Thursday, January 14, 2016

Notes from the Field: Integrated Care Experience

The following is an account written by Joseph Hoyle, MD, MPH, PGY-2 at the McLeod Family Medicine Residency Program and co-author John Schwartz, MS


As a family medicine resident, I have the opportunity to care for the poor and underinsured within a supervised environment.  I learn to complete the insurance paperwork, disability evaluations, electronic documentation, and refill requests usually handled by other members of an outpatient practice team.  Also, at McLeod I work in an efficient, quality-driven inpatient system.  It is no surprise why many of my resident colleagues choose hospital medicine.

Yet, I am planning a career in person-centered outpatient care.  Because of a trial experience of integrated behavioral care with a psychology graduate student from Francis Marion University, I have a renewed vision for what this career could be.

Over the course of approximately four months, I had available collaboration – by text or phone call – with an in-house behavioral health consultant John Schwartz, MS.  While his office was on the other side of the clinic, he was usually available within a few minutes and would either join me in the clinic room with the patient or meet me outside of the room and then go join the patient.   

At least 25 patients had the experience of seeing both of us within one clinic visit. Together, I was able to commit my first patient with suicidal tendencies and coordinate resources for my first child with autism; provide training on parenting, coping with grief, pain management, sleep hygiene, relaxation techniques, alcohol and smoking cessation; and coach patients on communication skills.  Additionally, several patients returned for follow-up appointments with Mr. Schwartz.

I was able to connect my patients with behavioral health resources while I gained a better perspective on the health priorities of my patients.   Their health care was better coordinated, they were better educated on their conditions, and they experienced less stigma about their behavioral health.  Not only was Mr. Schwartz on my “team,” the patient also had a more complete team.  We conducted “adaptive problem solving” for barriers to my provision of behavioral health care.[i]

The case for integrated behavioral health care is strong: “when treated in harmony with behavioral health, chronic physical health improves significantly, along with patient satisfaction” and “67% of persons with a behavioral health disorder do not get treatment.” In my experience true integrated care both furthers the Triple Aim (better health, better health care, lower cost), and increases job satisfaction.[ii] 

Because of administrative and payment barriers, it is unlikely that psychology students will continue to be a part of my residency experience.  Nevertheless, learning and serving together with John Schwartz has been an honor and an encouragement to my future career in outpatient medicine.  I want to collaborate with a behavioral health consultant, not just refer or co-locate.  I hope that other residents have a similar experience before they decline the opportunity of outpatient practice.

For more information on South Carolina Family Medicine Residency Training Programs or to Contact Dr. Hoyle, please contact Kristin Cochran at cochrak@musc.edu.
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35th Annual South Carolina School Nurse Conference in January

The 35th Annual South Carolina School Nurse Conference will be January 22-23 at the Embassy Suites at the Charleston Area Convention Center in North Charleston.  This year’s theme is “Somewhere Over the Rainbow: Believe It, Achieve It”.  Over 400 school nurses are expected to attend from across South Carolina to celebrate school nursing and improve the ability to protect and promote the health, safety, and wellbeing of school children in the state. 

The conference is approved for eight total contact hours of nursing credit and includes presentations on ethics, leadership in school nursing and orientation, school nurse challenges, seizures, emergency care, concussions, self-harming behaviors, common skin conditions and the benefits of laughter with children.  Various vendors will also be in attendance. 

For more information and to register, please visit: www.lcahec.com.

Pee Dee AHEC Completes Year One of NAO Grant for HPV Immunization Education

Pee Dee AHEC recently completed year one as a recipient of a National AHEC Organization (NAO) grant to conduct HPV (Human Papillomavirus) immunization education. This is the first of a potential five-year grant supporting this education.  The purpose of the grant is to disseminate education to providers on the latest Centers for Disease Control and Prevention (CDC) recommendations for immunization practices in the prevention of HPV.

The CDC has broadened its recommendations from 11- and 12-year-old girls to the addition of males in this age group, as well as males and females ages 13-26 who did not receive the immunizations at a younger age or did not complete the three dose series. In addition, they have added recommendations for any male through age 26 who engages in sex with other men and for men with compromised immune systems (including HIV) through age 26 if they did not receive the HPV vaccine when they were younger.

During the first year of the grant, health professions students from Pee Dee, Low Country, and Mid Carolina AHECs completed the training, as did a large group from the Pee Dee Pharmacy Association.  In addition, Benjamin Elder, M.D., faculty with McLeod Family Practice Residency Program, provided an HPV vaccine update at the November advanced practice registered nurse (APRN) monthly meeting. This update was recorded and is available as an on-demand CE program for APRNs, nurses and students through the South Carolina Health Occupations Outreach Learning System (SCHOOLS). Register by visiting the SC AHEC SCHOOLS website at www.scahec.net/schools.

Plans for year two of the HPV grant include collaborations with the South Carolina Department of Health and Environmental Control, the American Cancer Society, and the South Carolina Association of School Nurses in a state-wide effort to disseminate information to providers of the vaccine and/or correlating information regarding the vaccine.

Anyone interested in arranging HPV immunization education for other health care provider groups are encouraged to contact Pee Dee AHEC Continuing Education Coordinator Cheryl Neuner at cneuner@mcleodhealth.org or 843-777-5347. 

Lowcountry AHEC Offering CNOR Course in March

Lowcountry AHEC will be offering a CNOR (Certified Nurse Operating Room) Prep Course on March 19-20 at Trident Medical Center in North Charleston.  This two-day seminar is a broad, comprehensive review of preoperative, intraoperative and postoperative considerations for the surgical patient. This course will prepare perioperative nurses to take the CNOR exam and to demonstrate clinical competence and knowledge of practice standards.  This continuing nursing education activity will provide 16.0 instructional hours. 

Registration is open until March 11. Please go to www.lcahec.com for additional information and to register.

Pee Dee AHEC Health Careers Academy Students Give to Others in the Holiday Season

Pee Dee AHEC Health Careers Academy (HCA) students channeled the spirit of the season in December and volunteered to spread the holiday cheer. These future healthcare professionals worked together to give stuffed Christmas stockings to children in the McLeod Children’s Hospital.

The students were responsible for purchasing stocking stuffers suitable for male and female patients between infancy and 18 years of age. Emily Gaskins, an HCA sophomore said, “This is a form of helping those kids emotionally, which is a part of health.”

“Giving and wrapping gifts and stockings for the children in the hospital is a really amazing thing because I want to help kids one day as a pediatric nurse practitioner,” said Megha Patel, an HCA junior.

Using empathy, team building, and leadership skills the students stuffed gifts like bubbles, fuzzy socks, cars, dolls, and balls into 20 stockings. More than a dozen other gifts too large for a stocking were wrapped. Meredith Strickland, an HCA junior said, “This project showed me that you have to be full of imagination to be a doctor. You have to put yourself in the shoes of your patient.”

The HCA students also helped to deliver the stockings to patient rooms.  After the delivery, one student said, “I’m really glad I did this. I felt like I was going to cry in the room, but I didn’t.”

The Academy students gave more than enough for the children’s hospital. The extra gifts were donated to the House of Hope and the Chrysalis Center in Florence. “Helping with this project just shows that not only do I want to help people in the future, but I also want to help people now,” said Darrian Gardner, an Academy sophomore.

For more information about the Health Careers Academy, please contact Health Careers Program Coordinator Larrissa Clavon at lclavon@mcleodhealth.org.