Team-based Care for Patients with Mental Illness is Linked to PCP Confidence Level

Primary care physicians (PCPs) experience a lack of confidence in their own abilities to provide effective treatment for patients with mental illness, and that lack of confidence may negatively affect their interest in establishing team-based care regimens for their patients with mental illness, according to a study from the University of Colorado.

The study was based on results from a cross-sectional, self-efficacy, mail survey of 402 randomly-selected Colorado PCPs.

Danielle Loeb, MD, with the Division of General Internal Medicine at the University of Colorado, along with colleagues, designed the series of 3 self-efficacy surveys to evaluate PCPs’ beliefs about their ability to adopt the role of PCPs for patients with mental illness. Loeb and her team believes that high levels of PCP self-efficacy associated with mental healthcare “likely influences the degree to which PCPs engage in the activities necessary” to treat mental illness in their patients, and “participate meaningfully in team-based care.”

Measuring the self-efficacy of PCPs, according to Loeb’s research, should “help assess the success of interventions aimed at increasing physician engagement in treatment of mental illness and in team-based care” and may indicate PCPs’ willingness and readiness to assist with mental health management for patients in their care.

Because PCPs are in fact primary in terms of patient health (with over half of all patients with mental illness treated by these physicians), PCPs’ confidence in their own ability to diagnose, treat, and, if necessary, provide referrals to specialists is crucial in establishing communication between disparate healthcare providers, such as psychiatrists or therapists, creating a team-based approach to treatment of mental illness.

The mail survey asked PCPs to respond to 2 general questionnaires on mental health knowledge and communication strategies, as well as 3 self-efficacy scales constructed by the researchers which centered on management of chronic medical illness (CMI), mental illness management (MIM), and participation in team-based care (TBC).

The TBC scale is, according to researchers, based on the extant National Committee for Quality Assurance (NCQA) Patient Centered Medical Home 2011 scale which addresses “communication within the team, care coordination, population management, self-management support, and continuity of care.”

The MIM scale is designed to provide data on self-efficacy related to PCPs’ involvement in diagnosing and treating a range of mental illnesses but focuses on treatment of depression, generalized anxiety disorder, and bipolar depression—3 mental illnesses which, according to research data presented by Loeb and colleagues, are more commonly treated in primary care settings.

The last of the 3 self-efficacy scales, the CMI scale, according to researchers, provides a “benchmark against which the MIM could be contrasted.” The 2 additional questionnaires were modeled on the Mental Health Knowledge and Management Instrument, and Asbury’s Physician Confidence with Communication Strategies survey.

The expected outcomes of the survey were that PCPs would rate their self-efficacy for the MIM lower than that of the CMI, and that PCP participation in TBC would be effected. Data confirmed that the MIM scale was correlated to use of TBC for mental health in PCPs. Those PCPs who were uncertain about their efficacy in treating and diagnosing mental illness were notably less willing to participate in team-based care for their patients with mental illness.

According to Loeb, the TBC scale is useful as a tool to not only monitor engagement, but PCP transformation, noting that PCPs are often reluctant to “shift away from ‘physician-centric care’” into a collaborative model. A TBC approach to chronic illness is common among PCPs, but the survey found that more resistance, linked to a lack of confidence in their ability to treat mental illnesses, may be associated with a lack of TBC for patients with mental health issues.

Loeb and colleagues point out that “transitioning from one-on-one doctor—patient relationships to team models of care for patients with mental illness requires a significant change in the PCP role from the traditional patient-physician relationship,” but that the PCPs are a vital part of team based care, serving as the hub for patients with mental illness.

The article “Development and Initial Validation of Primary Care Provider Mental Illness Management and Team Based Care” appeared in the March-April 2017 issue of General Hospital Psychiatry.

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