distribu0on
Popula0on • Total number of unique patients: 402 • Total number of patient visits: 813 • Total number of establish care/new patients
to the St. Francis Health System: 353 • Male:Female: 44.2%:55.8% • Average age: 44 years
Produc0vity • Number of completed paGent visits
increased by 53% with the addiGon of the second exam room.
• Percentage of minutes spent in face-‐to-‐face encounters increased from 69% to 102%
