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From the the first Annual National Conference on Tobacco and Behavioral Health, which occurred May 19-20, 2014 in Bethesda, MD and was hosted by the Central East Addiction Technology Transfer Center, a program of The Danya Institute. You can see videos from the conference on our website www.ceattc.org (go to “Tobacco and Behavioral Health Resources” under “Special Topics”). Panel will focus on the necessary partnerships to integrate tobacco prevention and tobacco cessation in community and health systems. Three perspectives will be shared: Public Health, Primary Care, and Behavioral Health. Julie Wood, MD, is the Vice President for Health of the Public and Interprofessional Activities, American Academy of Family Physicians
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Integration of Policy, Practice
and Partnership
Julie K. Wood, MD, FAAFP
National Conference on Tobacco and Behavioral
Health
May 20, 2014
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Family Physicians
• The AAFP Represents 115,900 members—active, residents, and students.
• Approximately one in four of all office visits are made to family physicians. That is 240 million office visits each year– nearly 87 million more than the next largest medical specialty .
Strategic Goals of AAFP
• Advocacy• Education• Practice Advancement• Health of the Public
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Practice Advancement
• Patient Centered Medical Home (PCMH) is a focus.
• Medical Neighborhood• “Joint Principles: Integrating Behavioral
Health Care Into the Patient-Centered Medical Home”
• Published in the March/April 2014 Annals of Family Medicine
• http://www.annfammed.org/content/12/2/183.2
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Integrating Behavioral Health Care Into
the Patient Centered Medical Home
• Adjunct to original Joint Principles of the Medical HomeAUTHORING ORGANIZATIONS:• American Academy of Family Physicians• American Board of Family Medicine• Association of Departments of Family Medicine• Association of Family Medicine Residency Directors• North American Primary Care Research Group • Society of Teachers of Family MedicineENDORSED BY:• American Academy of Pediatrics• American Psychological Association• Collaborative Family Healthcare Association• AAFP Foundation
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Integrating Behavioral Health Care Into
the Patient Centered Medical Home
• Set of seven principles describes the characteristics of a PCMH in which behavioral health care is a part.
� Personal physician� Physician-directed medical practice� Whole-person orientation� Coordination of care� Quality and safety� Enhanced access� Payment
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Integrating Behavioral Health Care Into
the Patient Centered Medical Home
• Agreement on clear and consistent language across disciplines.
• Understanding of the central role of the patient and family in articulating needs and developing a care plan.
• Defining the different roles and skill sets required for physicians, behavioral health clinicians, and other members of the health-care team to provide whole-person care.
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Integrating Behavioral Health Care Into
the Patient Centered Medical Home
• Interdisciplinary training for practicing clinicians & other team members, faculty, fellows, residents, and students, for the roles that behavioral health clinicians as well as primary care clinicians will assume in the PCMH.
• Research to better define the optimal provision of whole-person health services in the PCMH, with attention to patient, practice, training, and financing issues.
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Integrating Behavioral Health Care Into
the Patient Centered Medical Home
• Recognition of local adaptations of integrated, whole-person care so as to include all persons and to take advantage of the differing requirements and resources of different communities across the entire country.
• Assurance that behavioral health services, as described in the Mental Health Parity and Addiction Equity Act of 2008, are included in all benefit plans.
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AAFP Health of the Public Resources
• Ask and Act Program• www.askandact.org• Evidence-based strategy• Provides the opportunity for every member
of the practice team to intervene at each visit.
• Materials for both physician and patient education and practice improvement.
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AAFP Health of the Public Resources
• Office Champions Program• Integrates systems changes into clinic workflow.• A quality improvement systems change model
built on team-based care. • www.askandact.org/officechampions• FQHC report:• http://www.aafp.org/dam/AAFP/documents/patient_care/to
bacco/office-champions-final-report-2013.pdf
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Best Practices
• Behavioral health coordinator in office and/or behavioral health professional embedded in office to address cessation needs at the point of care.
• Creating a medical neighborhood to support patients with behavioral health concerns and that desire cessation.
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Best Practices
• Partner with external behavioral health professionals, support groups, quitlines, and faith-based groups to create a successful medical neighborhood.
• Consider brief referral forms with release of information form as appropriate to facilitate communication and optimize patient care.
• Team-based efforts—the physician doesn’t have to do it all. Have staff trained to intervene and follow up, be well
trained in motivational interviewing.
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Barriers
• Payment • Time• Knowledge deficits• Transportation• Lack of effective internal flow when at-risk
patient is identified• Lack of effective referral process
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Opportunities
• Integration of primary care of public health• PCMH and medical neighborhood • Promotion of PCMH and integrated mental health• Continue to advocate for access to care and
appropriate cessation benefits• Education
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Questions?
• Julie K. Wood, MD, FAAFPVice President for Health of the Public & Interprofessional Activities
• Email: [email protected]• Twitter: @juliekwoodmd
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