Advertisement

Journal of Clinical Psychology in Medical Settings

, Volume 25, Issue 3, pp 267–277 | Cite as

Leadership Perspectives on Integrating Psychologists into Specialty Care Clinics: An Evolving Paradigm

  • Marwan Abouljoud
  • Michael Ryan
  • Anne Eshelman
  • Kelly Bryce
  • Michelle T. Jesse
Article
  • 109 Downloads

Abstract

Integration of health psychologists into specialty care is a shift in the tertiary care construct that addresses all aspects of a patient’s presentation, including psychiatric/social history, psychological well-being, and behavioral contributions to the disease process, assuring both optimal health outcomes and cost-effectiveness in a financially challenging healthcare environment. In this paper, we discuss leadership perspectives (physician and psychologists) on the factors involved in integrating a health psychologist into a busy tertiary care environment. Ultimately, we hope that this information provides a primer on how to frame a proposal for an integrated health psychologist emphasizing the elements important to senior medical leadership and administration. First, we briefly discuss the current payer framework, providing support for integration emphasizing costs and other metrics. Second, we introduce organizational structure models and strategies for integration. Lastly, we will discuss the unique skillset psychologists possess, and additional skills necessary, to be effective in the changing landscape of healthcare. We think this information is important both for leaders attempting to integrate a health psychologist into specialty care and for the early career health psychologist embarking on his/her first senior staff position.

Keywords

Integrated health psychologist Tertiary care Specialty care Leadership perspectives 

Notes

Compliance with Ethical Standards

Conflict of interest

The authors Marwan Abouljoud, Michael Ryan, Anne Eshelman, Kelly Bryce, and Michelle T. Jesse declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human participants performed by any of the authors.

