Improving Access to Primary Care Mental Health Integration Services to Community Based Outpatient Clinics Utilizing VA Video Connect Technology
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Share PrintAt time of this innovation implementation, South Texas Veterans Health Care System had seven contract community based outpatient clinics (CBOCs) with a total enrollment of about 19,000 patients. Both rurality and space constraints of these clinics made it difficult to meet staffing needs for Primary Care Mental Health Integration (PCMHI). The advent of VA Video Connect (VVC) technology allowed the integration of a telehealth PCMHI team, with prescribing needs met by a Mental Health Clinical Pharmacist Practitioner (MH CPP).
Origin:
October 2018, Audie L. Murphy Memorial Veterans' Hospital (San Antonio, Texas)
Adoptions:
1 successful
Awards and Recognition:
Clinical Pharmacy Practice Office Mental Health Strong Practice
Partners:
Clinical Pharmacy Practice Office
Recent Updates
Overview
The problem
Space constraints at CBOCs limited the co-location of PCMHI care as recommended by VHA Handbook 1160.01, Uniform MH Services in VA Medical Centers and Clinics. VVC was a new technology and afforded a creative opportunity to provide this level of MH care to CBOCs. If successful, patient care would be improved to better align with VA requirements and employee
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Space constraints at CBOCs limited the co-location of PCMHI care as recommended by VHA Handbook 1160.01, Uniform MH Services in VA Medical Centers and Clinics. VVC was a new technology and afforded a creative opportunity to provide this level of MH care to CBOCs. If successful, patient care would be improved to better align with VA requirements and employee satisfaction would increase by offering telework opportunity.
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The solution
Incorporate a 100% telehealth PCMHI team, including Clinical Pharmacist Practitioner as the prescribing FTEE. Utilize VVC for majority of encounters, with telephone as back-up. Engage with PACT teams via Microsoft Teams to facilitate same day access referrals.
The results
-Improvement seen in antidepressant adherence as measured by MDD47h (no longer a SAIL measure)
-Clinical utilization reports consistently > 80%
-Number of encounters (pharmacist productivity) tracked and maintained within fully successful range
-Clinical utilization reports consistently > 80%
-Number of encounters (pharmacist productivity) tracked and maintained within fully successful range
Diffusion tracker
Does not include Clinical Resource Hubs (CRH)
Implementation
Timeline
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Week 1
Meet with PCMHI Program Manager to review current staffing ratios, areas in need of coverage, high turnover clinics -
Week 2
Review SAIL metrics for identified clinics; develop tracking system to be able to monitor improvement over time -
Week 3
With consult managers, review baseline information on average number of Behavioral Health Interdisciplinary Program (BHIP) consults per month in identified CBOC’s (i.e., some of these referrals would have been appropriate for PCMHI, looking for reduction over time once PCMHI service is implemented) -
Week 4
Determine other key stakeholders involvement in management and clinic operations of PCMHI clinics (ACOS, Service Chiefs, Health Administrative Services, Group Practice Manager, Telehealth Coordinators) -
Week 5
With identified stakeholders, develop goals and proposed outcomes of plan. Review weekly. -
Week 6
Identify if current staffing utilization is optimized. Under-utilized providers may be aligned to provide this service. May need new FTEE which would require submission to Resource Management Committee (RMC) -
Week 7
Develop project plan to include location of providers (from facility or telework), MAS and nursing support -
Week 8
Present to Executive Leadership to receive buy-in and feedback prior to implementation -
Week 9
Identify and hire candidates that meets qualifications (e.g., internal candidate, direct hire, USA jobs) -
Week 10 (variable based on time to hire)
Once staff are selected, provide and complete competency training and resources on VVC/telework -
Week 11
Set-up clinics with appropriate stop codes, submit telework packet if required for staff that will be working from home, submit IT request for telework equipment if working from home (phone, laptop, second monitor, camera) or at minimum obtain camera for VVC if working from facility -
Week 12
Outline referral process to PCMHI team, including therapists and prescribers -
Week 13
Obtain or create contact list for primary care clinic team members (primary care providers, nurses, MAS), present at PACT collaborative or similar facility meetings on new service that will be available and include go-live date - ensure that this information reaches physicians and nurses in the clinic -
Week 14
Email referral process with point of contacts for new providers to all primary care clinic staff where PCMHI is being embedded, include go-live date -
Week 15
Consider site visits to clinics where service is being embedded so new providers can meet PACT teams -
Week 16
Clinic Implementation - Test - PCMHI team initiate multiple test VVC calls to other providers to ensure internet and VVC technology is working. If working from home, test call with supervisor to ensure suitable work environment -
Week 17
Ensure clinic grids are set up correctly -
Week 18
Clinic Implementation – Go Live Date -
Week 24 and ongoing
-Review CUSS report (goal 80%) and productivity metrics-Refine referral process if needed - provide education to primary care provider if inappropriate referrals are being sent, improve education given to patient to include sending “test VVC links” to practice technology prior to appointment, monitor referral numbers from specific clinics to ensure clinic flow is as intended-Maintain relationships with PACT providers by attending PACT collaborative and giving quarterly PCMHI update
Departments
- Mental health care
- Pharmacy
- Administration
- Telehealth
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About
Origin story
Space at CBOCs was difficult to come by, PCMHI services were needed and wanted, and VVC technology was new. Creativity sparked, collaboration ensued between stakeholders, and and a fully telehealth team was implemented to better meet the requirements of the VHA Handbook 1160.01, incorporating a fully telehealth PCMHI team.
Original team
Dr. Lindsey Garner
MH and Pain Clinical Pharmacy Program Manager
Dr. Holly Peters
PCMHI Clinical Pharmacist Practitioner
Dr. Cynthia Gutierrez
Associate Chief, Clinical Pharmacy
Dr. Diana Sayre
PCMHI Program Manager
Dr. Norma Erosa
PCMHI Program Manager
Dr. Richard Roberson
PCMHI Program Manager
Comment
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