Category: Primary Care
Rationale: Rising health care reform efforts pose unique service delivery challenges in integrated care. For example, population-based health care requires providers maintain quality care despite a push for higher caseloads with limited resources. Providers report significant barriers to meeting these expectations in integrated care implementation (e.g. time limitations, increased responsibility). With the use of patient-centered technologies on the rise (e.g., text messaging, smart phone applications), patient and provider burden may be reduced and resources maximized by using such technology. Montefiore Medical Center, serving a socio-economically challenged minority population, implemented the Bronx Behavioral Health Integration Program (BHIP) to improve behavioral health service delivery in primary care through the collaborative care model (CCM). BHIP aims to enhance “between-visit” contact by utilizing smartphone technology to improve provider’s ability to perform efficiently and effectively within CCM.
Methods: Behavioral health teams were integrated into seven Montefiore primary care sites to work collaboratively with primary care physicians. Participants enrolled (N = 4,029) were offered short-term, evidence-based treatment via CCM (e.g., psychotherapy, medication management), and enrollment in a smartphone application pilot to assist between-visit contact and collect self-report of depression and anxiety symptoms using the Patient-Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder Screener (GAD-7). Provider to patient contact via smartphone technology was utilized to promote patient self-management through psychoeducation, goal planning and reminders, and timely coaching through a chat feature.
Results: 55 out of 71 patients offered smartphone services consented to enrollment. Of the 32 patients engaged in the smartphone application, 47% completed a symptom scale through the app and 66% reviewed an educational article. During the time of the pilot, telephonic outreach including the telehealth platform contributed to 38% of total follow ups.
Conclusion: Collaborative care facilitated by smartphone applications may serve as a convenient tool to enhance between-visit contact and improve patient engagement. Integrating technology may also improve provider experience by maximizing resources. Strategies to further implement smartphone technology will be discussed.
Kelly Carelton– Project Manager, Montefiore Medical Center, Yonkers, New York
Evelyn Figuroa– Montefiore Medical Center, Yonkers, New York
Elizabeth Chapman– Montefiore Medical Center, Yonkers, New York
Stephanie Kelleher– Research Assistant, Montefiore Medical Center, Yonkers, New York
Michelle Blackmore– Program Director, Montefiore Medical Center, Yonkers, New York
Henry Chung– Vice President and Chief Medical Officer, Montefiore Medical Center, Yonkers, New York