Behavioral Health

Value-based care and the concept of connected health care communities go hand-in-hand. It is simply not possible to extract the full “value” of forward-looking care delivery models without a strategy that addresses patients’ whole health—both physical and behavioral—across the entire continuum. Connected community models achieve this objective through a comprehensive, sustainable and multi-faceted behavioral health strategy that improves treatment access at key entry points and across all levels of care.

Health care stakeholders increasingly recognize the power of connected community models, yet behavioral health remains significantly fragmented due to supply and demand challenges. While rapid evolution of integrated delivery networks is increasing scale and synergies on the medical side of the house, behavioral health lags behind partially due to professional shortages that exist in all U.S. states. These shortages are felt across the continuum, beginning in the most acute settings and flowing into outpatient care and referral networks.

Telepsychiatry models have emerged as one solution that holds great promise for changing this dynamic. Through video conferencing sessions that enable anytime, anywhere access, this model is opening new gateways to care and disrupting traditional approaches to behavioral health.

The Telepsychiatry Advantage

Providers and patients are embracing telepsychiatry as a viable treatment alternative for good reason: it meets the standard of traditional in-office care for diagnostic accuracy and quality, while also improving care continuity, outcomes and patient satisfaction.

Patients appreciate the convenience and privacy afforded by direct-to-consumer (D2C) telepsychiatry sessions that can be accessed at home or other comfortable locations that are private. By empowering patients with greater choice in location and time, telepsychiatry models help tear down communication barriers and reduce stigma—a key factor that keeps many from seeking treatment. Appointments are easily scheduled outside of traditional office hours where a reliable Internet connection exists. Additionally, patients can look outside of local areas to access services, expanding provider options.

In tandem with patient benefits, behavioral health providers often find telepsychiatry a good fit for work-life balance. Today’s health care communities rely heavily on existing behavioral health professionals to fill care gaps. As such, it’s not uncommon for those in the field to have upwards of three to four different jobs. Telepsychiatry relieves some of the pressure by allowing existing providers to schedule sessions in more convenient, creative ways.

In addition, many providers want to address the urgent need for services in rural communities and desire to fill care gaps. Yet, they often prefer to live in urban areas or are unable to relocate. Telepsychiatry allows them an outlet to reach those locations where the greatest need exists without moving their practice or making long commutes.

Leveraging Telepsychiatry Across the Continuum

Communities are realizing notable gains by integrating telepsychiatry across the continuum in various ways including:

Emergency departments (EDs)

Busy ED physicians often lack the psychiatric resources needed for timely evaluations of critical-need patients. As a result, patients are stuck waiting in the ED or transferred to a med/surg unit until a qualified provider is available. This scenario leads to higher costs associated with longer wait times and inappropriate admissions. Telepsychiatry relieves this pressure by ensuring timely evaluation and quick triage to the most appropriate level of care.

Other hospital-based applications

Telepsychiatry can also be used on medical floors of the hospital for psychiatric assessments of medical patients. Some hospital inpatient units utilize telepsychiatry providers to augment their in-person staff and ensure units have 24/7 psychiatric coverage.

Discharge Planning

Telepsychiatry is increasingly an important resource for discharge planners, who are tasked with helping patients access post-discharge services in a timely manner. Consider, for example, that patients are often discharged from hospitals, correctional facilities or other residential programs with a 10-day “bridge” prescription and are required to continue treatment with a community-based psychiatrist. In these instances, discharge planners can face notable challenges to securing a timely follow-up appointment as waiting lists for psychiatrists at some community clinics can reach upwards of several months.

Medication lapses are common, and if the patient misses a follow-up appointment, the situation is exacerbated, opening the door for conditions to deteriorate. Ultimately, this scenario results in a vicious cycle of patient readmissions.

Community based referrals

For under-resourced clinics, telepsychiatry provides a lifeline of support through remote providers who serve a regular caseload of new and existing patients just like an in-person psychiatrist. This enhanced provider pool increases a clinic’s psychiatric capacity and potentially shortens the long wait periods for psychiatric appointments that exist in many communities.

Provider referrals

More than half of all psychiatric drugs today are actually prescribed by non-psychiatrists due to provider shortages. Primary care doctors are increasingly sought for psychiatric care, although many are uncomfortable with or lack expertise with psychotropic drugs. Telepsychiatrists provide both an attractive referral option and consultative partnership, where knowledge and expertise can be shared.

Forward looking

While telepsychiatry is not a “magic wand,” it does provide an effective option for improving the fragmented behavioral health continuum. Communities are wise to consider effective telepsychiatry partnerships that can bolster behavioral health service lines. When these services are effectively integrated, communities achieve a more connected health care continuum that drives better outcomes and lower costs.

Geoffrey Boyce is Executive Director of InSight Telepsychiatry.

For those in health care who predominately work sitting down, it can be challenging – and easy to forget – to occasionally step away from your work. There is growing evidence that sedentary behavior is negatively affecting our health in a way that is costly to our employers and may literally be killing us.

A 2015 analysis of 41 international studies, published in the Annals of Internal Medicine, found that excessive sitting is associated with a higher risk of heart disease, diabetes, cancer and death, regardless of regular exercise. Researchers found that prolonged sedentary behavior contributes to a 15 to 20 percent higher risk of death from any cause and as much as a 90 percent increased risk of developing diabetes.

Most non-clinical health care professionals and administrators spend the majority of their workdays sitting. For instance, medical and health services managers are seated an average of 73.3 percent of their workday, according to the Bureau of Labor Statistics, while medical record and health information technicians sit an average of 85.4 percent of the time.

