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Electronic letters published:
![[Read Comment]](/icons/misc/sectionDOWN.gif){kind=icon}
Interstitial Care is Essential
The Medical Home and Mental Health
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Larry B. Mauksch, Seattle, USA Senior Lecturer, University of Washington Department of Family Medicine
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Improving quality of care for patients with chronic illnesses, especially mental illnesses and multiple illnesses, will require interventions like the one Griswold et al studied. Care management fills an enormous gap between the service silos in our health care system. And care management helps fill the large gap between primary care provider-patient discussions of chronic illness and the successful adoption of self-management by patients and their families1. We need health care funding designs2 that integrate and sustain this role as an essential part of health care, especially primary care. To justify this funding it would help to know how to design and integrate care management systems that sustain long-term change in patients with multiple chronic conditions. One issue brought up by these researchers is patient receptivity to providers from mental health and primary care sharing information. We asked 500 uninsured, low income, primary patients about preferences for information sharing between primary care and mental health. Ninety percent indicated they wanted this kind of information sharing3. As a mental health provider working in family medicine for over 25 years, I consent every patient about my sharing information with his or her family doctor. Less then five patients over the years have refused permission or expressed discomfort. Most respond by saying, “of course” and thank me. While some patients may have discomfort, the more significant barrier to mental health and primary care information exchange may be the barriers that exist in systems and providers. Resistance to sharing information may be more present in mental providers who are unaware of the complexity of primary care and preoccupied by the heavy, out-of-date cloak of confidentiality that surrounds mental health training. 1. Rothman AA, Wagner EH. Chronic illness management: what is the role of primary care? Ann Intern Med. Feb 4 2003;138(3):256-261. 2. Bachman J, Pincus HA, Houtsinger JK, Unutzer J. Funding mechanisms for depression care management: opportunities and challenges. Gen Hosp Psychiatry. Jul-Aug 2006;28(4):278-288. 3. Mauksch LB, Tucker SM, Katon WJ, et al. Mental illness, functional impairment, and patient preferences for collaborative care in an uninsured, primary care population. J Fam Pract. 2001;50(1):41-47. Competing interests: None declared |
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Thomas C. Rosenthal MD, Buffalo, NY, USA Professor and Chair
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As health care systems mature mental health becomes integrated into primary care delivery models.(Blount 1998) Human problems simply cannot be segregated into discrete emotional and physical arenas. Isolating either does not reflect either the generation or resolution of human conditions. There is no physical problem without stress and all reactions to stress include physical symptoms.(Rosenthal, Griswold et al. 2007) When persistent these physical reactions often become the disabling factor. One challenge to the newly evolving concept of a primary care medical home is to advance integration beyond simple office co-location and reduce stigma associated with mental health treatment. The research published by Griswold et al in this issue of the Annals clearly demonstrates that patients with psychiatric illness who are facilitated in their relationship to a primary care physician have significantly better physical and mental function than their counterparts in a traditional group of patients at 6 months with functional improvement beyond.(Griswold, Zayas et al. 2008) As the American version of the medical home is developed policy makers should not lose sight of the bio- medical-psycho-social perspective to efficient, quality health care. Blount, A. (1998). Integrated Primary Care: The future of medical and mental health collaboration. New York, W.W. Norton & Company. Griswold, K. S., L. E. Zayas, et al. (2008). "Primary Care After Psychiatric Crisis: A Qualitative Analysis 10.1370/afm.760." Ann Fam Med 6(1): 38-43. Rosenthal, T. C., K. Griswold, et al. (2007). Puzzling Physical Complaints. AAFP Home Study Self Assessment Program. Leawook, Kansas. Competing interests: None declared |
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