Steven M. Tovian, PhD, an assistant professor of psychiatry and behavioral sciences at the Feinberg School of Medicine at Northwestern University in Chicago, knows firsthand the ways psychologists' work as part of integrated teams improves care.
An independent practitioner, he is the former chief psychologist and director of health psychology at the NorthShore University Healthcare System Medical Group. His work focuses on integrating health care — including mental health treatment in medical settings to improve overall health.
APA spoke with Dr. Tovian about ways this integration improves care and lower costs.
Your research has focused on psychologists working in medical settings. What are some of the benefits of this collaboration?
Psychologists in medical settings teach health-care professionals, conduct research, become involved in health-care policy development, and provide direct assessment and intervention services to patients and staff. With health psychologists onsite, they are able to help patients cope with illness, adhere to medical regimens, understand emotional influences on disease, improve communication with their physicians and ultimately try to prevent disease or worsening of patients'current conditions.
They serve patient populations throughout the entire life span and address health problems in every category of disease classification in all disease stages, namely, primary, secondary and tertiary medical care and prevention. Empirically validated research and clinical programs have demonstrated that psychological interventions pre- and postsurgery can lessen patient anxiety before and after surgery, reduce complications related to surgery and recovery and lessen the need for postoperative pain medications. Additionally, these interventions can speed up recovery, allowing for a faster return to health and daily function.
It is estimated that approximately 60 percent of patients visit their primary-care physician for mental health issues, such as depression or anxiety. How would wider access to integrated care change this?
Mental health problems are often medical problems in the primary-care physician's office. There is a large incidence and prevalence of mental health disorders in primary care. There is also a high incidence of mental health diagnoses occurring with medical problems. The most frequent problems include depression, anxiety and panic, substance abuse and psychosomatic disorders. Untreated, these patients can become hard to manage by primary-care physicians and specialists. Timely and early mental health interventions by psychologists reduces unnecessary or unhelpful medical treatments, thereby improving clinical and cost outcomes.
How much could consumers and insurance companies save if mental health care is incorporated into primary care?
Results from the last 35 years of medical cost offset research reveal that cost offset is greater in organized health care settings where behavioral health care and primary care are integrated and where the behavioral health-care interventions are supported by research. Studies cited by Whitehouse (1997) indicate, for example, that well-designed behavioral interventions can save anywhere from 20 percent to 40 percent of previous total medical expenditures. In another controlled study, Medicaid outpatients who frequently visited their physicians and received integrated behavioral health treatment achieved a 21 percent reduction in medical costs after 18 months, while those who received no behavioral services had a 22 percent increase in their use of medical services (Pallack, Cummings, Dorken & Hanke, 1995).
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