Focus on Research March 2013
Focus on Research:
Giving Residents Skills to Diagnose Mental Illness
By Roger Garvin, MD
CALM CARE (Curriculum Activities for Learning Mood disorders and Community Approaches to Residency Education) is a project funded through Health Resources and Services Administration to prepare Family Medicine residents to care for the mental health needs of underserved and vulnerable patients using both patient-centered and community-focused approaches. People with mood disorders are commonly seen in primary care and family physicians need specific skills to bridge this divide in our delivery system.
People with mood disorders are common in our clinical practices with depression, anxiety and insomnia all in the top 10 diagnoses in our residency practices. The World Health Organization expects depressive illness to be the second leading cause of disability globally by 2020. Studies show that only half of depressed patients are given a diagnosis.
Of those who are diagnosed, only 23 percent are receiving appropriate treatment. Substance abuse complicates mood disorders more frequently than is often recognized. Nearly one-third of adults with a mental disorder also experience a substance abuse disorder. Patients with co-morbidities such as substance abuse have even greater challenges accessing care. Suicide is the most serious complication of major depressive disorders. Substance abuse is a factor in 20-50 percent of completed suicides, thus making it second only to depressive disorders as a contributor to suicide.
The curriculum developed from this grant addresses the needs of residents by:
- Training residents to provide patient education appropriate to the patient’s health literacy. We have developed our own health literacy checklist and are in the process of validating this as a tool for use in educational settings. Cliff Coleman has spoken about this topic in several settings and we have several manuscripts in process.
- Instructing residents about validated mood disorder screening tools and giving them the skills to apply the results of screening at the point of care. As all of our providers are aware we have implemented screening processes to identify patients who have depression but may not have that as a presenting complaint. The depression dotphrases in EPIC allow providers to easily document their care and gives point of care feedback on treatment choices. I have presented this process to a national audience of behavioral health educators.
- Teaching patient-centered care skills using simulated patients and video review and feedback. We have modified a tool that is used to evaluate the patient centeredness of the resident interactions with patients on video review. John Muench, MD, Assistant Professor, Director of Behavioral Health at FM at Richmond, has presented this nationally. John also has developed a unique method for video review which utilizes ipods in the exam room. A review of this process was just accepted for publication.
Using our electronic health record (EHR) to inform Quality Improvement (QI) projects within patient panels. The CALM CARE grant challenged the EPIC team to develop new ways of gathering information from the EHR. With the tools that we helped develop, the family medicine data team can now provide feedback to clinics and providers on their treatment of patients with depression.
These are just a few of the many innovations that have come from the CALM CARE grant so far. Our funding ends in a few months, but we anticipate that there will be ongoing improvements in our care of patients with depression.