E02 – The Interprofessional Precepting Room – Preliminary Data to Support Novel Integration through Consultation and Bidirectional Learning

Summary

One of the benefits of integrated primary care settings is the wealth of bi-directional learning that can occur through consultation and collaboration. In VA Connecticut’s Center of Education (COE) in Interprofessional Primary Care, residents from clinical health psychology (CHP), medicine, nursing, and pharmacy work together to provide fully integrated and comprehensive care. In the precepting room, physician (MD) and nurse practitioner (NP) residents meet with an attending provider to review patient care and develop a treatment plan. During interprofessional precepting, CHP residents provide mental and behavioral health consultation, and in turn, are exposed to professional practices in primary care. This project is an extension of previous work done examining active and passive learning in the precepting room. The sample consisted of 2 CHP residents, 14 physician (MD) residents, and 6 nurse practitioner residents (NP) over a 12-month period. During precepting, CHP residents tracked the type of consultation provided, if a CHP referral was discussed, and if a “warm introduction”was performed. CHP residents qualitatively indicated what they learned from precepting and themes were identified by two CHP providers not participating in precepting. Of the 122 patient visits precepted (60 by MD residents, and 62 by NP residents), consultation was provided 90% of the time. Consultation included health behavior change (70%), patient-provider communication (30%), understanding psychiatric presentations (22%), cultural considerations (11%), providing patient education handouts (10%), and mental health resources outside of the clinic (9%). Warm introductions were positively associated with health behavior change consultation (χ2= 6.81, p = .009). CHP referrals were discussed 30% of the time and were inversely associated with consultation on psychiatric presentations (χ2= 5.53, p=.019). Learning among CHP residents occurred 76% of the time and consisted of clinical/biomedical information (74%), profession-specific practices in primary care (19%), facility-related content (10%). MD and NP faculty identified coaching from CHP residents on communication techniques (e.g. motivational interviewing) as being particularly beneficial in MD/NP resident development. Other benefits of consultation included a greater appreciation for how mental health disorders impact care, alternative perspectives on clinical conceptualizations, and encouragement after multiple unsuccessful prior attempts to engage patients in changing health behaviors. Future directions include obtaining and examining qualitative data from MD and NP residents related to the impact of consultation with CHP residents on developing advanced competences in integrated care.