Mount Nittany Medical Center is committed to understanding and addressing the most pressing health and wellness concerns for its community. In order to do so, a community health needs assessment (CHNA) is completed by Mount Nittany Medical Center every three years. In conjunction with Centre Foundation, Centre County United Way and Centre County Partnership for Community Health, Mount Nittany Medical Center conducted a CHNA update from July 2015 to June 2016. After thorough analysis, three health issues were identified as priorities for the community: behavioral health, substance abuse and chronic disease.
The Mount Nittany Health Foundation Board unanimously approved funding to support these three needs. A portion of the unrestricted funds designated to the 2016 CHNA implementation plan will provide funding to have Timothy Derstine, MD, former medical director of behavioral health services, as a resource for primary care providers. Dr. Derstine is consulting with Mount Nittany Physician Group to develop and implement a collaborative care model to improve behavioral healthcare in primary care settings. An initial pilot, modeled after the work of the AIMS Center at the University of Washington’s IMPACT (Improving Mood – Promoting Access to Collaborative Treatment) study, is close to launching in one Mount Nittany Physician Group primary care site, and it will assess the feasibility of expanding the model across other primary care practices.
“The goal of collaborative care is to improve access to behavioral health treatment through a collaboration between primary care clinicians and a behavioral health team,” Dr. Derstine said. “The biggest goal is to get a good team in place in the primary care physician’s office so that more treatment can be rendered earlier in the patient’s course of illness.”
For instance, Dr. Derstine explained that having a licensed clinical social worker (LCSW) embedded in the primary care practice will help to identify patients who are not responding to initial behavioral health treatment and, along with the collaborating psychiatrist, recommend adjustments in treatment plans. In addition, the LCSW can help break down barriers patients may have in receiving proper intervention and treatment, working as an advocate or navigator for the patient in seeking needed services.
“It can be a very complicated process for patients to negotiate through the system,” said Dr. Derstine. “Providing access to behavioral healthcare in the primary care setting, close to home, is game-changing. If patients come in during a crisis, they can be seen by a behavioral health specialist sooner, and treatment options can be determined more quickly, reducing the likelihood of unnecessary trips to the Emergency Department or a behavioral health inpatient admission. When fully operational, reduced visits to the primary care clinician’s office are also expected. Studies show that this model improves outcomes and patient satisfaction.”
“Dr. Derstine brought this model forward years ago,” said Sue Trainor, CRNP, CDE, diabetes nurse practitioner, Mount Nittany Health. “We know that many patients who live with chronic diseases, such as diabetes, also face obstacles in managing their chronic disease related to co-morbid depression and anxiety. Often, these patients may be called ‘non-compliant’ because they are not able to effectively manage diseases, such as diabetes or heart failure, when their depression or anxiety is not being addressed or treated. In many situations, care for behavioral health conditions and chronic diseases, such as diabetes, is fragmented, with care for depression or anxiety occurring in one office, and care for diabetes or other diseases in a completely different practice. In the past, lack of management for depression or anxiety, or lack of care coordination between practices, would perpetuate the cycle, making diabetes or other chronic conditions, as well as depression and anxiety, worse. Now, the IMPACT model brings collaboration right into the clinic and integrates counseling with pharmacologic treatment. And it is all provided in the primary care setting — the patient’s medical home — where he or she is comfortable and familiar.”
Addressing and treating patients as quickly as possible is critical. Earlier behavioral health treatment profoundly impacts any recurring episodes and has a huge impact on the course of a patient’s life.
“A patient presenting with a first major depressive episode has about a 50 percent chance of a second episode,” stated Dr. Derstine. “When presenting a second time, the chances for recurrence goes to greater than 80 percent, and following a third episode, a patient has more than a 90 percent chance to have a recurrence, so you can see why effective early treatment and intervention are essential.”
Primary care physicians not working as part of a collaborative model often face challenges diagnosing and treating behavioral health and substance use disorders. By working with Dr. Derstine, Mount Nittany Health is taking steps to improve patient access to screening tools, education and support, as well as initiating and referring for treatment. The key to the collaborative care model is to identify patients earlier in the process, which helps to prevent an acute problem from becoming chronic, which is more difficult and expensive to treat. By collaborating with primary care physicians on a regular basis, Dr. Derstine expects to see improvements in integration of services, which will generate a positive impact on the overall cost of care over time, and he anticipates that the success of the IMPACT pilot may eventually expand to other Mount Nittany Health primary care sites.
“It’s about making the entire community healthier,” said Trainor. “By coordinating and integrating behavioral health and primary care, we can improve the quality of life for our patients. By providing the best, most comprehensive care possible, we can help our patients enjoy life and do the things that matter most to them.”
“It takes a strong will to invest in the infrastructure to implement the IMPACT model, and Mount Nittany Health’s commitment to do something now will have a significant impact on the lives of people residing in Centre County,” said Dr. Derstine. “The goal is for people living here to have early access to treatment for behavioral health and substance abuse disorders, just like any other disease. The commitment to this pilot shows we aren’t comfortable with the status quo, and I’m very grateful to the Foundation for providing the funds to make this a priority.”
To learn more about the community health needs assessment, visit mountnittany.org/healthneeds. To learn more about ways Mount Nittany Health is bettering our community, go to foundation.mountnittany.org.
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