{"id":45933,"date":"2014-05-01T13:28:51","date_gmt":"2014-05-01T17:28:51","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=45933"},"modified":"2014-05-01T14:52:22","modified_gmt":"2014-05-01T18:52:22","slug":"two-versions","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2014\/05\/01\/two-versions\/","title":{"rendered":"two versions…"},"content":{"rendered":"\n

I’ve tried to steer clear of the guild side of psychiatry in this blog and focus on the misinformation generated on the psychopharmacologic side of the world. But reading about this push for Integrative Care<\/font><\/strong> coming from the APA has sort of put it in my face. Unless I’m grossly misreading things, the APA is currently actively participating in removing the medical specialty of psychiatry from the clinical care of patients. Here’s the APA Infographic<\/a><\/em> subtext again: <\/p>\n\n\n\n\n\n\n
<\/td>\n <\/td>\n<\/td>\n<\/tr>\n
\n
• Makes initial diagnosis and prescribes medications<\/div>\n
• Modifies treatment based on patient preferences,needs, and psychiatrist recommendations<\/div>\n<\/td>\n
\n
• Identifies goals, needs, and preferences for treatment<\/div>\n
• Participates in regular screening<\/div>\n<\/td>\n<\/tr>\n
\n
<\/td>\n<\/tr>\n
<\/td>\n <\/td>\n<\/td>\n<\/tr>\n
\n
• Monitors all patients in practice<\/div>\n
• Provides education<\/div>\n
• Tracks treatment response<\/div>\n
• May offer brief psychotherapy<\/div>\n
• Assures patient engagement<\/div>\n<\/td>\n
\n
• Provides team leadership<\/div>\n
• Reviews caseload regularly<\/div>\n
• Educates and consults<\/div>\n
• Sees patients who are not making improvements<\/font><\/strong><\/div>\n<\/td>\n<\/tr>\n<\/table>\n

George Dawson of Real Psychiatry<\/a> was onto Integrative Care<\/font><\/strong> earlier than most of us [see The Model of Psychiatric Care for the Future<\/a>, Collaborative Care Model – Even Worse Than I Imagined<\/a>], certainly before I was [see his recent comments here<\/a>, here<\/a>, and here<\/a>]. In the second post […Even Worse Than I Imagined<\/a>], he mentions a JAMA article with an earlier version of the Integrative Care<\/font><\/strong> model:<\/p>\n

\n
Health Reform, Research Pave Way for Collaborative Care for Mental Illness<\/a><\/div>\n
by Bridget M. Kuehn, MSJ<\/div>\n
JAMA<\/font><\/strong>, June 19, 2013 309[23]:2425-2426. <\/div>\n

<\/p>\n

<\/div>\n<\/blockquote>\n
The difference in these versions is fairly obvious. Here’s my image from the Infographic<\/a><\/em> with the difference highlighted in red:<\/div>\n
<\/div>\n
The psychiatrist never sees the patient or the primary care physician in the JAMA version. Here’s what Dr. Dawson has to say about that:<\/div>\n
\n
\n
As predicted in my original post, the psychiatrist here is so marginalized they are close to falling off the page.  And let’s talk about what is really happening here.  This is all about a patient coming in and being given a PHQ-9 depression screening inventory.  For those of you not familiar with this instrument you can click on it here<\/a>.  It generally takes most patients anywhere from 1 – 3 minutes to check off the boxes.  Conceivably that could lead to a diagnosis of depression in a few more minutes in the primary care clinic.  At that point the patient enters the antidepressant algorithm and they are they are officially being treated.  The care manager reports the PHQ-9 scores of those who do not improve to the "supervising" psychiatrist and gets a recommendation to modify treatment.<\/div>\n

<\/p>\n

This is the model that the APA has apparently signed off on and of course it is ideal for the Affordable Care Act.  It is the ultimate in affordability.  The psychiatrist doesn’t even see the patient – so in whatever grand billing scheme the ACA comes up with – they won’t even submit a billing statement.  The government and the insurance industry have finally achieved what they could only come close to in the past – psychiatrists working for free.  Of course we will probably have to endure a decade or so of rhetoric on cost effectiveness and efficiency, etc. before anyone will admit that. Keep in mind what the original government backed model for treating depression<\/a> was over 20 years ago and you will end up shaking your head like I do every day.  Quality has left the building.<\/div>\n<\/blockquote>\n
I have more than two cents to add here, but knowing the attention span of the average expectable blog reader, I’m going to let this sit for a bit and gather my thoughts before diving in. But the hiatus doesn’t mean I don’t have an opinion…<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

I’ve tried to steer clear of the guild side of psychiatry in this blog and focus on the misinformation generated on the psychopharmacologic side of the world. But reading about this push for Integrative Care coming from the APA has sort of put it in my face. Unless I’m grossly misreading things, the APA is […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-45933","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/45933","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=45933"}],"version-history":[{"count":11,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/45933\/revisions"}],"predecessor-version":[{"id":45957,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/45933\/revisions\/45957"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=45933"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=45933"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=45933"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}