PSYCHIATRY AND HISTORY
Fall 2021 Issue |
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Collaborative Care in the Department of Psychiatry and Neurobehavioral Sciences at the University of Virginia
By Richard Lawrence (Larry) Merkel, Jr., MD, PhD
Professor
Director of Outreach
Department of Psychiatry and Neurobehavioral Sciences
University of Virginia
The Department of Psychiatry and NBS at UVA has been doing telepsychiatry since 1998. Initially it consisted of ad hoc consults by available individual psychiatrists to Primary Care Providers (PCP) primarily in Southwest Virginia. In 2003, Dr. Larry Merkel began devoting a half day per week for psychiatric consults with PCP clinics, building an on-going relationship with these providers. In 2006, the Division of Child and Adolescent Psychiatry of the Department also began providing regular consultations, primarily to CSBs in SW Virginia. In 2008, PGY IV residents began working with Dr. Merkel to provide adult psychiatric consultations to various PCP clinics as an elective.
With this increase in availability, the service started doing more of a Collaborative Care with the PCP providers. Dr. Merkel and participating PGY IV residents would take a few days and drive to SW Virginia to visit the various sites with which they were collaborating, in order to build more personal connections with the primary care providers, as well as to understand the nature and circumstances of the PCP practices. This was an eye-opening experience for these residents, most of whom had never traveled in SW Virginia before. This continued for three years, but in 2012 the Department of Psychiatry and NBS decided that the experience of doing telepsychiatry, especially using a Collaborative Care Model, was so important an experience for psychiatry residents that the telepsychiatry effort was moved into the PGY III year and combined with the regular outpatient experience. Each resident is assigned to one or more clinics in SW Virginia, with the goal of getting to know the providers at that clinic and building a working relationship with them along the Collaborative Care model. Residents have found this to be a valuable experience, and to be especially helpful after graduation, when developing or joining a practice. A few residents have adopted careers that fully encompass telepsychiatry.
In addition to the experiences via telepsychiatry, the Collaborative Care Model has been used by the Department of Psychiatry and NBS in other ways. In 2010, Dr. Merkel, and one to three PGY IV residents, began seeing refugee patients in the International Family Medicine Clinic, part of the Department of Family Medicine, which has the responsibility of providing medical care to refugees in the greater Charlottesville area. This has resulted in a close working relationship between the psychiatrists providing refugee care and the Family Medicine faculty and residents in the clinic. Since then, psychiatrists in the department have become imbedded in Family Medicine and Internal Medicine outpatient clinics, the Epilepsy clinic of the Department of Neurology, satellite Primary Care clinics, and Intensive Care Units at UVA.
The effort to enhance Collaborative Care with various outlying facilities has been enhanced by the development of an ECHO program at UVA. The Department of Psychiatry and NBS has utilized ECHO to provide PCP providers with case-based clinical knowledge in treatment of opioid addictions, Neonatal Abstinence Syndrome, and Behavioral Medicine. During the COVID pandemic ECHO was utilized to help PCP providers gain knowledge about the diagnosis and treatment of COVID. It was also used to provide care and support to the residents and staff in long-term care facilities. ECHO provides an important adjunct to telepsychiatry consultations by equipping PCP providers with basic psychiatric knowledge and in-session consultative support, so that PCPs become more familiar with recognizing, diagnosing, and treating basic psychiatric disorders, as well as knowing when to refer for telepsychiatry consultations and how to better collaborate with psychiatric providers.
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