Speaking of Psychology: Treating the whole person, with Parinda Khatri, PhD

A growing body of research has shown a connection between our minds and bodies – a relationship that can affect our overall health. In this episode, psychologist Parinda Khatri, PhD, discusses the impact of an integrated and patient-centered health care model, which brings psychologists, physicians and patients together to treat the whole person.

Parinda Khatri, PhD is chief clinical officer at Cherokee Health Systems, a comprehensive community health care organization with 56 clinical sites in Tennessee. She earned her doctorate in clinical psychology at the University of North Carolina at Chapel Hill and completed a fellowship in behavioral medicine at Duke University Medical Center.

As chief clinical officer at Cherokee Health Systemsopens in new window, Khatri provides oversight and guidance on clinical quality, program development and management, workforce development, clinical research and clinical operations for blended primary care and behavioral health services within the organization. Khatri also trains, consults and presents extensively on integrated care. Khatri is president of the Collaborative Family Healthcare Associationopens in new window and also serves as a co-chair of the Behavioral Health Special Interest Group for the Patient Centered Primary Care Collaborativeopens in new window.

Audrey Hamilton: Psychologists are experts in behavior and mental health, but can they have an impact on our physical health? Behavioral health teams working in tandem with primary care physicians can improve outcomes and reduce cost. So how does it work? We speak with one psychologist who focuses on patient-centered and integrated health care providing more comprehensive and coordinated care for patients and their families. I’m Audrey Hamilton and this is “Speaking of Psychology”. 

Parinda Khatri is a chief clinical officer at Cherokee Health Systems, a comprehensive community health care organization with 56 clinical sites in Tennessee. Dr. Khatri provides oversight and guidance on blended primary care and behavioral health services within the organization. In addition, she trains, consults and presents extensively on integrated care. Thank you for joining us, Dr. Khatri. 

Parinda Khatri: Thank you very much. 

Audrey Hamilton: We hear a lot today about integrated health care. You know, are patient-centered health care and integrated health care the same thing? 

Parinda Khatri: Well, they certainly are related but they are not the same thing. Patient-centered care is really about a model of care that focuses on comprehensive, holistic care that is coordinated, provides access and emphasizes quality and safety. And so, patient-centered care is really an overall model of care and approach to care. 

Integrated care is a pathway, if you will, to patient-centered care. So, integrated care is an approach to care in which primary care, medical clinicians and behavioral health clinicians work closely together as part of a team with patients and families using a very systematic and cost-effective approach for defined population. And so that care may address mental health and substance abuse issues, health behaviors, including their contribution to chronic medical illness, life stressors, crises, stress-related physical symptoms, health care utilization. 

Audrey Hamilton: So, what for example, what is a patient-centered medical home? 

Parinda Khatri: So a patient-centered medical home is a model of care that focuses on concepts of, of course, number one, patient-centered care in which the patient is really a partner with their health care team. The care is also comprehensive and that means that all of the patients’ health care needs, including lifestyle management, prevention, wellness, as well as chronic and acute conditions are taken care of. So, it’s much more comprehensive than just focusing on one specific system like your respiratory system or, you know, only a very certain set of issues in your body. It’s really designed to cover all aspects of your health. The care is also expected to be coordinated, so that means that in a patient-centered medical home, you are going to have a team of providers who are linking all of the dots for you, if you will. If you have to go to different specialists – if you have to get different labs – all of the different elements of the broader health care system are coordinated within this patient-centered home. 

And then certainly quality and safety is emphasized. That because the patient-centered medical home is such a core part – and almost a cornerstone in someone’s health care, we really want to make sure that it is of the highest quality possible and that it’s safe.

Audrey Hamilton: So I have a primary-care physician. Does that mean my care is being delivered in a patient-centered care model?

Parinda Khatri: It’s certainly a first step to getting patient-centered care is to have a primary care physician, but again, the core elements of how the care is provided – is it really engaging you as a partner? Is it comprehensive? Is it coordinated? Do you have easy access to your provider 24 hours a day, seven days a week? Is there a strong commitment to quality and safety? All of those components have to be there. So, having a primary care physician is certainly the first step, but it’s not the only step in getting good patient-centered care. 

Audrey Hamilton: You know, patient-centered care is sometimes referred to as patient and family-centered health care. Why is that? 

Parinda Khatri: People have begun to realize that patients, individuals, don’t live in isolation -- that we all have social networks and partnerships and relationships that are incredibly important to us.  Not only are they important to us personally, they’re important to our health. Many of us live with other people. We live perhaps with our parents, siblings, partners, children, extended families, friends. All of these people construct a very important social network that has a very strong impact on any person’s overall health status. So, many people believe that the pit term “patient-centered care” is just not sufficient to adequately describe this approach – that there has to be a broader framework in which we recognize the role of the family and the role of this overall social network in someone’s health care. 

Audrey Hamilton: Let’s talk about some particularly pressing health conditions – obesity and diabetes. They’re critical health problems for a large segment of the population. Will patient-centered care help reverse the trends, you think, for these two diseases? 

