Transcript
“Stepping Care” Using a Stepped-Care approach to improve access to Psychological Resources Marie Carey CNS in Cognitive Behaviour Therapy (CBT); Registered Nurse Prescriber HSE South, Carraig Oir, West Tipperary MH Services, Cashel, Co. Tipperary.
Stepping Care: Do you need to prescribe for Anxiety and Depression?
Objectives:
To increase access to CBT specific psychological resources in primary care To promote a stepped-care approach in supporting integration between primary and secondary care Rationalisation of combination therapy and when not to prescribe
Stepping Care GP Liaise with CBT nurse in secondary care
GP provide CBT online
Benefits/ Results:
GP provide CBT Bibliotherapy
CNS in CBT a new service development post to South Tipperary MH service. CBT Business Case 2014, NRS interview 2015. Clinical responsibility to West Tipperary sector. CNS identified need for greater access to CBT resources at primary care level. Integrated Care: Adopting a stepped care approach where GP’s can initially direct their clients to CBT specific Bibliotherapy, thereafter CBT on-line resources and finally secondary care CBT. CNS is using prescriptive authority since 2011 –utilised in the rationalisation of client’s medication alongside CBT treatment, reducing/ augmenting/stopping, as appropriate, in liaison with Consultant Psychiatrist.
GP’s in Tipperary/ Cashel sector are more informed in terms of disorder specific treatment via CBT. They can refer their clients to the Overcoming Series of books as a first line approach to psychological intervention or can refer them to the advised on-line CBT courses readily available. Tipperary Town demographic is a socially deprived catchment area, thus sensitivity that all material advised is free to access e.g. CBT Library provision. Enhance self-reliance V’s medication reliance to ameliorate greater relapse prevention. Stat: 50% non-adherence with SSRI medication. GP’s have an opportunity to be involved in the client’s psychological recovery through collaborative goal setting and also in engaging the GP if they are becoming part of the maintenance cycle of a particular problem e.g. Health Anxiety Disorder / SSD
Potential GP/ Client Maintenance Cycle Health Anxiety
Client presents to GP
(SSD)
Client Reassurance Seeking/ GP Reassurance Provision
Temporary Client/ GP relief
Increase in Physical Investigations
Conclusions:
Method:
Each GP was contacted to advice of new service provision in secondary care. Requested to meet GP’s to discuss how we can work together and use the resource as efficiently as possible. Provided GP with recommended CBT Bibliotherapy/ online resources; CBT specific books sought for local library also. Active promotion of the stepped-care ethos to utilise the least intensive intervention that is likely to result in significant improvement.
Through continued trust, rapport building and ease of access to the CBT nurse in secondary care – the GP is being supported to have greater access to CBT specific/ evidenced based psychological input - in a timely manner. This stepped-care intervention gives the client relief of their symptoms and increased power to self-help. From the time of referral, the client is getting a clinically specific intervention as opposed to being on a waiting list with no intervention. Communication of CBT progress/ case formulation to GP Future Development: Audit implementation of the model. Extend role to further assist GP and NCHD/ Nursing training needs.
