HealthApril 22, 2024

Practical support for primary care physicians: Real-world solutions for shouldering the burden of mental healthcare

Primary care physicians are playing an ever more critical role in not just their patients’ physical but also mental healthcare. However, providing effective guidance in mental health can be incredibly challenging.

Primary care physicians do not have as much specialized training, support from sub-specialist colleagues, nor the necessary tools to quickly and confidently make evidence-based mental health decisions. It’s no wonder that doctors are reporting all-time highs in burnout, with levels now reaching 63% in a recent American Medical Association national survey.

Dr. Anne Travis, MD, MSc, FACG, AGAF, the Director of Clinical Content – Advanced Clinical Decision Support at UpToDate® at Wolters Kluwer Health, dug into these issues in the Scottsdale Institute webinar “Supporting PCPs as They Shoulder the Burden of Mental Health Care.”

Dr. Travis explained practical ways to address this issue with examples of real-world results. As she states, “We’re not only supporting the patients in terms of their needs, but we’re also helping with things like provider burnout to make them feel more supported.”

Mental health: A rising challenge for primary care physicians

Many countries have seen a positive shift toward open discussions around the need for mental healthcare access. This has led to continuous growth in various mental health fields. The U.S. Bureau of Labor and Statistics reports steady increases, with three occupations reporting faster than average growth and six others projecting much faster than average growth.

Despite this positive trend, there remains a mental health crisis. A 2022 survey conducted by the Kaiser Family Foundation and CNN discovered that 33% of respondents were unable to get sufficient access to mental health services, with 80% citing cost as an impediment.

As a result, the workload is falling on primary care physicians, who already have a full workload when practicing general medicine. Unfortunately, these professionals often do not have what they need to also balance handling mental health issues. Dr. Travis highlighted three areas of concern:

Limited training

Patients may expect their primary care providers to have all or at least most of the answers at their fingertips for what to do in any domain of health. What the public often doesn’t understand is that mental health is a unique specialty that requires specific training.

Primary care practitioners focus on internal medicine in their training. According to an estimate by Dr. Robert C. Smith, M.D., medical students receive 5.1 weeks of training in school and less in residencies, totaling only 2.5% of their total healthcare education. This dearth of specialized learning can create unwelcome stressors for all.

For example, unlike the more definitive diagnoses a physician can generate with physical tests and examinations, mental health can feel more subjective. Consequently, a lack of confidence in how to treat such issues can motivate a physician to sidestep addressing mental health while dealing with problems she or he is more comfortable with.

Limited time and resources

Additionally, primary care physicians have limited resources and time constraints. Primary care doctors still stick to visits in 15-minute intervals. That time already seems insufficient for handling just physical health problems.

Dealing with mental health challenges is not like a simple “add-on” to an existing service. Getting to the root of a problem typically takes in-depth conversations. As this would consume a majority of time in the doctor’s already tight schedule, the professional would likely put off addressing mental health challenges.

Delaying treatment only exacerbates time management struggles and increases costs for healthcare organizations. Repeated studies find that physical comorbidities commonly accompany mental health disorders. Unsurprisingly, someone with anxiety, lagging energy, weak motivation, or low self-worth will struggle with maintaining a care routine, engaging with physicians, and adhering to care plans.

The need to overcome stigmas 

Though mental health is receiving increased attention, a stigma remains around treatment, particularly for certain communities and groups. The aforementioned KFF and CNN survey found that 60% report shame and stigma as an obstacle to requesting mental health treatment.

Therefore, doctors who are earnestly trying to address their patients’ mental health may grapple with gaining engagement and adherence. This, too, compounds their workload and feelings of overwhelm. 

Clinical decision support and alternative care models: Proven strategies to enhance mental healthcare delivery

The good news is that forward-thinking institutions and experts are finding actionable solutions to the mental health crisis. What can health leadership teams implement to counteract this burden? Dr. Travis offered three solutions that have achieved tangible results:

Alternative care models

Executives may need to adopt another care framework. For instance, the colocation model for collaborative care has proven beneficial. This puts primary care providers and mental health experts in the same location to collaborate on care. When professionals in different specialties work within the same space, patients can often get more effective and efficient treatment.

Physicians can more quickly get advice and strategies from colleagues, coordinate patient care, and offer referrals. The crux of these teams is a behavioral healthcare manager who synchronizes communication between stakeholders.