References

  1. Abouljoud, M., Klintmalm, G., & Whitehouse, S. (2012). Transplant organizational structures: Viewpoints from established centers. American Journal of Transplantation, 12, 2623–2629.  https://doi.org/10.1111/j.1600-6143.2012.04189.x.CrossRefPubMedGoogle Scholar
  2. Abouljoud, M., & Whitehouse, S. (2013). Transplant programs, centers, and institutes: What does it all mean? Current Opinion in Organ Transplantation, 18, 229–234.CrossRefPubMedGoogle Scholar
  3. Aiello, A., Simanek, A., & Galea, S. (2010). Population levels of psychological stress, herpesvirus reactivation and HIV. AIDS and Behavior, 14, 308–317.CrossRefPubMedGoogle Scholar
  4. American College of Surgeons, Commission on Cancer. (2012). Cancer program standards 2012: Ensuring patient-centered care. Chicago: American College of SurgeonsGoogle Scholar
  5. Auxier, A., Runyan, C., Mullin, D., Mendenhall, T., Young, J., & Kessler, R. (2012). Behavioral health referrals and treatment initiation rates in integrated primary care: A Collaborative Care Research Network study. Translational Behavioral Medicine, 2, 337–344.CrossRefPubMedPubMedCentralGoogle Scholar
  6. Ayalon, L., Areán, P. A., Linkins, K., Lynch, M., & Estes, C. L. (2007). Integration of mental health services into primary care overcomes ethnic disparities in access to mental health services between black and white elderly. The American Journal of Geriatric Psychiatry, 15, 906–912.CrossRefPubMedGoogle Scholar
  7. Beacham, A. O., Van Sickle, K. S., Khatri, P., Ali, M. K., Reimer, D., Farber, E. W., & Kaslow, N. J. (2017). Meeting evolving workforce needs: Preparing psychologists for leadership in the Patient-Centered Medical Home. American Psychologist, 72, 42–54.CrossRefPubMedGoogle Scholar
  8. Bertges Yost, W., Eshelman, A., Raoufi, M., & Abouljoud, M. S. (2005). A national study of burnout among American transplant surgeons. Transplantation Proceedings, 37, 1399–1401.CrossRefPubMedGoogle Scholar
  9. Blount, A. (2003). Integrated primary care: Organizing the evidence. Families, Systems, & Health, 21, 121–134.CrossRefGoogle Scholar
  10. Burwell, S. M. (2015). Setting value-based payment goals—HHS efforts to improve US health care. New England Journal of Medicine, 372, 897–899.CrossRefPubMedGoogle Scholar
  11. Butler, J. A., Roderick, P., Mullee, M., Mason, J. C., & Peveler, R. C. (2004). Frequency and impact of nonadherence to immunosuppressants after renal transplantation: A systematic review. Transplantation, 77, 769–776.CrossRefPubMedGoogle Scholar
  12. Centers for Disease Control and Prevention. (2017). Chronic diseases: The leading causes of death and disability in the United States. Retrieved from https://www.cdc.gov/chronicdisease/overview/.
  13. Charns, M. P., & Young, G. (2011). Organization design and coordination. In L. R. Burns, E. H. Bradley, & B. J. Weiner (Eds.), Shortell and Kaluzny’s healthcare management: Organizational design & behavior (6th ed, pp. 64–90). Clifton Park, NY: Thomson Delmar Learning.Google Scholar
  14. Chomienne, M. H., Grenier, J., Gaboury, I., Hogg, W., Ritchie, P., & Farmanova-Haynes, E. (2011). Family doctors and psychologists working together: Doctors’ and patients’ perspectives. Journal of Evaluation in Clinical Practice, 17, 282–287.CrossRefPubMedGoogle Scholar
  15. Chwastiak, L. A., Davydow, D. S., McKibbin, C. L., Schur, E., Burley, M., McDonell, M. G.,. … Daratha, K. B. (2014). The effect of serious mental illness on the risk of rehospitalization among patients with diabetes. Psychosomatics, 55, 134–143.CrossRefPubMedGoogle Scholar
  16. Davydow, D. S., Russo, J. E., Ludman, E., Ciechanowski, P., Lin, E. H., Von Korff, M., … Katon, W. J. (2011). The association of comorbid depression with intensive care unit admission in patients with diabetes: A prospective cohort study. Psychosomatics, 52, 117–126.CrossRefPubMedPubMedCentralGoogle Scholar
  17. Denhaerynck, K., Dobbels, F., Cleemput, I., Desmyttere, A., Schafer-Keller, P., Schaub, S., & De Geest, S. (2005). Prevalence, consequences, and determinants of nonadherence in adult renal transplant patients: A literature review. Transplantation International, 18, 1121–1133.  https://doi.org/10.1111/j.1432-2277.2005.00176.x.CrossRefGoogle Scholar
