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

Medical
Practitioner

Integrated Collaborative Care

Medical
Practitioner
Relational
Field
Mental Health
Specialist
Mental Health
Specialist
Co-location
 Integration
 Separate services offered
 Interaction blurring boundaries
between mind & body
 Facilitates “screen and refer”
 Quality of collaboration depends
on quantity of interaction between
clinicians
A + B = A' + B'
 Facilitates immediate assessment
 Quality of collaborative relationship
is a part of the therapeutic process
AxB=C
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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:
Anxiety
Marital/Family Stress
Grief
Alcohol Abuse
Job Stress
Co-morbid Depression
Body Image/Eating
Disorders
Adjustment Reactions
Panic Disorder
All others
29%
27%
12%
5%
4%
4%
3%
3%
3%
3%
8%
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Patient Profiles
Total Patients Seen
(n=62)
Phone Survey
Sample (n=33)
Age Distribution:
20-45 years
46-64 years
65+ years
17 (27%)
27 (44%)
18 (29%)
8 (24%)
15 (45%)
10 (30%)
12 (19%)
15 (24%)
35 (57%)
6 (18%)
8 (24%)
19 (58%)
60
2
31
2
45 (72%)
17 (28%
20 (60%)
13 (40%)
Type of patient:
New patient
Regular Office Visit
Interval Visit
Gender:
Female
Male
Seen before 9/11
Seen after 9/11
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Initial Response to Collaborative Care
What was your initial
response to the concept of
collaborative care?
70%
60%
50%
40%
Positive
Neutral
Negative
30%
20%
10%
0%
Percent
 87% somewhat or
very comfortable with
information revealed
at the visit
 83% thought the pace
of the visit was good
 61% thought price
was appropriate
 58% cited trust in Dr.
Hoffman as reason
they participated
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Perceived Benefits of the Visit
 79% articulated
positive benefit, 48%
mentioned the
integration of
“mind/body” issues
 56% said they would
do it again
 50% said it would
increase their ease of
raising mental health
issues in the future
66% of patients took action
as a result of the visit:
40
35
30
25
20
15
10
5
0
Follow up with
J. Olken
Follow up with
other mental
health provider
Implemented
Behavior
Change
Medication
Follow up with
other services
PERCENT
TAKING
ACTION
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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
predisposed:
 83% took action
 83% would have
another CC visit
 71% said visit
was beneficial
Of those not
predisposed :
Yes
36%
No
64%
Slice 1
Slice 2
 57%
had issue
they wanted to
discuss
 52% took action
 48% would have
another CC visit
 92% said visit was
beneficial
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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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