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Bridging The Gaps In Mental Health Care Coordination In Oklahoma


July 06, 2017

Written by Kristin Pareja, PharmD, BCPS, Managed Market Liaison with Otsuka Pharmaceutical Development & Commercialization, Inc., and Laura Anguiano, PhD, Medical Science Liaison with Otsuka Pharmaceutical Development & Commercialization, Inc.

On April 19, 2017, PsychU sponsored the workshop, “Bridging the Gaps in Mental Health Care Coordination,” held in Oklahoma City, Oklahoma. This meeting was the result of a partnership between PsychU and the University of Oklahoma College of Pharmacy’s Pharmacy Management Consultants.

The objectives for the workshop were to:

  • Identify and discuss barriers, challenges, and gaps to successful transitions facing Oklahoma patients with severe mental illness between health care and community settings
  • Develop potential collaborative solutions to overcome these barriers, challenges, and gaps to successful transitions for Oklahoma patients, and
  • Initiate an ongoing stakeholder workgroup to develop practical recommendations to bridge identified barriers, challenges, and gaps to successful transitions

In addition to the objectives described above, participants were asked what else they would you like to learn from the live meeting. Comments included learning about what other organizations are doing to reduce barriers in care coordination, how to better communicate with providers and allow them to understand the law enforcement perspective of the basic issues. A third and commonly voiced comment was how to determine what solutions will make the largest impact with the least amount of funding given that many of the identified issues are not caused by lack of awareness or willingness to serve, but rather by inadequate funding for the most vulnerable citizens.

The meeting was moderated by Tammy L. Lambert, Pharm.D., Ph.D., Clinical Assistant Professor from the University of Oklahoma College of Pharmacy, Kristin Pareja, Pharm.D., BCPS, Managed Market Liaison from Otsuka Field Medical Affairs and Laura Anguiano, Ph.D., Medical Science Liaison from Otsuka Field Medical Affairs. The workgroup participants included members of organizations such as National Alliance on Mental Illness (NAMI), Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS), local Community Mental Health Centers (CMHCs), inpatient and outpatient facilities, Oklahoma Health Care Authority, Oklahoma Police Department’s Crisis Intervention Team, St. Anthony Behavioral Health Unit, Patient Aligned Care Teams (PACT), Mental Health Association of Oklahoma, the Texas Medical Foundation (TMF) Health Quality Institute, the Oklahoma County Crisis Intervention Center, and the Oklahoma State Department of Health. Collectively, the participants were representative of a diverse group of stakeholders from the Oklahoma community. Other participants included members of the Oklahoma College of Pharmacy and Otsuka Medical Affairs.

The program opened with a brief introduction to PsychU, followed by a presentation of the results of a survey administered to the attendees prior to the meeting (see results in Figures 1-3 (below)). All attendees felt there are existing barriers to successful transitions of care which were perceived as being a major or moderate problem. Barriers perceived as most problematic included alcoholism or drug addiction, financial instability, co-morbid medical conditions, unstable housing, unstable transportation, and inability to maintain established care. Meeting participants were gathered into small groups for round table discussions of the high priority barriers and solutions to address these barriers. Questions addressed included challenges the participants face with the barriers, obstacles standing in the way of removing the barriers, how communication and collaboration both within their organization and between facilities can be improved, how participants can collaboratively and effectively implement changes across systems of care, and how participants can take the learnings from the workshop and implement into clinical practice around the Oklahoma City area.

In addition to discussion around barriers, participants also discussed examples of initiatives from participant organizations and highlighted best practices to share with the group. The meeting concluded with discussion of proposals for the most actionable solutions to improve care transitions and a call for volunteers to champion an ongoing workgroup. This live meeting was the initial step toward bridging the gaps in care coordination and through the formation of an ongoing workgroup, a collaborative team will continue the efforts in the Oklahoma City area. The next steps in bridging the gaps will involve compilation and analysis of solutions to barriers, continued communication, collaboration, and partnership between stakeholders in Oklahoma City and throughout the state and ongoing meetings with workgroup champions to further the efforts to improve transitions of care.

Figure 1

http://www.psychu.org/wp-content/uploads/2017/06/MRC2.CORP_.X.01507-PsychUSummary-Bridging-the-Gaps-In-Mental-Heal-CC..-copy.jpg

 

Figure 2

When thinking of the process of transferring care for patients with severe mental illness to another entity, please select how problematic the following barriers are for the transferring care for mental health patients.

http://www.psychu.org/wp-content/uploads/2017/06/MRC2.CORP_.X.01507-PsychUSummary-Bridging-the-Gaps-In-Mental-Heal-fig2-e1496416952111.jpg

 

Figure 3

Referring to the list of barriers, if you could fix one thing about the provision of mental health services in Oklahoma, what do you think would make the most difference?

Transition Of Care Barriers

Participant Response (%)

Unstable housing

19.2

Alcoholism or drug addiction

11.5

Inability to follow treatment recommendations

11.5

Inability to maintain established care

11.5

Length of time to outpatient follow-up

7.7

Financial instability

7.7

Lack of outpatient providers

3.8

Incarceration

3.8

Other co-morbid medical conditions

3.8

Inconsistent requirements for reimbursement

3.8

Lack of positive social support

3.8

Limited range of services covered by payer

3.8

Continuity between independent systems

3.8

Other

3.8

Referring to the list of barriers, if you could fix one thing about the provision of mental health services in Oklahoma, what do you think could be the easiest to solve?

Transitions Of Care Barriers

Participant Response

Continuity between independent systems

19.2

Inability to maintain established care

15.4

Length of time to outpatient follow-up

15.4

Low health literacy

11.5

Encounters with law enforcement

7.7

Lack of medication continuity

7.7

Unstable transportation

7.7

Lack of outpatient facilities

3.8

Inconsistent requirements for reimbursement

3.8

Lack of outpatient providers

3.8

Other

3.8

 

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