- Cindi Stone, DBH, Director of Behavioral Health, Community Care Physicians, Glenmont, NY
- Lesley Manson, PsyD, Clinical Associate Professor, Arizona State University, Phoenix, AZ
- Kristine Campagna, DO, Physician, Latham Medical Group-Community Care Physician, Latham, NY
- Holly Cleney, MD, Family Physician, Latham Medical Group of Community Care Physicians, Latham, NY
- Elizabeth Locke, MD, Managing Physician, Community Care Physicians, Clifton Park, NY
As the demands on primary care providers (PCPs) are increasing, addressing the stress levels of PCPs, specifically daily stressors, is crucial (Bodenheimer & Sinsky, 2014). These stressors lead to burnout and are affecting PCPs at alarming levels. Bodenheimer and Sinsky (2014) report “…46% of US physicians experience symptoms of burnout…68% of family physicians would not choose the same specialty if they could start their careers anew” (p.574). While much of this frustration is associated with administrative work, this has had a ripple effect in leaving little time and energy for engaging with more difficult complex patients who present as some of the most draining of patient encounters (Babbott et al., 2014). Physicians report this is primarily because they see little improvement in many of these patients and realize that their medical school training did not prepare them for dealing with this (Linzer et al., 2002). They are specifically referring to additional skills and ways to interact with these patients, understand them, and enhance their motivation to change. In the attempt to assist with this, leveraging additional benefits of integrated care, the following intervention carried out by the behavioral health consultant (BHC) was developed. This intervention combines the basic skills of motivational interviewing and training on the diagnosis and treatment of medically unexplained symptoms (MUS) or, as it presents more commonly in primary care, stress illness.
The intervention in this study is focused on 1) teaching PCPs the spirit of motivational interviewing (MI) and basic MI skills and 2) educating PCPs on MUS/ stress illness including skills for diagnosis, discussion, screening, and treatment of these patients many of whom have experienced childhood stressors (Anda & Felitti, 1998). The participants in this study are patients, PCPs, Nurse Care Managers (RNs), a Pharmacist, and BHCs of a large integrated primary care practice following the primary care behavioral health model. This study involves a two-part training comprised of 4 forty-five minute didactic, interactive and experiential group training along with optional individual BHC-PCP shadows involving real-time training. All components of training will be designed as achievable within the fast pace of primary care. The goal of the study is to lower physician daily stress levels (DSLs) and improve treatment outcomes for MUS/ complex patients. With this intervention, the expected results will transform the frustration associated with the treatment of these patients into a collaborative relationship, employing joint decision-making processes, increasing patient adherence, and improving treatment outcomes while additionally reducing the PCP’s stress affiliated with these visits and improving daily stress levels (Rollick et. al, 2008). The study is currently in progress and as a result of COVID-19 is not complete. We are encouraged to use this as an opportunity to explore the impact of COVID on integrated primary care, specifically on the effects of this study, and to delve deeper into the particular teaching components of this intervention providing practical “take-homes”. We will be detailing the core components of our training program/ intervention in the hopes of adding value to programs and ideas that may be implemented in settings nationwide. Additional time will also be allotted for role play, feedback, questions to accomplish this goal.
- Identify challenges for PCPs in treating complex patients and how this leads to increased provider stress and burnout.
- Describe how the use of motivational interviewing skills assists in the treatment f complex patients
- Identify the factors that contribute to and constitute stress illness in patients who have experienced childhood or current stressors to aid in the diagnosis and treatment of these patients with complex issues.