UC Davis Train New Trainers (TNT) Primary Care Psychiatry ... · Primary Care Setting: De Facto ....

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UC Davis Train New Trainers (TNT) Primary Care Psychiatry (PCP): Fellowship Robert M. McCarron, D.O., DFAPA, FACP Co-Director TNT PCP Fellowship Psychiatry, Internal Medicine, Pain Medicine Psychosomatic Medicine Shannon Suo, M.D., DFAPA Co-Director TNT PCP Fellowship Psychiatry, Cultural Psychiatry, Community Psychiatry, Family Medicine Michelle Burke Parish, M.A. Director of Research TNT PCP Fellowship Counseling Psychology, Mental Health Services Research Sergio Aguilar-Gaxiola, M.D., Ph.D. Director of Outreach TNT PCP Fellowship Clinical Internal Medicine Matt Reed, M.D. Director of Education TNT PCP Fellowship Psychiatry, Internal Medicine, Pain Medicine

Transcript of UC Davis Train New Trainers (TNT) Primary Care Psychiatry ... · Primary Care Setting: De Facto ....

Page 1: UC Davis Train New Trainers (TNT) Primary Care Psychiatry ... · Primary Care Setting: De Facto . Mental Health Care System Primary care physicians – provide up to 60% of all psychiatric

UC Davis Train New Trainers (TNT) Primary Care Psychiatry (PCP): Fellowship

Robert M. McCarron, D.O., DFAPA, FACPCo-Director TNT PCP Fellowship

Psychiatry, Internal Medicine, Pain MedicinePsychosomatic Medicine

Shannon Suo, M.D., DFAPACo-Director TNT PCP Fellowship

Psychiatry, Cultural Psychiatry,

Community Psychiatry, Family Medicine

Michelle Burke Parish, M.A.Director of Research TNT PCP Fellowship

Counseling Psychology, Mental Health Services Research

Sergio Aguilar-Gaxiola, M.D., Ph.D.Director of Outreach TNT PCP Fellowship

Clinical Internal Medicine

Matt Reed, M.D.Director of Education TNT PCP FellowshipPsychiatry, Internal Medicine, Pain Medicine

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UC Davis TNT PCP Fellowship

The Problem– Poor access to mental health care

– Education gaps in those delivering the care

UC Davis and Integrated Care – National leader

Primary Care Mini-fellowship– Teaching PCP’s the essentials of psychiatry

– Improving access to care through education

Future considerations…

Page 3: UC Davis Train New Trainers (TNT) Primary Care Psychiatry ... · Primary Care Setting: De Facto . Mental Health Care System Primary care physicians – provide up to 60% of all psychiatric

Psychosomatics 41:5 Sept 2000 , Psychiatric Services Jan, 2006Annals of General Psychiatry, 2015.

Primary Care Setting:De Facto Mental Health Care System

Primary care physicians – provide up to 60% of all psychiatric care in U.S.

Up to 40% of primary care patients haveprimary, active psychiatric problems

50% of patients with mental health referrals do not follow up (stigma, poverty, language barriers, paucity of psychiatrists, financial constraints)

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Primary Care is the “De Facto”Mental Health Care System

Wang P et al., Twelve-Month Use of Mental Health Servicesin the United States, Arch Gen Psychiatry, 62, June 2005

Page 5: UC Davis Train New Trainers (TNT) Primary Care Psychiatry ... · Primary Care Setting: De Facto . Mental Health Care System Primary care physicians – provide up to 60% of all psychiatric

Mental Health and Access…

Suboptimal routine mental

health care

Increased need for unavailable inpatient care

Impacted ER’s in the region

Impacted PC Centers

SMI populationUnderservedVulnerable

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Annals of General Psychiatry. 14 (13) 2015 ,WJM Jan 170, No.1, 1999

Psychosomatics 41:5 Sept 2000 , Psychiatric Services Jan 2006

PRIMARY CARE PSYCHIATRYTRAINING ISSUES Less than half of primary care patients with mental illness receive any

treatment

50-70% MDD is not accurately diagnosed or treated in the primary setting

Roughly 80% of all antidepressants are prescribed by non-psychiatrists

More than half of primary care patients on antidepressants do not meet criteria for MDD

Only 1/3 of internal medicine residents are comfortable treating MDD

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General Hospital Psychiatry 2006

PRIMARY CARE PSYCHIATRYTRAINING ISSUES

Page 8: UC Davis Train New Trainers (TNT) Primary Care Psychiatry ... · Primary Care Setting: De Facto . Mental Health Care System Primary care physicians – provide up to 60% of all psychiatric

