Evaluating A Clinical Microsystem Utilizing The Microsystems Guide And The 5ps ( See Appendix A )

Throughout the years public health efforts have evolved in order to meet health care need of populations. Despite advances the United States continues to have high morbidity rates of individuals with chronic illness. Adding to the rates, many Americans are suffering from mental health disorders. The issue caused many research studies to focus on integrating behavioral health and primary care in order to reduce health disparities in the nation. This paper will analyze how the integration of behavioral health in primary care facilities help serve the need of our population.

Problem Statement: The World Health Association defines ‘good’ health as: “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” However, in the United States, access to care and funding for mental health care are grossly neglected and underfunded in comparison to other aspects of health care.

A clinical microsystem is a “small, interdependent group of people who work together regularly to provide care for specific groups of patients” (Institute for Healthcare Improvement, p.1). It is the goal of this paper to discuss the findings of the Johnson Clinical Microsystem Assessment Tool to the microsystem where I am employed on-call, the Multnomah County Health Department (MCHD), HIV Health Service Center (HSC), a primary medical home for patients with HIV/AIDS. Additionally, I will address each of the 5 P’s of the microsystem; purpose, patients, professionals, procedures and patterns that will then inform a practice change for the clinic.

Mental health providers utilize many forms of research from the interventions that they use to provide care to their clients all the way to the assessment’s that they use to gauge the level of satisfaction of their clients with their services and how effective their services are in regards to their overall mental health wellness.

The majority of research that exists on 12-step programs often focus on determining the success rate of 12-step programs such as AA. There is little to no research on problems associated with 12-step programs or problematic areas of 12-step programs. The little research that does exist argue that 12-step programs are not structured for comorbid individual, they may not be the best option for mild substance use disorder, and the central theme of powerlessness can conflict with a therapist’s theoretical orientation and be harmful to the therapeutic alliance. (Kelly & Myers, 2007, Laudet et al., 2004, L, Ingvarson, Richard, 1995). The National Institute of Mental Health (2013) has found that 43.6 million adults aged 18 and older have at least one mental illness and 45 percent of individuals with one mental disorder met criteria for two or more disorders. The presence of comorbid disorders can severely affect the treatment and outcome of individuals (Terra et al., 2006). Many studies have found that clients with a dual diagnosis experience increased rates of hospitalization and increased use of emergency services (Helzer & Pryzbeck, 1998). It is easy to imagine how hospitalization can interrupt treatment by making it difficulty for individuals to attend.

“Evidence combined with the growing recognition that physical, mental, substance abuse and social challenges are interrelated-has led to calls to integrate behavioral health care into primary care services.” (Klein & Hostetter, 2014, p. 9) Behavioral health and substance abuse treatment in the primary care office is rare and in some cases non-existent. This is mostly due to no or little financial incentive or administrative advantages to integrating these services within the primary care office. Dr. Roger Kathol, M.D. president of the Cartesian Solutions Inc., believes the biggest obstacle in integrating mental health and substance abuse treatment into the primary care office is low payment from payers. Payers use separate provider networks,

Rivers Integrated Care (RIC) is a primary care facility located in Phoenix Arizona. This clinic recently transitioned from an urgent care facility to an integrated primary care and emergency clinic. The goal of this transition is to become a patient-centered medical home and behavioral health facility. The clinic currently has a Behavioral Health Consultant, who is also the Site Administrator, Physician Assistant (PA) and a Primary Care Provider (PCP). The plan is to employ a full-time Psychiatrist to prescribe psychotic medication. Although employees of RIC consider this clinic a fully integrated facility. According to the Agency for Healthcare Research and Quality's (AHRQ) integration assessment tool, the clinic is partially integrated.

In today’s society there is a greater awareness of mental illnesses. With this greater awareness one might assume that there would be a substantial increase in government involvement or funding in the area of mental illness treatment. Unfortunately this isn’t the case in the U.S. today. There are hundreds of thousands of people with mental illness that go untreated. These potential patients go untreated for many reasons. These reasons are discussed in the Time article “Mental Health Reform: What Would it Really Take.

The Finger Lakes Organization for Wellness, Education, and Recovery (FLOWER) is poised to initiate a new and exciting Partnership to support the objectives of New York’s Delivery System Reform Incentive Payment (DSRIP) and Finger Lakes Performing Provider System (FLPPS). Mental health and substance use disorder prevention is a priority area of the New York State Prevention Agenda for DSRIP. The mental, emotional, and behavioral (MEB) health promotion and disorders prevention is a relatively new field, requiring a paradigm shift in approach and perspective.

Boston Medical Center is an medical center that has added the cost of social workers, psychiatric nurse practitioners and patient navigators on a trial basis. The reason for this investment is to help the medical center succeed in future value-based contracts, or as an accountable care organization, by allowing it to share in any savings that accrue from improving outcomes and reducing costs Klien, & Hostetter, 2014). In contrast, Greenleaf is a stand-along facility in the community of Valdosta, Ga., and enjoys a fairly symbiotic relationship with South Georgia Medical Center. Both Boston Medical Center and Greenleaf offer a wide variety of inpatient and outpatient services for behavioral health. However, I would prefer Greenleaf because it

The clinician interviewed is Sara Gavin, Director of Behavioral Health of CommuniCare Health Centers of Yolo County. They provide services in Davis, California; Woodland, California; and West Sacramento, California. CommuniCare Health Centers is a Federally Qualified Health and it has been providing health care since 1972. The goal of the program

Chief Complaint: Frank was having incessant wheezing for the last 2 weeks. His pediatrician decided to refer him to an allergist to assess his issues with chronic asthma and nasal congestion (rhinitis).

This organization puts lots of energy into advancing research to improve the techniques of identifying mental health issues (American Psychiatric Nurses Association, 2015). With earlier detection, psychiatric nurse clinicians will be able to promote the proper health and wellness to those on the

I thought you did a great job on this week’s discussion post. “A clinical microsystem is the place where patients, families, care teams, and information come together” (Nelson, Batalden, & Godfrey, 2007, p. 233). The rehabilitation unit at St. Joseph Medical Center that you described is a great example of this. It takes a variety of people and staff to run a microsystem properly. Everyone has to work together for the greater good of the unit. You talked about communication being an issue, but I believe communication is a matter that needs to be worked on in every microsystem. As nurses voicing our opinions and asking others for help is key to communication. We all can learn from one another and that is something I try to never forget.

I believe an excellent alternative to the current approach to behavioral health issues would be the incorporation of Telemedicine encounters into the reimbursement schedule for Medicaid patients. If Medicaid and other payers in the industry would take a more proactive approach to the treatment of diseases and illnesses such as substance abuse or PTSD, then there would be more exposure and treatment available to people who suffer from these conditions and it would increase the overall population health in areas where Telemedicine services are provided and encounters with psychiatrists can be conducted via videoconferencing between the patients in their home and providers at their usual location that wouldn’t otherwise have been conducted at all.