Behavioural health can have a substantial impact on health as a whole, but historically it has not been given the same attention as physical symptoms. Efforts are underway to change that, but there are still significant challenges when attempting to integrate behavioural health into primary care.
What do we mean by behavioural health?
The term behavioural health can be used to refer to people’s thoughts, beliefs and emotions, and how these affect their actions. This could mean a diagnosable mental health condition, or it could simply be how their feelings and attitudes impact their ability to manage their health, such as attending medical appointments.
A behavioural health consultant (BHC) is a behavioural health specialist who can be based in a multidisciplinary primary care team, but other team members may also consider behavioural health as part of their service. For example, a clinical pharmacist may need to consider a patient’s difficulties in taking medication regularly, and help them develop strategies to follow their prescription.
Why is it an important part of primary care?
Primary care is generally the first destination for people experiencing psychological and emotional problems, so GPs need to be prepared for these situations. Many treatment plans for health conditions, both physical and psychological, include lifestyle changes such as adjustments to diet and exercise routines, and these are only manageable if patients have the right mindset. Effective interventions at the primary care level can prevent more serious issues later. This is why it is so important to try and integrate behavioural health under the wider primary care banner.
Success stories
Many attempts to integrate behavioural health into primary care can be seen in the USA. The Primary Care Behavioral Health (PCBH) model allows patients to be referred from GPs to BHCs, whilst BHCs help other team members from other disciplines become more comfortable with understanding and managing behavioural health. In Alaska, the “Nuka” system of the South Central Foundation (SCF) has also had success with its holistic 6-level approach, where BHCs work with doctors, nurses, administrators and assistants looking to improve patients’ physical, mental, emotional and spiritual wellbeing.
Improving Access to Psychological Therapies (IAPT) is one of the main ways that the NHS has tried to integrate behavioural health into primary care. Early results in Cambridgeshire and Peterborough CCG saw hospital admissions and A&E attendance fall by 75% and 61% respectively. There were also fewer GP appointments for chronic conditions such as diabetes. IAPT-Long Term Condition (LTC) services are particularly aimed at patients managing chronic health problems who may be experiencing associated depression or anxiety, or who have unexplained ongoing symptoms.
Challenges
IAPT services vary by region, as does the degree of integration. It still relies on a complicated system of screenings and referrals that may exclude some patients, and there can be problems with long wait lists. Space and funding can be issues when trying to co-locate services. A lack of consistent definitions as to what constitutes behavioural health or integrated care can make it difficult to monitor success.
Integrating behavioural health into the wider primary care model continues to present a range of challenges, but when done successfully, it can have a significant impact on all aspects of a patient’s well-being.
Resources:
https://bmcprimcare.biomedcentral.com/articles/10.1186/s12875-016-0485-0
https://psychologyinterns.org/wp-content/uploads/Reiter2018_Article_ThePrimaryCareBehavioralHealth.pdf
https://www.england.nhs.uk/mental-health/adults/nhs-talking-therapies/integrating-mental-health-therapy-into-primary-care/
https://www.england.nhs.uk/wp-content/uploads/2018/08/guidance-co-locating-mental-health-therapists-primary-care.pdf
What services does Clinical Rx provide?
In general, clinical pharmacists exist to help with the management of medication. They ensure patients receive the correct prescription, that it works as intended, that potential side effects are monitored, that their dosage is adjusted as needed, and that reviews are carried out as necessary. This is of particular use for those with chronic conditions who require long term management, and who are particularly reliant on the ongoing support of their GP practice.
Utilisation of clinical pharmacists allows the practice as a whole to work more efficiently, ensuring doctors can focus on more complex diagnoses and treatments, and it improves the patient experience by providing them with quicker and more tailored care. Increased efficiency in time, organisation and costs ensures ARRS funding is put to good use, to the benefit of a practice or entire PCN.
There are several benefits to utilising the services of Clinical Rx, in particular, which works as a remote clinical pharmacist provider supporting a range of PCNs and practices as needed on a flexible basis. As well as streamlining prescription management and reviews, relieving pressure on GPs, and improving patient care, it can clear the backlog and help meet QOF targets. Meeting QOF targets, in particular, allows you to be rewarded for good performance, increasing your practice income. This makes ARRS funding a profitable investment as well as one that is effective in terms of patient outcomes.
It can be a difficult decision to decide how best to use ARRS funding, but Clinical Rx can provide specific benefits for patients and doctors both in terms of efficiency and cost effectiveness. This leads to better outcomes for everyone in the PCN or practice, and for the PCN or practice itself.
For improved outcomes, we believe that communication is vital between the different professions. At Clinical Rx®, we welcome feedback and reviews, so we can continue to offer the best possible service. By working together, the team can better address the complex needs of patients, improve outcomes, and enhance the overall patient experience. Ultimately, the goal is to provide high-quality care in a collaborative and patient-centred approach.Â
Our Pharmacists are not limited to medication management only. We understand that every GP Practice has different needs at times. Whether it be assistance with protocols, quality improvement work or additional work for CQC inspections – we can help, contact us for more information.Â
References: 1. Duncan, P. et al. (2020) ‘Barriers and enablers to collaborative working between GPS and Pharmacists: A qualitative interview study’, British Journal of General Practice, 70(692). doi:10.3399/bjgp20x708197.