  18. Dew, M. A., DiMartini, A. F., De Vito Dabbs, A., Myaskovsky, L., Steel, J., Unruh, M., … Greenhouse, J. B. (2007). Rates and risk factors for nonadherence to the medical regimen after adult solid organ transplantation. Transplantation, 83, 858–873.  https://doi.org/10.1097/01.tp.0000258599.65257.a6.CrossRefPubMedGoogle Scholar
  19. DiMatteo, M. R., Lepper, H. S., & Croghan, T. W. (2000). Depression is a risk factor for noncompliance with medical treatment: Meta-analysis of the effects of anxiety and depression on patient adherence. Archives of Internal Medicine, 160, 2101–2107.CrossRefPubMedGoogle Scholar
  20. Freeman, E., McGuire, C. A., Thomas, J. W., & Thayer, D. A. (2014). Factors affecting costs in Medicaid populations with behavioral health disorders. Medical Care, 52, S60-S66.CrossRefGoogle Scholar
  21. Gallo, J. J., Zubritsky, C., Maxwell, J., Nazar, M., Bogner, H. R., Quijano, L. M., … Levkoff, S. E. (2004). Primary care clinicians evaluate integrated and referral models of behavioral health care for older adults: Results from a multisite effectiveness trial (PRISM-e). Annals of Family Medicine, 2, 305–309.CrossRefPubMedPubMedCentralGoogle Scholar
  22. Golden, S. H., Lazo, M., Carnethon, M., Bertoni, A. G., Schreiner, P. J., Roux, A. V. D., … Lyketsos, C. (2008). Examining a bidirectional association between depressive symptoms and diabetes. Journal of the American Medical Association, 299, 2751–2759.CrossRefPubMedGoogle Scholar
  23. Guck, T. P., Guck, A. J., Brack, A. B., & Frey, D. R. (2007). No-show rates in partially integrated models of behavioral health care in a primary care setting. Families, Systems, & Health, 25, 137.CrossRefGoogle Scholar
  24. Health Resources & Services Administration. (2006). Credentialing & privileging health center practitioners. Policy Information Notice 200116. (2001, 2006). Retrieved from https://bphc.hrsa.gov/programrequirements/policies/pin200116.html.
  25. Health Service Psychology Education Collaborative. (2013). Professional psychology in health care services: A blueprint for education and training. American Psychologist, 68, 411–426.  https://doi.org/10.1037/a0033265.CrossRefGoogle Scholar
  26. Hunter, C. L., & Goodie, J. L. (2010). Operational and clinical components for integrated-collaborative behavioral healthcare in the patient-centered medical home. Families, Systems, & Health, 28, 308.CrossRefGoogle Scholar
  27. Hunter, C. L., Goodie, J. L., Oordt, M. S., & Dobmeyer, A. C. (2017). Integrated behavioral health in primary care: Step-by-step guidance for assessment and intervention (2nd ed.). Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  28. Jesse, M. T., Abouljoud, M., & Eshelman, A. (2015). Determinants of burnout among transplant surgeons: A national survey in the United States. American Journal of Transplantation, 15, 772–778.  https://doi.org/10.1111/ajt.13056.CrossRefPubMedGoogle Scholar
  29. Jesse, M. T., Abouljoud, M. S., Hogan, K., & Eshelman, A. (2015). Burnout in transplant nurses. Progress in Transplantation, 25, 196–202.  https://doi.org/10.7182/pit2015213.CrossRefPubMedGoogle Scholar
  30. Jesse, M. T., Rubinstein, E., Eshelman, A., Wee, C., Tankasala, M., Li, J., & Abouljoud, M. (2016). Lifestyle and self-management by those who live it: Patients engaging patients in a chronic disease model. The Permanente Journal, 20, 45–50.PubMedPubMedCentralGoogle Scholar
  31. Jesse, M. T., Ryan, M. E., Eshelman, A., Ghanem, T., Williams, A. M., Miller-Matero, L. R., & Yaremchuk, K. (2015). Integrated psychological care in head and neck cancer: Views from health care providers, patients, and supports. The Laryngoscope, 125, 1345–1351.CrossRefPubMedGoogle Scholar
  32. Kathol, R. G., McAlpine, D., Kishi, Y., Spies, R., Meller, W., Bernhardt, T., … Gold, W. (2005). General medical and pharmacy claims expenditures in users of behavioral health services. Journal of General Internal Medicine, 20, 160–167.CrossRefPubMedPubMedCentralGoogle Scholar
  33. Kazak, A. E., Nash, J. M., Hiroto, K., & Kaslow, N. J. (2017). Psychologists in patient-centered medical homes (PCMHs): Roles, evidence, opportunities, and challenges. American Psychologist, 72, 1–12.CrossRefPubMedGoogle Scholar