UC Davis Psychiatry and Integrated Care Leading the Way…

Two combined residency programs Leader in Telepsychiatry (STP and ATP) Coordinated Care Integrated clinics

– FM, IM, Pain Psychiatry, Sac County (IBH)

Seven dually trained faculty Integrated care curriculum…

Page 9: UC Davis Train New Trainers (TNT) Primary Care Psychiatry ... · Primary Care Setting: De Facto . Mental Health Care System Primary care physicians – provide up to 60% of all psychiatric

A – AnxietyM – Mood P – PsychosisS – Substance Misuse

Psychiatric curriculum for PCP’s

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Preventive Medicine in Psychiatry: General Principles

Cardiovascular and Pulmonary Disorders

Endocrine and Metabolic Disorders

Infectious Disorders

Oncologic Disorders

Special Topics

– Pain

– Geriatric

– Child Psychiatry

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Page 12: UC Davis Train New Trainers (TNT) Primary Care Psychiatry ... · Primary Care Setting: De Facto . Mental Health Care System Primary care physicians – provide up to 60% of all psychiatric

Expanding the Workforce…

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Education = Workforce

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UC Davis Train New Trainers (TNT) Primary Care Psychiatry (PCP) Fellowship

Core Objectives:

Complete a quick and targeted psychiatric assessment

Focus on how to treat common psychiatric conditions

Learn when to refer to a mental health specialist and how best to interface with mental health colleagues

Learn how to train other providers

Over 50 contact hours with faculty and 40 CME credits per learner

Expand mental health access to care

Page 15: UC Davis Train New Trainers (TNT) Primary Care Psychiatry ... · Primary Care Setting: De Facto . Mental Health Care System Primary care physicians – provide up to 60% of all psychiatric

UC Davis Train New Trainers (TNT) Primary Care Psychiatry (PCP) Fellowship

Longitudinal, one-year learning module– Two, case-based tele-education learning modules per month

(normally 12-1 PM or early evening)

– Two weekend (4 days) learning sessions with dually trained faculty per year

– One hour of mentorship with faculty per month

Curriculum provided Certificate program from UC Davis School of Medicine

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Based on AMPS Diagnosis and Treatment

“AMPS”

Screening For Common Psychiatric IllnessA – Anxiety disorders

M -- Mood disorders

P – Psychotic disorders

S – Substance use disorders

S – Suicide risk assessment

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TNT PCP Topics Covered AMPS primary care psychiatric interview Mental status examination Cultural psychiatry Mood disorders Anxiety disorders Trauma related disorders Substance misuse disorders Psychotic disorders Somatic symptoms disorders Pain psychiatry Fundamentals of psychopharmacology

Neurocognitive disorders Personality disorders Suicide risk assessment Cognitive behavioral therapy Supportive psychotherapy Motivational interviewing Traumatic brain injury Collaborative care Teaching how to teach ADHD

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TNT PCP Core FacultyRobert McCarron, D.O., Co-Director TNT FellowshipPsychiatry, Internal Medicine, Pain Medicine, Psychosomatic MedicineShannon Suo, M.D., Co-Director TNT FellowshipPsychiatry, Cultural Psychiatry, Community Psychiatry, Family MedicineMatt Reed, M.D., TNT Director of EducationPsychiatry, Internal Medicine, Pain MedicineSergio Aguilar-Gaxiola, M.D., Ph.D., TNT Director of OutreachInternal Medicine, Psychology Michelle Burke Parish, M.A., MFTI, TNT Director of ResearchClinical Therapy, Counseling, Psychology, ResearchJaesu Han, M.D. Psychiatry, Community Psychiatry, Family MedicineGlen Xiong, M.D. Psychiatry, Geriatric Psychiatry, Internal MedicineJohn Onate, M.D. Psychiatry, Community Psychiatry, Internal Medicine

Lorin Scher, M.D. Psychiatry, Emergency Psychiatry, Psychosomatic MedicineDavid Liu, M.D. Psychiatry, Emergency Psychiatry, Psychosomatic MedicineAmir Ramezani, Ph.D Psychology, Pain Psychology, NeuropsychologySwati Rao, M.D.Psychiatry, Family Medicine Jim Bourgeois, O.D., M.D.Psychiatry, Psychosomatic Medicine Shawn Hersevoort, MDPsychiatry, Psychosomatic MedicineScott Fishman, M.D.Internal Medicine, Psychiatry, Pain Medicine, Palliative Care Efrain Talamantes, M.D., MBA, MSHPM Internal Medicine

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2016 TNT PCP Fellow Demographics

79%

21%

Female

Male

Total number of fellows = 33

TNT PCP Fellowship

Average Age = 43.7

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2016 TNT PCP Fellow Demographics

