Shared appointment, no outside face-to-face meeting “I developed more understanding of the impact of social stressors on health” N “The alternate perspective on disease often provides the key to treatment adherence” N
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“I learned to have a stronger communication with my patient’s family.” N “I learned different ways of addressing medication problems with the patient and how to approach her about her chronic pain.” Y “I learned about ethical issues, physician obligations, and reporting requirements to law-enforcement.” Y “I learned about community resources available for IV drug addicts.” N “With BHI, patients have additional support and tend to be more compliant.” N No residents in this group reported this major theme “I learned about the severity of my patient’s Post-traumatic Stress Disorder, which he had only mentioned to me briefly, and I got more information about his coping resources.” N No shared appointment or face-to-face meeting Theme 2 Interpersonal Communication Skills Awareness Associations were examined between face-to-face interactions and the frequency of each major learning theme category. Qualitative responses were coded thematically by two researchers using grounded theory. Residents were asked open-ended questions regarding what they had learned from co-managing with an IBHC. Associations between the degree of face-to-face interaction and these two outcomes were assessed using multiple logistic regression and linear regression. Respondents were asked about other features of the visit, including: (1) whether or not they received feedback from the IBHC on their management, and (2) to rate the episode’s impact on the patient’s care. To assess the degree of face-to-face interaction during their most recent co-managed case, residents were asked whether or not the co-management included (1) a shared visit with the IBHC and/or (2) meeting face-to-face to discuss the patient’s care. METHODS: Residents were surveyed from 2 Internal Medicine (IM) and 3 Family Medicine (FM) residency training programs with behavioral health integration in residents’ continuity clinics. They noted that IP “is not a new thing” and questioned their ability to integrate PCMH mandates with an authentic mission to provide patient-centered care: “there’s a difference between…checking off all the boxes for PCMH and…really incorporating the spirit of it…like having a PCMH mind versus a PCMH heart.” Faculty perspectives, however, were more ambivalent.
Patients noted that participating in a teaching clinic was “more than about me” and described benefits receiving care from supervised trainees. Learners were excited about IP work and anticipated high quality interactions with other professions. Learners, faculty, and patients each emphasized the importance of defining roles within a team and communicating roles to patients. Both similarities and distinct perspectives emerged across stakeholders when discussing these issues and most attitudes were positive. RESULTS: Themes present in all stakeholder groups were labeled 1) team engagement, 2) the role of technology in care delivery, 3) insurance/cost of care, 4) involving patients in the learning process, 5) time constraints, 6) scope of practice, and 7) autonomy, interdependence, and decision-making.
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