HealthMay 06, 2024

The growing stress on PCPs and how to help them manage responsibility for mental health care

Primary care providers are now delivering 60% of mental health care, despite not being trained as specialists. Organizational support and evidence-based solutions can help them shoulder some of this burden.

The evolving role of the primary care provider

The role of primary care provider (PCP) in the healthcare ecosystem has changed from what we may have traditionally envisioned. Particularly after the COVID-19 pandemic and regarding mental health.

Post-pandemic, 23% of adults in the U.S. are living with mental health challenges or illnesses, and yet only 28% of the population lives in an area with enough specialized mental health professional support to get the care they need. 

What that means is mental health care is shifting into the primary care setting. Up to 40% of patients seen by a PCP or an advanced practice provider report a mental health concern. The pressure of that demand for support and services is landing firmly on PCPs, and as a result, they’re becoming the front line of mental health. Despite not having specialized training, and in many cases having limited support, PCPs today are delivering an astounding 60% of mental health care and writing 79% of prescriptions for antidepressants.

And yet, their window for providing patient care is not expanding to support this new need.

PCPs typically are only scheduled 15 minutes with each patient, with median visits estimated to last 18 minutes. In that time, they are expected to accomplish:

  • Patient history review
  • Review of systems
  • Preventive care
  • Medication history review
  • Prescription adjustments and refills
  • Physical exam
  • Diagnosis and treatment
  • Diagnostic test orders
  • Referral orders
  • Health counseling
  • Addressing patient questions and concerns
  • Social determinants of health assessment
  • Follow-up planning
  • Visit documentation
  • And now … mental health support

As an industry, we need to make sure that they have the right tools to support what is a growing patient need and potential cause of professional stress and burnout.

Increasing attention on the need for mental health care and services

Additionally, since the pandemic, there has been an increase in media attention and a general spotlight on mental health. 

One of the things it has helped bring to light is the sheer volume of patients with mental health illness alongside other conditions. Studies show that 36.6% of people with mental health disorders also have chronic medical conditions, such as high blood pressure, heart disease, or diabetes. 

The incidence of depression in conjunction with some chronic conditions does vary, but in many cases, it is remarkably high. For example, the number of patients who both have depression and Parkinson’s disease is over 50%.

The many impacts of mental health on the healthcare system

While patients are struggling, trying to navigate medical and mental health comorbidities at the same time, the impact and cost of their care has ripple effects across the healthcare system:

  • Patients with major depression have 50-100% greater medical costs than patients without major depression after controlling for a number of factors. This results in a significantly greater burden to manage these patients.
  • Readmission rates tend to be higher for this population, creating a strain on resources, on PCPs, and on the patients themselves.

When we at Wolters Kluwer speak to clinicians about their experience, they admit that they feel overwhelmed and overburdened. PCPs feel pressured by the need to help their patients, and those patients feel like they have nowhere else to go.

To help meet that need, PCPs are turning to a number of tools to help provide support and guidance and to streamline some of the care that’s being provided. But we believe we can and should do more to support them in this challenging task.

How do we help PCPs address mental health care challenges?

First and foremost, healthcare leaders are looking to try to hire more mental health specialists to help relieve the burden from PCPs. They’re looking to encourage their PCPs to refer as many patients as possible in an attempt to close some of that demand-supply gap. This is absolutely the right thing to do and the right place to start.

But the reality is, we're never fully going to be able to close that gap. PCPs are going to feel that pain, even in organizations that have really focused on hiring more specialists.  

That’s why we’ve been working on content and tools within the UpToDate® clinical decision support solution specifically to help PCPs with mental health care delivery. Because mental health disorders often feel like somewhat subjective diagnoses, because there isn’t a test that can confirm them, PCPs may not feel confident about making the diagnosis, or they may not feel particularly confident about their treatment plan. We want to reinforce them with evidence-based best practices and tools that are really effective for saving time, building confidence, and supporting decision-making.

Webinar: Solutions to support primary care providers

The future for PCPs will definitely include a responsibility for mental health care. We want to look beyond today’s solutions to see what we can do to help increase efficiency while boosting satisfaction among primary care providers. Learn more from my colleague Anne Travis, MD, Director, Clinical Content for Advanced Clinical Decision Support, Wolters Kluwer, Health, in the Scottsdale Institute webinar “Supporting PCPs as They Shoulder the Burden of Mental Health Care.”

This webinar was first presented to the Scottsdale Institute Members.

Watch the webinar by filling out the form below

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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