Given the daily demands of your job, you are likely unaware how much continuous “seat time” at work you are accumulating. That is not even factoring in the amount of personal time you are seated while commuting, dining, lounging or engaging in recreational activities.

What is “Sitting Disease”? How is it Negatively Affecting Our Health?

“Sitting disease” is a term created by the health care community to communicate the potential ill effects of a sedentary lifestyle. This includes sitting for long periods of time and/or spending hours at a time with little movement. All of these sedentary behaviors have been linked to a myriad of increased health risks including obesity, high blood pressure, lower levels of LDL or “good” cholesterol, high blood sugar (diabetes) and an increased risk of heart disease. As Mayo Clinic cardiologist Martha Grogan states “For people who sit most of the day, their risk of heart attack is about the same as smoking.”

While sitting is the most common form of sedentary behavior among working professionals, any protracted activity requiring little or no physical energy is considered a sedentary behavior. Sitting disease is not just seen in office workers, it is also among those who are sedentary in other activities such as extended television watching, protracted video gaming or prolonged driving/commuting.

Current Research on “Sitting Disease”

The mechanisms driving negative health effects related to prolonged sitting have not been fully determined. Current research suggests that sitting disease has harmful effects on sugar and fat metabolism, which can lead to diabetes, obesity and heart disease.

Consider some of the following research:

• A 2015 report found that more than 50% of our waking hours are spent sitting.
• A 2010 American Cancer Society study indicated that (during the time period studied):

o   Women who sat more than 6 hours a day and were relatively sedentary were 94 percent more likely to die than those who were physically active and sat less than 3 hours per day.

o   Men who sat more than 6 hours daily and were relatively inactive were 48 percent more likely to die than their –non-sitting male colleagues.

• A 2015 study found that exercise alone cannot undo the negative health effects of excessive sitting; the study indicates that sitting many hours each day increased the risk of coronary artery calcification, regardless of exercise level.

While the American Heart Association recommends “at least 150 minutes per week of moderate exercise or 75 minutes per week of vigorous exercise (or a combination of moderate and vigorous activity),“ unfortunately, this guideline does not take into effect the harm being done if we are sedentary the rest of the day. Regrettably, many of us have become so sedentary that the detrimental effects of 8+ hours a day of sitting may not be neutralized by 30 or more minutes a day of vigorous exercise.

Common-Sense Counteractive Strategies

At first blush, the best approach to fighting “sitting disease” is simply to move around more and sit less. While that sounds easy, you will likely also need some simple ways to help accomplish this goal.

Consider incorporating some of following ideas into your daily routine:

• Get a movement-encouraging app on your smart phone. Download an app that encourages physical movement and use it to help you remember to get out of your chair. Possible app options include: StandApp, Hotseat, Stand Alarm, Move More, Time to Move and Stand Up! If you don’t like apps, you can set a watch or alarm, or set a reminder in your calendar to stand up, take a walk or stretch several times a day.
• Stand or walk whenever possible. Consider standing whenever you talk on the phone at work or home, or when you’re eating a snack or lunch. Improvise or invest in a standing desk. Walk the stairs as an alternative to taking the elevator. Purposely park as far away as possible from your building’s entrance.
• Walk during your meetings. When feasible, hold a walking meeting. Walk laps and have a discussion with colleagues in close proximity to you, in lieu of instant messaging or e-mail conversations.
• Use the “20-8-2” rule. For every 20 minutes of sitting, try to stand for 8 minutes and move your body for 2.
• Track how much you walk each day. Get a simple pedometer to track how many steps you are taking in a day. Strive for a minimum of 5,000 steps per day and work up to 10,000 steps per day over time. Reward yourself (in a non-caloric and non-sedentary way) for meeting your walking goals.
• Use the TV to remind you. Walk, stretch or exercise during commercials while watching TV. Stand and stretch while watching your favorite weekly TV shows.

If you are a manager/supervisor, encourage your employees to get up and away from their chairs by doing so yourself, and suggesting that they do likewise. Host weekly (or even daily) group outings that get staff members moving. Hold friendly intra-office exercise or fitness competitions. Bring in an outside expert, such as a nutritionist or fitness instructor, to speak to your employees and offer up new ideas.

The steps for combatting “sitting disease” both at work and in life don’t have to be complex to be effective. How about picking at least one of the suggestions above, and trying to make a habit of it?

Bottom line, whether you work in a clinical or non-clinical role, as an employee in the health care industry, it’s important for you to engage in and model healthy, non-sedentary activities. By doing so, you will likely be more productive at work, and more importantly improve your own health!

Ellen Griffith is a consultant with Freed Associates.

By Stan Popovich

Stress and anxiety are very common when you work in the Healthcare Industry

As a result, here is a list of techniques for a person who works in healthcare can use to help manage their daily stresses and anxieties.

Sometimes, we get stressed when everything happens all at once at our healthcare job. When this happens, a person should take a deep breath and try to find something to do for a few minutes to get their mind off of the problem. A person could take a walk, listen to some music, read the newspaper or do an activity that will give them a fresh perspective on things.

When facing a current or upcoming task at your healthcare job that overwhelms you with a lot of anxiety, divide the task into a series of smaller steps and then complete each of the smaller tasks one at a time. Completing these smaller tasks will make the stress more manageable and increases your chances of success. [Read more…] about How To Manage The Stresses of Working In The Healthcare Industry