  34. Kessler, R. (2012). Mental health care treatment initiation when mental health services are incorporated into primary care practice. Journal of the American Board of Family Medicine, 25, 255–259.CrossRefPubMedGoogle Scholar
  35. Kheirkhah, P., Feng, Q., Travis, L. M., Tavakoli-Tabasi, S., & Sharafkhaneh, A. (2016). Prevalence, predictors and economic consequences of no-shows. BMC Health Services Research, 16, 13.  https://doi.org/10.1186/s12913-015-1243-z.CrossRefPubMedPubMedCentralGoogle Scholar
  36. Kirch, D. G., & Ast, C. E. (2017). Health care transformation: The role of academic health centers and their psychologists. Journal of Clinical Psychology in Medical Settings, 24, 86–91.CrossRefPubMedGoogle Scholar
  37. Kubzansky, L. D., Koenen, K. C., Spiro, A., Vokonas, P. S., & Sparrow, D. (2007). Prospective study of posttraumatic stress disorder symptoms and coronary heart disease in the Normative Aging Study. Archives of General Psychiatry, 64, 109–116.CrossRefPubMedGoogle Scholar
  38. LaPaglia, D., Thompson, B., Hafler, J., & Chauvin, S. (2017). Training for leadership roles in academic medicine: Opportunities for psychologists in the AAMC LEAD Program. Journal of Clinical Psychology in Medical Settings, 24, 118–123.CrossRefPubMedGoogle Scholar
  39. Leto, L., & Feola, M. (2014). Cognitive impairment in heart failure patients. Journal of Geriatric Cardiology, 11, 316–328.PubMedGoogle Scholar
  40. Levant, R. F., House, A. T., May, S., & Smith, R. (2006). Cost offset: Past, present, and future. Psychological Services, 3, 195.CrossRefGoogle Scholar
  41. McDaniel, S. H., Grus, C. L., Cubic, B. A., Hunter, C. L., Kearney, L. K., Schuman, C. C., … McCutcheon, S. (2014). Competencies for psychology practice in primary care. American Psychologist, 69, 409.CrossRefPubMedGoogle Scholar
  42. Medicare.gov. (2017). Hospital compare. Retrieved from https://www.medicare.gov/hospitalcompare/search.html.
  43. Meyer, T., Eshelman, A., & Abouljoud, M. (2006). Neuropsychological changes in a large sample of liver transplant candidates. Transplantation Proceedings, 38, 3559–3560.CrossRefPubMedGoogle Scholar
  44. Miller-Matero, L. R., Dykuis, K. E., Albujoq, K., Martens, K., Fuller, B. S., Robinson, V., & Willens, D. E. (2016). Benefits of integrated behavioral health services: The physician perspective. Families, Systems, & Health, 34, 51–55.CrossRefGoogle Scholar
  45. Miller-Matero, L. R., Hyde-Nolan, M. E., Eshelman, A., & Abouljoud, M. (2015). Health literacy in patients referred for transplant: Do patients have the capacity to understand? Clinical Transplantation, 29, 336–342.  https://doi.org/10.1111/ctr.12519.CrossRefPubMedGoogle Scholar
  46. Mitchell, A. J., Chan, M., Bhatti, H., Halton, M., Grassi, L., Johansen, C., & Meader, N. (2011). Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: A meta-analysis of 94 interview-based studies. Lancet Oncology, 12, 160–174.  https://doi.org/10.1016/s1470-2045(11)70002-x.CrossRefPubMedGoogle Scholar
  47. Nash, J. M., McKay, K. M., Vogel, M. E., & Masters, K. S. (2012). Functional roles and foundational characteristics of psychologists in integrated primary care. Journal of Clinical Psychology in Medical Settings, 19, 93–104.CrossRefPubMedGoogle Scholar
  48. National Comprehensive Cancer Network. (2017). NCCN Clinical Practice Guidelines in Oncology. Distress Management, Version 1.2017. Retrieved from https://www.nccn.org/professionals/physician_gls/pdf/distress.pdf.
  49. Park, M., Katon, W. J., & Wolf, F. M. (2013). Depression and risk of mortality in individuals with diabetes: A meta-analysis and systematic review. General Hospital Psychiatry, 35, 217–225.CrossRefPubMedPubMedCentralGoogle Scholar
  50. Pinsky, B. W., Takemoto, S. K., Lentine, K. L., Burroughs, T. E., Schnitzler, M. A., & Salvalaggio, P. R. (2009). Transplant outcomes and economic costs associated with patient noncompliance to immunosuppression. American Journal of Transplantation, 9, 2597–2606.  https://doi.org/10.1111/j.1600-6143.2009.02798.x.CrossRefPubMedGoogle Scholar
  51. Porter, M. E. (2008). Value-based health care delivery. Annals of Surgery, 248, 503–509.PubMedGoogle Scholar
  52. Reiss-Brennan, B. (2014). Mental health integration: Normalizing team care. Journal of Primary Care & Community Health, 5, 55–60.CrossRefGoogle Scholar
