24 Jul Treating Depression and Physical Comorbidity: Integrated Care for the Whole Person

Depression is prevalent among patients with chronic physical conditions. Because a client’s physical well-being significantly impacts behavioral health outcomes and vice-versa, it’s important that they receive treatment with an integrated care approach. For clients with chronic illnesses, physical health goals can be an integral part of their key indicators. Working closely with a primary care provider allows clinicians to treat the whole person. A well-designed behavioral health EHR (Electronic Health Record) will aid in tracking comorbidity and reveal correlations that can lead to better outcomes for the client—both mentally and physically. 

Prevalence of Depression in Medical Disorders

Patients with severe, chronic medical disorders–such as heart disease, cancer, and diabetes–often experience depression. Comorbidity influences the treatment and outcomes of both conditions. Depression exacerbates harmful consequences, leading to a reduced quality of life and an increased mortality rate. At the same time, factors associated with medical illness can trigger or worsen depression. 

• Heart Disease — The link between heart disease and depression is a two-way relationship. Several environmental and behavioral factors are linked to both conditions. Sedentary behavior associated with depression potentially leads to coronary heart disease. Likewise, cardiovascular risk factors such as elevated triglycerides and inflammation are related to depression. 
• Cancer — A cancer diagnosis brings with it psychological and emotional stress. While grief and sadness may be a normal response to a life-changing diagnosis, chronic stress may lead to a major depressive disorder for a patient or their caregiver. On average, almost 13 percent of cancer patients report symptoms of clinical depression, however, the prevalence varies by type of cancer, and increases with the severity of symptoms. 
• Diabetes — Depression is twice as likely to occur in patients with diabetes than is seen in the general population. Both conditions share underlying biological and behavioral factors such as sleep disturbances, inflammation, an inactive lifestyle, and poor diet. 

 
Integrated Care Model

In the last eight years, behavioral health systems have begun integrating their patient care with a primary provider. For comorbid clients, these services are central to the master treatment plan. In a primary care environment, providers typically see patients at a high volume of encounter-based sessions. They may not be accustomed to long-term treatment plans dedicated to one client. To work in a multi-disciplinary team, some primary providers may need additional training in behavioral health treatments and objectives.

As healthcare models evolve, the multi-disciplinary team needs are becoming more widespread. In addition to adding extra staff, such as Nurse Practitioners (NPs), some clinics are beginning to integrate specialized services such as physical, occupational, and speech therapy. Consistent communication and shared data between providers facilitate higher-quality care for the individual. The multi-disciplinary team needs quick access to a wide range of data. With data-tracking EHR software, providers can layer medical measures with mental health progress and look at outcomes from the whole-person perspective. 

Data Tracking with an EHR

While you may not need medical data on all clients, those with long-term comorbidity may present with both physical and mental symptoms. Tracking medical symptoms can provide therapists with crucial information about clients’ chronic conditions. Regular evaluation of vital signs, such as pulse-oxygen and glucose levels, provide the clinician with discrete data. Comparing medical indicators to behavioral health measures can reveal correlations that inform treatment. Then, through charting and graphing, you can see what‘s working for the client.

Tracking comorbidity as a key indicator can improve outcomes for both conditions. But some behavioral healthcare providers don’t know where to begin. You can always start with default forms that come “out of the box” with your EHR. As your practice evolves, you’ll need flexible software that grows with you. To get you started, here are five best practices to incorporate into your workflow.

• Discrete Data
  Physiological indicators are best tracked using data that can be charted and graphed, rather than documented in narrative paragraphs. Start with a discrete evaluation related to comorbidity as part of the intake packet and regular re-evaluation assessments.
• Integrated Master Treatment Plans
  Instead of focusing solely on relief of depressive symptoms, incorporate primary health concerns into the master treatment plan, including goals, objectives, interventions, and measurables. For example, a client with diabetes has goals such as regularly taking their medication and keeping blood sugar under control.
• One Streamlined EHR
  In an integrated behavioral healthcare facility, a single, unified EHR allows providers to chart goals and objectives on a master treatment plan. Integrated data are incorporated into dashboards that show clinical outcomes. Control charts can highlight unusual events so you can see potential correlations.
• Daily Logs
  Residential homes can incorporate physical health tracking into what floor staff quickly observe during a shift. They can mark observable behavior that may relate to outcomes. For example, one client’s reduced appetite is related to increased suicidal ideation. Recording how much the client eats each day flags potential suicide risks.
• Client Collaboration
  With apps and web-based EHRs, outpatient clients can chart with you. They take their own physical indicators (such as glucose levels, blood pressure) at home and enter their data directly. They can even journal about their perception of what’s going on with their physical and mental health. Emerging research suggests that web-based journaling can lower depressive symptoms.

 
Closing Thoughts

Behavioral healthcare accommodates a wide range of therapies, and the ways we integrate care are changing. When it comes to collaboration, you can start small and evolve over time. A fully integrated electronic system, such as NextStep Solution, provides flexibility for your practice to grow.

The time is now to start incorporating primary care into master treatment plans. Considering the prevalence of depression and physical comorbidity, many clients need a whole-person approach to treatment. Collaborating with primary care providers gives better insight and clarity into the client’s overall health, leading to better treatment outcomes.