Description
Worldwide, chronic disease burden is increasing and poor mental health prevents treatment. Psychiatry’s role in treating chronic disease has been limited to treating only mental health. Our healthcare environment incentivizes acute care for illness making multi-modal treatment expensive and impractical. The collaborative care model (CoCM), an integrated model of care funded by Medicare, is financially viable, evidence-based, can be adapted to deliver chronic disease treatment, and allows psychiatrists to treat underlying mental health issues throughout. Methods: Remote telehealth treatment was delivered to Medicare patients in cardiology with hypertension or atrial fibrillation. Patients were screened for anxiety, depression, insomnia, nutrition, physical activity. A pathway was selected based on scores and patient preference. Remote patient monitoring occurred via blood pressure cuff/weight scale. Care was delivered by care managers (registered nurse or clinical social worker), health coaches, registered dieticians, physical therapists, fitness experts. Scales used were the Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 (GAD-7), the Insomnia Severity Index (ISI), Starting the Conversation (STC), Five-Times-Sit-to-Stand Test (FTSST). Weight, blood pressure, minutes of physical activity were also tracked based on pathway. Results: After 12 weeks of treatment, patients with PHQ-9, GAD-7, and ISI scores in the moderate-severe range depression scores decreased 50.6% (N=23), anxiety scores decreased 58.4% (N=17), and insomnia scores decreased 39.3% (N=16). Patients treated in the nutrition pathway (N=60) lost on average 6.7lbs. Average blood pressure decreased 9.1 mmHg systolic and 4.5 mmHg diastolic (N=19). Patients treated in the fitness pathway increased minutes of daily exercise 71.5% from 8.6 to 30.2 and average days per week with exercise 62.2% from 1.7 to 4.6 (N=18). Average seconds for the FTSST decreased 28% from 14.2 sec to 10.2 sec (N=20). The overall program was acceptable to participants with care rating of 4.88 out of 5 on a Likert scale. Financially, one referring clinic with 16 physicians generated ~$1,000,000 of additional revenue with the Nudj Health program. Data collection continues. Conclusion: Adapting Collaborative Care to deliver multi-modal treatment for chronic disease is effective and financially viable. Treatment was acceptable, met accepted targets for anxiety, depression and insomnia, resulted in weight loss, decreased blood pressure from grade 1 hypertension to normal values, and improved strength and physical activity to meet U.S. physical activity guidelines. Income from Collaborative Care added additional revenue. Future program improvements include technology to assist staff measurement collection, integration of additional objective data, modification of nutrition pathway to improve weight loss, and the expansion of group offerings to promote community and peer support.
Format
Recorded webinar.
This content was recorded during the APA 2023 Annual Meeting.
Learning Objectives
- Describe psychiatry's role in treating the epidemic of chronic disease via collaborative care.
- Describe how collaborative care treatment principles can be used to implement nutrition and fitness treatment pathways with good outcomes.
- Describe how including fitness and nutrition prescriptions with typical collaborative care management reduces the burden of chronic disease.
- Describe elements of a successful telehealth approach to collaborative care treatment delivery.
- Describe elements of fitness and nutrition program prescriptions for treating behavioral conditions in individuals with multiple chronic diseases.
Target Audience
Medical Students, Residents/Fellows, Psychiatrists, non-psychiatrist Physicians
Estimate Time to Complete
Estimated Duration: 1.5 hours
Program Start Date: May 1, 2025
Program End Date: May 1, 2028
Faculty and Planner Disclosures
The American Psychiatric Association adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Medical Education. Any individuals in a position to control the content of a CME activity — including faculty, planners, reviewers or others — are required to disclose all relevant financial relationships with ineligible entities (commercial interests). All relevant conflicts of interest have been mitigated prior to the commencement of the activity.
Instructors
- Katharina Hil, MD
- Ashley Nader, RD
- Amy Pike, MPT
Planners
- Vishal Madaan, MD, Chief of Education and Deputy Medical Director at the American Psychiatric Association.
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