(013) Barriers and interventions toward robust integration of psychiatric case conferencing into a resident-run primary care clinic

Abstract: Background/Significance:

The collaborative care model (CCM) has been shown to result in faster remission and shorter duration of depressive symptoms (Garrison 2016). Unfortunately, significant barriers impede timely implementation of case conference recommendations from integrated behavioral health teams (Bao 2012). Our team recently characterized barriers specific to our large-sector resident-run primary care clinic, including patients being seen by varying primary care physicians for follow-up visits, patients being lost to follow-up, and prioritization of medical concerns that were perceived as more acute during short appointments (abstract accepted for presentation at APA 2022). This team now seeks to examine the impact of targeted interventions based on the barriers perceived by internal medicine (IM) residents for implementing case conference recommendations.



Methods:

An anonymous pre-survey was disseminated to approximately 150 IM residents and responses were recorded and quantified. Interventions were implemented targeting barriers identified by survey respondents: 1) targeted education surrounding CCM, 2) integration of recommendations into pre-established workflows, and 3) facilitation of handoffs between providers. Finally, a post-survey will be disseminated and changes in responses will be compared between pre- and post-survey responses using a marginal homogeneity test. Free text responses will be grouped by thematic content and quantified. Study received institutional review board (IRB) exemption from the University of Southern California (IRB#HS-19-00934).



Results:

Approximately 100 IM residents responded to the pre-survey. The interventions were performed in March 2022. Post-survey dissemination planned for June 2022. The study team hypothesizes that IM residents will report a greater awareness of and improved ease of access to recommendations and increased frequency of recommendation implementation.



Discussion:

CCM and proactive outpatient consultation based on chart review is unfamiliar to IM residents accustomed to traditional forms of consultation. As a result, IM residents were less likely to consistently implement case conference recommendations. This study asserts that a multi-pronged approach can quickly and dramatically improve awareness and implementation of recommendations.

Conclusions/Implications:

Proactive collaborative case conferencing educates IM residents about management of common psychiatric disorders and improves clinical outcomes. This study illuminates barriers that hinder adoption of such a model and suggests strategies for its successful integration.



References:
Bao Y, et al. Unpacking Collaborative Care for Depression: Examining Two Essential Tasks for Implementation. Psychiatr Serv. 2016 Apr;67(4):418–24.

Garrison MG, et al. Time to Remission for Depression with Collaborative Care Management (CCM) in Primary Care. Journal of the American Board of Family Medicine January 2016, 29 (1) 10-17; DOI: https://doi.org/10.3122/jabfm.2016.01.150128

Reed SJ, et al. Effectiveness and Value of Integrating Behavioral Health Into Primary Care. JAMA Intern Med. 2016;176(5):691–692.