To understand the role of primary care in screening and treating patients with depression, we interviewed Paul Mikulecky M.D., chief medical officer with CareMore Health. Dr. Mikulecky shared his insights into the connection between physical and behavioral health, and how CareMore Health’s interdisciplinary clinical model meets the holistic health needs of patients.
How is depression affected by chronic medical conditions?
One of the things that drew me to CareMore Health was its holistic approach to patients. When we look at a patient’s health, the physical and mental are closely interlinked. Patients with chronic diseases may feel overwhelmed or out of control. This can create a sense of depression and/or anxiety, which may cause a patient to withdraw from their treatment regimen or even give up trying to manage their health.
By screening for depression, we’re working to empower patients, educating them and helping them overcome the barriers that make them feel overwhelmed.
When a patient has diabetes, it may be because that’s the way they’ve always eaten. It may be their culture, how they were raised, or how they find comfort. Undergoing change may involve grieving over how they’ve lived their life in the past vs. how they need to change to live a healthier life. This experience can create depression, angst, and a sense of disconnect. Helping them work through the grieving process and live a healthier life is part of our goal.
What is the role of the primary care physician in diagnosing depression?
At CareMore Health, we emphasize and promote our multidisciplinary care approach. Our primary care clinicians are there to screen, treat and bring in assistance as needed. The CareMore Health model incorporates therapists, behavioral health case managers, and behavioral health nurse practitioners as well as psychiatrists.
In our integrated care model, behavioral health nurse practitioners and therapists complement the work of primary care clinicians. Behavioral health clinicians can spend additional time talking to patients, exploring cultural barriers, depression, sense of loss and grieving. The primary care clinician and nurse practitioners can prescribe medications, which complement the total treatment.
Our goal is getting to the root cause, addressing barriers that prevent patients from managing their disease state – whether depression, diabetes or congestive heart failure.
Are older patients more likely to experience depression?
The aging process brings greater clinical complexity and challenges. There is more to deal with from a behavioral aspect. Patients may lose their independence or become more isolated because of transportation issues. They may develop complications related to their underlying disease. For example, they may have started with diabetes, but now they have complications such as numbness in their feet that may increase the risk of falls, limiting their independence and creating isolation.
As clinicians, we see a progression in complications related to a patient’s physical as well as mental health. It is even more critical to approach these patients holistically. We need to consider how well they get around including ambulation and transportation as well as side effects related to medications. Patients may not tolerate the side effects of medications as their metabolism slows. All these factors come into play, creating a more complicated picture.
What is the role of primary care in a multidisciplinary team?
I’ve always thought of primary care as the hub of a wheel, with spokes of support. The support includes behavioral health clinicians, social workers, pharmacists, cardiologists, podiatrists specialists, and other members of the multidisciplinary care team. The primary care clinician is working with case managers and all these moving pieces to help create a coordinated and seamless approach to the patient’s care.
In the CareMore Health model, clinical teamwork and communication is critical. Our teams have secure texting and messaging in addition to our EMR system. We’re building on our remote patient monitoring program for congestive heart failure patients and expanding that to diabetes. These technologies enable us to gather information from patients, as well as other team members, improving the care we can deliver.
What are the benefits of virtual and home-based care?
Virtual care is an opportunity to break away from the traditional method of delivering care. The patient may not be able to come to the clinic because they cannot drive or coordinate transportation. Home and virtual care addresses the social isolation that occurs in some of our Medicare patients or those who lose their independence.
By offering virtual care, which was fast-forwarded by Covid, we’re able to expand our services beyond the clinic. We’re able to accommodate more patients and have them seen where they need to be seen – which is part of the goal.