  53. Robinson, P. J., & Reiter, J. T. (2016). Behavioral consultation and primary care: A guide to integrating services (2nd ed.). Cham: Springer.CrossRefGoogle Scholar
  54. Rodrigue, J. R., Nelson, D. R., Hanto, D. W., Reed, A. I., & Curry, M. P. (2013). Patient-reported immunosuppression nonadherence 6 to 24 months after liver transplant: Association with pretransplant psychosocial factors and perceptions of health status change. Progress in Transplantation, 23, 319–328.  https://doi.org/10.7182/pit2013501.CrossRefPubMedGoogle Scholar
  55. Rutledge, T., Reis, V. A., Linke, S. E., Greenberg, B. H., & Mills, P. J. (2006). Depression in heart failure: A meta-analytic review of prevalence, intervention effects, and associations with clinical outcomes. Journal of the American college of Cardiology, 48, 1527–1537.CrossRefPubMedGoogle Scholar
  56. Schmaling, K. B., & Linton, J. C. (2017). Psychologists in academic administration: A call to action and service. Journal of Clinical Psychology in Medical Settings, 24, 110–117.CrossRefPubMedGoogle Scholar
  57. Scott, K. M., Lim, C., Al-Hamzawi, A., Alonso, J., Bruffaerts, R., Caldas-de-Almeida, J. M., … Kessler, R. C. (2016). Association of mental disorders with subsequent chronic physical conditions: World mental health surveys from 17 countries. JAMA Psychiatry, 73, 150–158.  https://doi.org/10.1001/jamapsychiatry.2015.2688.CrossRefPubMedPubMedCentralGoogle Scholar
  58. Söllner, W., DeVries, A., Steixner, E., Lukas, P., Sprinzl, G., Rumpold, G., & Maislinger, S. (2001). How successful are oncologists in identifying patient distress, perceived social support, and need for psychosocial counselling? British Journal of Cancer, 84, 179.CrossRefPubMedPubMedCentralGoogle Scholar
  59. U.S. News & World Report. (2017). Best Hospitals. Retrieved from http://health.usnews.com/best-hospitals.
  60. United Network of Organ Sharing. (2017). Policy. Retrieved from https://unos.org.
  61. Walsh, T. L., Hanscom, B., Homa, K., & Abdu, W. A. (2005). The rate and variation of referrals to behavioral medicine services for patients reporting poor mental health in the national spine network. Spine, 30, E154–E160.CrossRefPubMedGoogle Scholar
  62. Weng, F. L., Chandwani, S., Kutyka, K. M., Zacker, C., Chisholm-Burns, M. A., & Demissie, K. (2013). Prevalence and correlates of medication non-adherence among kidney transplant recipients more than 6 months post-transplant: A cross-sectional survey. BMC Nephrology, 14, 261.CrossRefPubMedPubMedCentralGoogle Scholar
  63. Westphal, J. A. (2005). Resilient organizations: Matrix model and service line management. Journal of Nursing Administration, 35, 414–419.CrossRefPubMedGoogle Scholar
  64. World Health Organization, World Organization of National Colleges, Academies, & Academic Associations of General Practitioners/Family Physicians. (2008). Integrating mental health into primary care: A global perspective. Geneva: World Health Organization.Google Scholar
  65. Wright, K. M., Simpson, G. K., Koh, E.-S., Whiting, D. L., Gillett, L., Simpson, T., & Firth, R. (2015). Development and evaluation of information resources for patients, families, and healthcare providers addressing behavioral and cognitive sequelae among adults with a primary brain tumor. Journal of Neuroscience Nursing, 47, 135–145.CrossRefPubMedGoogle Scholar
  66. Young, J. Q., Kline-Simon, A. H., Mordecai, D. J., & Weisner, C. (2015). Prevalence of behavioral health disorders and associated chronic disease burden in a commercially insured health system: Findings of a case-control study. General Hospital Psychiatry, 37, 101–108.  https://doi.org/10.1016/j.genhosppsych.2014.12.005.CrossRefPubMedGoogle Scholar
  67. Zabora, J., BrintzenhofeSzoc, K., Curbow, B., Hooker, C., & Piantadosi, S. (2001). The prevalence of psychological distress by cancer site. Psycho-Oncology, 10, 19–28.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Transplant InstituteHenry Ford Health SystemDetroitUSA
  2. 2.Division of Transplant and Hepatobiliary Surgery, Department of SurgeryHenry Ford Health SystemDetroitUSA
  3. 3.Henry Ford Cancer InstituteHenry Ford Health SystemDetroitUSA
  4. 4.Psychosomatic Medicine, Behavioral HealthHenry Ford Health SystemDetroitUSA
  5. 5.Center for Health Policy & Health Services ResearchHenry Ford Health SystemDetroitUSA

Personalised recommendations