Family Care Medical Center

1
Family Care Medical Center Mental Health
Resources in Denver

• Roxanne Baca
• 10/06/06

2
A Little Bit About Me
3
What Were Going to Cover

• Practice Overview
• My Location
• My Preceptor
• Typical Day
• Practice Demographics
• Patient Encounter Stats

4
What Were Going to Cover

• Case Presentation
• Patient HPI
• Problem list
• PCPs role in management...
• Medical
• Socioeconomic
• Community Resources

5
My Location
6
Family Care Medical Center

• My Preceptor - Aris Sophocles, MD
• Practiced in Breckenridge for 10 years
• Began FCMC in early 1980s
• Received MBA in 1983
• Created a Physicians Fee Schedule Software
• Received JD in 1990
• Is a malpractice expert witness once a month

7
Family Care Medical Center

• The Typical Day
• 12 patients (99 adults)
• 2-4 TABs (6-10 weeks)
• 2-4 post-TAB exams scheduled (35 show up)
• 1-2 PE per day
• rest are acute illness
• 50 of total encounters are same day
  appointments, with 1-2 walk-ins per day

8
Family Care Medical Center

• Demographics
• 30 Caucausian
• 30 African American or African immigrants
• 30 Hispanic (1/3 of these Spanish only)
• 10 Asian, or other
• 50 with insurance
• 50 out of pocket

9
Family Care Medical Center

• Patient Encounter Statistics
• 130 patients over 5 weeks
• Most common was TAB related (27)
• 2nd most common was Sinusitis and/or URI
• 3rd most common was Health Maintenance

10
Case Presentation

• Patient History of Present Illness
• 39 year old woman with 2 years of depression
  precipitated by 4 deaths in her family over one
  year
• She has tried multiple antidepressants (Celexa,
  Cymbalta, and Zoloft) since first being seen at
  FCMC in 2004
• currently poorly controlled on Zoloft

11
Case Presentation

• Problem list
• depression
• asthma
• insomnia
• skin hyperpigmentation
• requests documentation of depression for
  financial difficulties...
• Leave of absence from work
• Social Services

12
Case Presentation

• PCPs role in management
• Medical
• Socioeconomic
• Mental Health Community Resources?

13
Case Presentation

• Management - Medical
• Depression assess and change Rx
• Zung Self-Rating Depression Scale (similar to
  PHQ)
• depression poorly controlled on Zoloft
• Patient is experiencing financial difficulties
  and wants samples- limits our options to Cymbalta
• returns 2 weeks later, no improvement, new SI,
  wants to try higher dose of Zoloft

14
Case Presentation

• Management - Medical
• Other medical issues controlled, refill Rxs
• Asthma - Albuterol, Theophylline, Q-var
• Insomnia - Trazadone
• Hyperpigmentation - Retin-A

15
Mental Health Resources

• Management - Socioeconomic
• PCP assisted her with socioeconomic needs in a
  variety of ways
• 3 month work leave of absence
• Social Services - State Aid to the Needy and
  Disabled
• Denver Employment First - Food Stamp Job Search
• Qwest Emergency Medical Certificate

16
Mental Health Resources

• Management - Community Resources
• Pt desires psychotherapy but cannot afford it
• Many psychiatrists/therapists do not take
  insurance
• insurance companies have capitated fees and
  created an unreasonable burden of documentation
• Most do not provide a sliding scale
• high demand creates full patient load

17
Mental Health Resources

• Management - Community Resources
• What are some options for patients like her?
• Denver Health
• Mental Health Center of Denver (MHCD)
• Private, non-profit created in 1989 that serves
  more than 7500 Denver area residents
• Offers financial assistance
• Large component of medicaid patients
• Others?

18
Mental Health Resources

• Management - Community Resources
• Pt found the Empowerment Program for women
• Helps women affected by poverty, AIDs,
  incarceration
• Counseling - groups and individual case workers
• Education - GED program, project Bedtime story
• Healthcare - drug treatment program, AIDS
  programs
• Housing - provide housing, financial assistance
  with rent
• Employment services - training and job finding

19
Mental Health Resources

• Management - Community Resources
• Empowerment Program helped our patient find
  affordable/free psychotherapy
• Jewish Family Center
• Maria Drost Center

20
Family Care Medical Center and Mental Health
Resources

• Family Medicine allows for a variety of unique
  practice settings
• Mental Health Resources can be difficult to find
• Often we can learn from our patients