Parinda Khatri: Well, certainly the research data and our clinical experience seems to indicate that having patient-centered care is going to have a profound impact on chronic health conditions as well as overall lifestyle behaviors, such as the kind of behaviors that can lead to obesity. So when we think about, really, the pandemic of obesity, we have to think about all of the different components that are involved – diet, nutrition, certainly genetic vulnerability or predispositions. And also with diabetes – diet, activity level, overall self-management of health – they’re all important concepts and all important aspects of health. So if we have a model of care that’s able to very aggressively partner with a person in addressing kind of the full scope of factors associated with obesity – for example, how you eat – how active you are – and you have someone partnering with you in this process and really walking alongside you in this process. Certainly we have a much stronger likelihood of addressing this problem and helping someone manage this problem and address it in an effective manner than if you don’t have the team or that support around you. 

And certainly for diabetes, this is even more so the case because within a patient-centered medical home a patient really partners with their health care team in setting self-management goals for themselves. We recognize that good management of diabetes, good management of glucose requires constant vigilance – checking sugars, taking insulin if that’s prescribed, making significant changes in diet, making significant changes in lifestyle behaviors such as smoking and activity level. And to expect one person to do it on their own is certainly, you know, I think challenging and we recognize that these are major changes and if we can certainly work together and we have partners to help us kind of walk us past, to cheer us on when things are challenging, to give us feedback from lab results to make sure that they’re available to us whenever we feel like we aren’t doing as well, that’s going to of course create a much better environment for addressing these two very dangerous health conditions. 

Audrey Hamilton: Now the health system you work in, Cherokee Health System, is a leader in providing patient-centered care. Can you tell us about how that works? 

Parinda Khatri: So Cherokee Health Systems is a federally qualified health center and a community mental health center. We have a clinical health service delivery model that has a paradigm of integrated health care services. And what that means on the ground is that when people come to our clinic, in fact even when they walk in, all of their health care needs are assessed. And so when at the point of care when someone comes in for primary care services, if there are any behavioral health issues, any health care issues that require behavioral health intervention, that person is able to access that service immediately, on the spot, in the exam room. And so think about how powerful that is for someone to come into their medical doctor’s office and to say “hey, I’m having a lot of stress at work” or “I’d like to lose weight” or “man, I’m getting these migraines. I’m having a really hard time even though I’m taking medication in managing it.” Rather than just getting a card or a pamphlet to make an appointment somewhere else in the future, in that moment a psychologist is able to come and speak with you, help you set some goals, learn some behavioral strategies to help manage those issues. 

Audrey Hamilton: So as a psychologist, which you are, what’s your role on the patient-centered care team? 

Parinda Khatri: I think psychologists have a tremendous amount to offer on a patient-centered medical team or a patient-centered health care team. And the psychological contributions can range from certainly providing direct clinical services and assessment within that health care environment so in the trenches, seeing patients, conducting assessments, providing interventions and consulting with the health care team to improve the quality of care and provide access to care to each individual patient and their family. 

But, the role of psychology in a patient-centered medical home is much broader than that. Psychologists can be involved in the program development and program evaluation component of PCMH. There is, as we’ve discussed, quality and safety are key aspects and fundamental aspects of a PCMH. And so evaluating whether or not the interventions or the services provided are effective, not only for an individual, but for an entire panel of patients, such as all of the diabetics in the practice or everyone in the practice who has diagnoses of hypertension. 

Also, we have discussed the program development component. Part of what happens in a PCMH is an expectation of taking care of a population. So that means that a psychologist can get as involved in developing an overall program, such as group interventions, protocols and guidelines, health education aids, teaching aids for patients that can help address the population health in aggregate, not individuals or by individual. 

Audrey Hamilton: We know that depression has a high level of disease burden for the patient, you know that is recognizing when a patient is depressed and getting them effective treatment is very important. Is patient-centered care better at treating depression than traditional health care? 

Parinda Khatri: Well, certainly the data suggests that when we engage the patient in the process of their own health, that we take a partnership approach rather than a top-down, I will tell you what to do approach. That we’re going to see better outcomes. That once patients are engaged, particularly in a condition like depression, in which it’s too easy, it’s so easy for the patient to be passive and feel helpless and feel like something needs to be done to them. So, certainly what we found is that partnering with the patient, having a patient-centered approach can remarkably improve the likelihood of developing and implementing management, depression management program, intervention and treatment plan. That’s a really good fit for that specific patient and we recognize that one size does not fit all and so partnering with the patient helps us do that. 

The other thing that is really critical about patient centered medical home and depression is that we recognize that depression is related to so many other health issues. And so, if we can address those other health issues, number one, we may be able to also improve the depression. Certainly when we all feel that physically. You know, it’s hard to feel good mentally and vice versa. That if we can address and improve the depressive symptoms, we certainly can help someone manage their health better and by extension, improve their clinical outcomes for their other health conditions. 

Audrey Hamilton: Well, Dr. Khatri, thank you so much for joining us. It’s been a pleasure. 

Parinda Khatri: Thank you very much. 

Audrey Hamilton: For more information on integrated health care and patient-centered medical care, please visit our website . With the American Psychological Association’s “Speaking of Psychology” I’m Audrey Hamilton.