22%

66%

3%

15%

Asian

White

African American or Black

Other or Declined to State

Race

TNT PCP Fellowship

Ethnicity

15% Hispanic 85% Not Hispanic

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2016 TNT PCP Fellows Career Demographics

84%

12%4%

Family Medicine Internal Medicine Pediatrics

Medical Specialty

TNT PCP Fellowship

Average Years in Practice = 11.2

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2016 TNT PCP Fellows Career Demographics

57%

17% 17%

10%

MD NP PA DO

Medical Discipline

TNT PCP Fellowship

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TNT PCP Fellow Work Satisfaction

TNT PCP Fellowship

51.50%

27.30%21.20%

0%

Strongly Agree orAgree

Neutral Disagree Strongly Disagree

I frequently feel burned out at work

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TNT PCP Fellow Training Attitudes

TNT PCP Fellowship

Strongly Agree Agree Neutral StronglyDisagree orDisagree

0%

18%22%

60%

I received adequate psychiatric training during my formal training

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TNT PCP Fellow Mental Health Treatment Attitudes Pre and Post Test

Strongly Agree Agree Neutral StronglyDisagree orDisagree

0%6%

24%

70%

26%

65%

5% 2%

I am satisfied with my overall knowledge base in the area of psychiatry

Pre-test Post-test

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TNT PCP Fellow Mental Health Treatment Attitudes Pre and Post Test

Strongly Agree Agree Neutral StronglyDisagree orDisagree

0%

24%

61%

15%24%

74%

0% 2%

I feel confident treating patients who have mental illness

Pre-test Post-test

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Strongly Agree Agree Neutral Strongly Disagreeor Disagree

12%

64%

15% 9%

85%

15%

0% 0%

I feel comfortable treating depressionPre-test Post-test

TNT PCP Fellow Mental Illness Treatment Attitudes Pre-test vs. Post-test

Page 28: UC Davis Train New Trainers (TNT) Primary Care Psychiatry ... · Primary Care Setting: De Facto . Mental Health Care System Primary care physicians – provide up to 60% of all psychiatric

Extremely helpful -Very helpful

Moderately helpful Slighlty helpful orless

87%

8% 5%

How helpful or unhelpful is your mentor?

TNT PCP Fellow Post Fellowship Satisfaction

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TNT PCP Fellow Post Fellowship Satisfaction

Extremelysatisfied

Satisfied Neutral Dissatisfied

71%

23%

2%2%

Overall, how satisfied or dissatisfied are you with your experience in the fellowship?

Page 30: UC Davis Train New Trainers (TNT) Primary Care Psychiatry ... · Primary Care Setting: De Facto . Mental Health Care System Primary care physicians – provide up to 60% of all psychiatric

TNT PCP Fellow Post Fellowship Satisfaction

Extremely wellor very well

Moderatelywell

Slightly well ornot well at all

94%

6% 0%

Overall, how well do the professors in this fellowship program teach?

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TNT PCP Fellow Post Fellowship Satisfaction

0123456789

10

How likely are you to recommend this fellowship program to friends or colleagues?

Extremely

Not likely

Page 32: UC Davis Train New Trainers (TNT) Primary Care Psychiatry ... · Primary Care Setting: De Facto . Mental Health Care System Primary care physicians – provide up to 60% of all psychiatric

UC Davis TNT PCP Fellowship

Directed by PCP’s who are also psychiatrists

Nationally recognized curriculum

PCP’s learn during non-clinical time

Improving regional mental health access

Recruiting now for the January 2017 class

Tuition is $15,000 per learner

Certificate of fellowship completion and ongoing primary care psychiatry mentorship

TNT PCP Fellowship

Page 33: UC Davis Train New Trainers (TNT) Primary Care Psychiatry ... · Primary Care Setting: De Facto . Mental Health Care System Primary care physicians – provide up to 60% of all psychiatric

Future Thoughts…

TNT Primary Care Pain Medicine Fellowship

TNT Preventive Medicine in Psychiatry Fellowship

TNT Culturally and Linguistically Appropriate Services (CLAS)

Training

TNT PCP Fellowship

Page 34: UC Davis Train New Trainers (TNT) Primary Care Psychiatry ... · Primary Care Setting: De Facto . Mental Health Care System Primary care physicians – provide up to 60% of all psychiatric

TNT PCP Fellowship

First Cohort of TNT PCP Fellows (2016)

Page 35: UC Davis Train New Trainers (TNT) Primary Care Psychiatry ... · Primary Care Setting: De Facto . Mental Health Care System Primary care physicians – provide up to 60% of all psychiatric

https://www.youtube.com/watch?v=2p0E2ChnWWw&feature=youtu.be

TNT PCP Fellowship


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