The AAFP recently joined five other national family medicine organizations to release "Joint Principles: Integrating Behavioral Health Care Into the Patient-Centered Medical Home."(www.annfammed.org) Published in the March/April Annals of Family Medicine, the new document complements the Joint Principles of the Patient-Centered Medical Home (PCMH) and was created to address bringing behavioral health into the PCMH model.
"The incorporation of behavioral health care has not always been included as practices transform to accommodate to the PCMH ideals," according to the document. "This is an alarming development because the PCMH will be incomplete and ineffective without the full incorporation of this element, and retrofitting will be much more difficult than prospectively integrating into the original design of the PCMH."
The PCMH is a model of primary care in which a team of clinicians offers accessible first-contact care that is personalized, coordinated and comprehensive and meets most or all of a person's health care needs, including behavioral health, according to an AAFP news release. As defined in the new joint principles document, behavioral health includes mental health care, substance abuse care, health behavior change, and attention to family and other psychosocial factors.
- The AAFP has joined five other family medicine organizations in publishing the article "Joint Principles: Integrating Behavioral Health Care Into the Patient-Centered Medical Home" in the March/April 2014 Annals of Family Medicine.
- The behavioral health joint principles are intended to supplement, not replace, the original Joint Principles of the Patient-Centered Medical Home (PCMH) that were released in February 2007.
- The new document builds on the seven principles laid out in the PCMH joint principles, integrating elements of behavioral health care into each.
The behavioral joint principles document is intended to supplement, not replace, the original PCMH joint principles document that was developed by the AAFP, the American Academy of Pediatrics (AAP), the American College of Physicians and the American Osteopathic Association (AOA) and released in February 2007.
Created by the AAFP, the American Board of Family Medicine, the Association of Departments of Family Medicine, the Association of Family Medicine Residency Directors, the North American Primary Care Research Group and the Society of Teachers of Family Medicine, the new document also was reviewed and endorsed by the AAFP Foundation, the AAP, the AOA, the American Psychological Association and the Collaborative Family Healthcare Association.
The document follows the order and language of the original PCMH joint principles and describes how behavioral health care tenets can be incorporated into the seven PCMH principles. In brief,
- Personal physician -- Every patient in the PCMH has a personal physician who knows the patient's living situation and who is committed to the well-being of that patient and accepts responsibility for appropriate care.
- Physician-directed medical practice -- Typically, the physician's practice will be the site of the PCMH, and the practice will rely on a team of health care professionals who act together to integrate the physical, mental, emotional and social aspects of the patient's health care needs by either performing these activities or referring the patient to nearby behavioral health specialists.
- Whole-person orientation -- More than half of primary care patients have a mental or behavioral diagnosis or symptoms that are significantly disabling, and nearly every medical problem has a psychosocial dimension. Thus, a whole-person approach to patient care demands inclusion of both physical and behavioral elements.
- Coordination of care -- The one factor that most seriously harms the quality and integrity of the health care system is fragmentation, and the most fully institutionalized fracture in that system is the separation of behavioral health care from primary care. Barriers to communication among health care professionals must be mitigated to make regular information-sharing the rule rather than the exception.
- Quality and safety -- When it comes to the care planning process, behavioral health clinicians must be included in the partnership of physician, patient and family. Information technology, particularly electronic health records with appropriate security, privacy and confidentiality protections, must incorporate the behavioral health provider's notes, mental health screening and case-finding tools, and outcomes tracking.
- Enhanced access -- Facilities with integrated behavioral health clinicians should consider open-access clinics for behavioral health care and substance use issues. Physical integration of a behavioral health professional into the PCMH can improve both access and coordination because it enables warm handoffs at the moment the patient or family is ready and, thus reduces stigma, improves adherence and augments access to support groups, parenting programs and other medical neighborhood services.
- Payment -- Appropriate payment recognizes the added value behavioral health care brings to the PCMH and, specifically, the role of behavioral health clinicians as members of the team. It is in the best interest of patients, families, employers and payers to improve and sustain patients' mental health by paying for effective collaboration between primary care and behavioral health clinicians.
The behavioral health principles lay out other critical needs that must be addressed when integrating behavioral health care into the PCMH, such as clear and consistent language across disciplines regarding the respective roles and skill sets required for physicians, behavioral health clinicians and other members of the health care team.
It will also be important for all health care professionals involved in patient care to have a solid understanding of the role of the patient and family in articulating needs and developing a care plan. The behavioral health principles call for research to better define how best to achieve whole-person health care in the PCMH, with attention to patient, practice, training and financing issues.
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