WOMEN-CENTERED

COLLABORATIVE CARE IN THE

FEE FOR SERVICE SETTING

BEYOND CO-LOCATION

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Question:
Is an electron a particle or a wave?

Answer:
Both… depending on the context!
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 Context = Structure and
Form of Medical Services

Structure Form
•Primary Care •7 minute visit
•Specialty Care •Organ focus
•Emergency Care •Physical/Mental
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The structure and form
of medical services…
… enables & constrains the way people

formulate their understanding of health and

illness
…influences the way they seek healthcare

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Traditional Collaborative Care Integrated Collaborative Care

  Medical
Practitioner

 Relational

Field

Mental Health
Medical Mental Health Specialist
Practitioner Specialist

Co-location  Integration

 Separate services offered  Interaction blurring boundaries

between mind & body
 Facilitates “screen and refer”
 Facilitates immediate assessment
 Quality of collaboration depends
 Quality of collaborative relationship
on quantity of interaction between is a part of the therapeutic process
clinicians

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A + B = A' + B' AxB=C
Pilot Study Design

 Random patient selection: All patients seen in

Dr. Hoffman’s office on Tuesday
 Patients invited to participate by Dr Hoffman
 Patients seen by both providers: jointly and/or
sequentially
 Single patient record
 Collaborative diagnosis at time of patient visit
 Collaborative treatment plan put into place at first
visit

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75% of patients participating had at
least one mental health issue:
Depression: 29%
Anxiety 27%
Marital/Family Stress 12%
Grief 5%
Alcohol Abuse 4%
Job Stress 4%
Co-morbid Depression 3%
Body Image/Eating 3%
Disorders
Adjustment Reactions 3%
Panic Disorder 3%
All others 8% 7
 Patient Profiles
Total Patients Seen Phone Survey
(n=62) Sample (n=33)

Age Distribution:
20-45 years 17 (27%) 8 (24%)
46-64 years 27 (44%) 15 (45%)
65+ years 18 (29%) 10 (30%)

Type of patient:
New patient 12 (19%) 6 (18%)
Regular Office Visit 15 (24%) 8 (24%)
Interval Visit 35 (57%) 19 (58%)

Gender:
Female 60 31
Male 2 2

Seen before 9/11 45 (72%) 20 (60%)

Seen after 9/11 17 (28% 13 (40%)
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Initial Response to Collaborative Care
What was your initial
response to the concept of  87% somewhat or
collaborative care? very comfortable with
70% information revealed
60% at the visit
50%  83% thought the pace
of the visit was good
40% Positive
Neutral  61% thought price
30%
Negative was appropriate
20%
 58% cited trust in Dr.
10% Hoffman as reason
0% they participated
Percent
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 Perceived Benefits of the Visit
66% of patients took action
 79% articulated
positive benefit, 48% as a result of the visit:
mentioned the
integration of 40
“mind/body” issues 35 Follow up with
J. Olken
30
 56% said they would Follow up with
25 other mental
do it again health provider
20 Implemented
 50% said it would 15 Behavior
Change
increase their ease of 10 Medication

raising mental health 5 Follow up with

issues in the future 0 other services

PERCENT
TAKING
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ACTION
 Predisposition to Collaborative Care
Q: If you had been offered a collaborative care
visit when you registered, or had seen a brochure
would you have taken advantage of the service?

Of those Of those not

predisposed: Yes predisposed :
 57% had issue
No they wanted to
36%
 83% took action discuss
 83% would have  52% took action
another CC visit 64%  48% would have
another CC visit
 71% said visit
 92% said visit was
was beneficial beneficial

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Slice 1 Slice 2
 Responses were consistent
across categories of patients
 Post 9/11 patients were more likely to see positive
benefits (79%) and take action (77%), but pre 9/11
patients also saw positive benefits (70%) and
took action (55%)
 New patients (12) had similar responses to
overall group: 66% had positive initial reaction,
67% took action, and 50% would do it again
 Reaction to price did not influence outcomes. Of
those who thought price was high, 67% took
action. Of those who thought price was
appropriate or didn’t remember what they paid,
62% took action.
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 Feedback Very Positive

“My first time was the best visit to a doctor’s office

that I had in my life”
“I never would have entertained seeing a therapist,
this was an introduction and it worked out well”
“These guys really saved my life”
“You get a more comprehensive view of yourself, it’s
great to be seen as a whole person”
“The visit jump-started the issue and I later saw a
psychiatrist. I had been thinking about going to a
psychiatrist.”
“ It’s good to know the service is there if you need it”
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 INTEGRATED COLLABORATIVE CARE
RESULTS IN EXPONENTIAL BENEFITS

 Allows patient to describe and deal with issues

as they experience them – a mixture of mental,
physical & social factors
 Expands scope of issues discussed
 Allows immediate initiation of action
 Takes pressure off patient to initiate mental
health care
 Yields high patient satisfaction
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