Having a chronic disease like diabetes or heart disease or migraines is hard enough on its own. But some people also suffer from mental illnesses such as anxiety or depression, which exacerbates their other disease.
Yet more than 70 percent of patients who are referred to an outside specialist never book an appointment to get that additional care.
So to better treat the whole patient, many primary care doctors are starting to work in combination with mental and behavioral health professionals. With this combined care approach, many patients have far more successful outcomes.
Now a University of Vermont-led research team has received more than $18 million in funding to study whether patients with both medical and behavioral problems do better when their doctors all work together.
“In two trials that I've been part of, one in Vermont and one nationally, when referrals have made within primary care to behavioral health condition within a primary care office, the rates of starting treatment are in the area of 75 to 90 percent,” says Dr. Rodger Kessler is an associate professor of family medicine at the University of Vermont, and the project director of this grant.
He says the success rates are so much higher because the behavioral and mental health specialists are right there in the same building. Then the patients don’t even have to book a separate appointment, they can just walk a few doors down.
“Many patients are comfortable with their health care being delivered in their primary care office,” he says.
But “the process of getting a piece of paper in your hand that says, ‘here's a telephone number of a set of providers — to literally making the call, to scheduling an appointment, to responding to answering machines and then to going in some places that you're not familiar with— it’s is a daunting task for many folks.”
Bringing doctors to the patient
Kessler says that the federally funded UVM study will in part be designed by a Vermont based patient team.
“There are patients involved in every element of our work,” he says. “We have a patient team that has worked with us in the design of the research question and the design of the intervention and everything in between.”
Kessler says having the patients serve as co-investigators in the study helps to ensure that their perspective goes into designing a successful study that can be applicable to real-world situations.
He says the study doesn’t look into the cost of different approaches to treatment, however, “there is mounting evidence from other research that suggests that there are in fact methods of lessening the burden on patients in terms of time in terms of cost.”
Kessler says research has shown that better, healthy outcomes do reduce the overall cost of health care, so “if we improve clinical care there will be other potential benefits.”
Kessler says the project is funded for five years. He hopes that it will be able to provide data not only to the public, but to policymakers and to national medical organizations and to legislators.