While beneficial, such models require a significant investment in time and resources. Therefore, this solution will not be practical for all organizations. In such cases, care teams can collaborate with telehealth options that allow patients to conveniently access additional mental health treatment.

Furthermore, alternative care models can require substantial time to implement, delaying when care teams can start seeing measurable results. What can care organizations do now to support primary care physicians?

Clinical decision support systems

The adoption of advanced technologies can provide evidence-based clinical decision support (CDS) materials that simplify and expedite mental health treatment. These tools give primary care physicians confidence in making recommendations. Of course, health leaders must ensure that such resources have their foundation in evidence-based practices to provide the benefits they’re seeking.

Of even greater advantage is the ability to use interactive algorithms to speed up the decision-making process. The most advanced tools also bring in patient-relevant factors by integrating with electronic health records. Providers can quickly find out which side effects or comorbidities to be aware of without having to sort through and digest reams of information for each patient.

These tools also ensure that the entire clinical team has consistent references for information. Adopting a suite of CDS systems streamlines care plan execution, reduces errors that harm patient outcomes, and boosts patient adherence. 

Patient engagement platforms

Likewise, patient engagement solutions can complement these tools. Patients get appropriate education at the right time and in the right format. A solution that integrates with the physician’s CDS system ensures patients are not hearing one thing from the doctor and getting other advice from their take-home materials.

Patients will access such information in a language they can read comfortably and at a health literacy level that is easily accessible. Video and multimedia presentations ensure that an individual gets instruction about care plans in a more digestible format.

Of course, physicians must use these tools to supplement empathetic care, never to replace it. By doing so, patients are more apt to adhere to care plans and improve their outcomes.

Solutions worth adopting: Real-world benefits of effective mental health care

Empirical data verifies the effectiveness of these solutions in care facilities around the world. This has led to increased satisfaction among primary care physicians and reduced costs for healthcare institutions. Most importantly, adopters of these strategies have gained improved outcomes for patients.

For example, one study that the National Library of Medicine published involved 97 veterans with serious mental illness who used a colocated care system. The patients increased primary care visits and significantly improved physical health goals regarding cholesterol, blood pressure, triglycerides, and BMI.

Adopting CDS systems has also been a cost-effective way of immediately streamlining workflows and mitigating the burden on physicians. A brief example of this is a study that took place at the University of Chicago using UpToDate® among 10 physicians in four primary care clinics. The physicians who used the CDS tool were able to answer 79% more questions than those who did not have access. This also led to 75% of cases receiving corrections to care plans.

Another case is the use of UpToDate Patient Engagement Solutions (formerly Emmi®) to conserve resources and allow care teams to properly allocate their time. The University of Alabama Birmingham Medical Center found that using the system’s interactive voice response system was a significant timesaver. Nurses went from spending 5.2% of phone calls on patients who needed attention to spending 100% of calls with patients who required hands-on help. The savings equaled the value of the salary of 1.5 full-time employees.

Health leadership must bear in mind that implementing such strategies without properly educating care teams on their use can reduce their effectiveness. Dr. Travis pointed out that good communication and openness to feedback allow health leaders to roll out these strategies in a way that delivers a maximum return on investment.

A proactive approach: Health leaders role in supporting physicians who must navigate mental health care

When healthcare leaders take these practical steps to address primary care physician burnout, the results are more productive and happier teams that realize better patient outcomes. Still, leaders can only successfully implement such approaches by first educating themselves on their value and use.

The corresponding Scottsdale Institute webinar provided more detailed insights on these points. Watch the program to get a fuller understanding of using CDS services, patient engagement tools, and collaborative care to support primary care physicians as they address their patients’ mental health.

If you are ready to investigate or try Wolters Kluwer’s CDS and patient engagement solutions now, learn more here.

Julie Frey expert bio photo.
Head of Provider Product, Clinical Effectiveness, Wolters Kluwer Health
Julie Frey, MBA, is the Head of Provider Product at Wolters Kluwer Health, working closely with healthcare providers on clinical decision support and patient solution strategies.
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To learn more, watch the webinar, “Supporting PCPs as they shoulder the burden of mental healthcare.” This webinar was first presented to the Scottsdale Institute Members.
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