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Orme WH, Fowler JC, Bradshaw MR, Carlson M, Hadden J, Daniel J, Flack JN, Freeland D, Head J, Marder K, Weinstein BL, Madan A. Functional Rehabilitation: An Integrated Treatment Model for Patients With Complex Physical and Psychiatric Conditions. J Psychiatr Pract 2022; 28:193-202. [PMID: 35511095 DOI: 10.1097/pra.0000000000000623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The health care delivery system in the United States, structured to provide single-disease care, presents unique challenges for patients with complex physical and psychiatric comorbidities. Patients in these populations are often referred to multiple specialty clinics, encounter little continuity of care or collaboration among their providers, incur high health care costs, and experience poor treatment outcomes. Given these barriers, questions remain about the extent to which siloed and fragmented care, as opposed to the complex nature of the illnesses themselves, contribute to poor outcomes. If given the opportunity to receive well-integrated, consistent, and personalized care, can patients with historically difficult-to-treat comorbid medical and mental illnesses make progress? This article describes an innovative model of care called functional rehabilitation that is designed to address existing barriers in treatment. The functional rehabilitation program seeks to disrupt the escalating effects of interacting comorbidities by offering highly collaborative treatment from a small team of clinicians, personalized interventions using a shared decision-making framework, multipronged treatment options, colocation in a large hospital system, and significant 1:1 time with patients. The article includes a case example with longitudinal outcome data that illustrates how progress can be made with appropriate programmatic supports. Future research should examine the cost-effectiveness of this model of care.
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Sasangohar F, Bradshaw MR, Carlson MM, Flack JN, Fowler JC, Freeland D, Head J, Marder K, Orme W, Weinstein B, Kolman JM, Kash B, Madan A. Adapting an Outpatient Psychiatric Clinic to Telehealth During the COVID-19 Pandemic: A Practice Perspective. J Med Internet Res 2020; 22:e22523. [PMID: 32936768 PMCID: PMC7546859 DOI: 10.2196/22523] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/04/2020] [Accepted: 09/14/2020] [Indexed: 01/05/2023] Open
Abstract
As the demand for telepsychiatry increases during the COVID-19 pandemic, the strengths and challenges of telepsychiatry implementation must be articulated to improve clinical practices in the long term. Currently, observations within US contexts are lacking; therefore, we report on the rapid implementation of telepsychiatry and workflow experiences in a psychiatric practice based within a large health care system in southeast Texas with a national catchment area. We discuss the logistics of the implementation, including modes of communication, scheduling, coordination, and capacity; the psychological effects of web-based services, including both the loss of the physical therapeutic environment and the unique interpersonal dynamics experienced in the virtual environment; and postadoption patterns of engagement with our services and with other clinical functions affected by the rapid adaptation to telemedicine. Our art therapy group programming serves as an applied case study, demonstrating the value of a well-managed web-based program (eg, patients were receptive and well-engaged, and they appreciated the continuity of accessible service) as well as the challenges (eg, the need for backup plans and technological fallbacks, managing interruptions and telecommunication learning curves, and working around the difference in resources for art and music therapy between a well-stocked clinical setting versus clients’ home spaces). We conclude from our experience that the overall strengths of telepsychiatry include receptive and well-engaged responses from patients as well as the expansion of boundaries, which provides a directly contextualized view into patients’ home lives. Challenges and corresponding recommendations include the need for more careful safety planning for high-risk patients; maintaining professional boundaries in the newly informal virtual setting; designing the physical space to both frame the patient encounter and maintain work-life balance for the therapist; allowing for delays and interruptions (including an initial acclimation session); and preserving interprofessional care team collaboration when the physical locations that normally facilitate such encounters are not accessible. We believe that careful observations of the strengths and challenges of telepsychiatry during this pandemic will better inform practices that are considering telepsychiatry adoption both within pandemic contexts and more broadly thereafter.
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Affiliation(s)
- Farzan Sasangohar
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, United States
| | - Major R Bradshaw
- Behavioral Health Clinic, Houston Methodist Hospital, Houston, TX, United States
| | | | - James N Flack
- Behavioral Health Clinic, Houston Methodist Hospital, Houston, TX, United States
| | - James C Fowler
- Behavioral Health Clinic, Houston Methodist Hospital, Houston, TX, United States
| | - Diana Freeland
- Behavioral Health Clinic, Houston Methodist Hospital, Houston, TX, United States
| | - John Head
- Behavioral Health Clinic, Houston Methodist Hospital, Houston, TX, United States
| | - Kate Marder
- Behavioral Health Clinic, Houston Methodist Hospital, Houston, TX, United States
| | - William Orme
- Behavioral Health Clinic, Houston Methodist Hospital, Houston, TX, United States
| | - Benjamin Weinstein
- Behavioral Health Clinic, Houston Methodist Hospital, Houston, TX, United States
| | - Jacob M Kolman
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, United States
| | - Bita Kash
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, United States
| | - Alok Madan
- Behavioral Health Clinic, Houston Methodist Hospital, Houston, TX, United States
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