Doctor: Survey tool led to ‘epiphany’ with patient

Not long ago, Dr. Zane Gates of Empower3 Center for Health primary care was finishing up with a patient who had come in for treatment of migraines when he glanced at the results of a survey tool his office has been using for 18 months to identify those having problems with mental health, drugs or alcohol.

The patient’s score was high for mental health matters, putting a stop to Gates’ plans for discharging her and triggering a discussion that led to tears, a confession about depression and the summoning of a care coordinator who evaluated the patient and directed her to proper treatment elsewhere for that depression.

The survey tool and the care coordinator in Gates’ office — and in two other primary care practices in Altoona — are features of the Screening, Brief Intervention and Referral to Treatment (SBIRT) initiative, a national program funded with federal money in those local practices, which were the subject of a review visit on Monday by a senior adviser in the White House Office of National Drug Control Policy and the state secretary of the Department of Drug and Alcohol Programs.

Gates’ work with SBIRT has led to an “epiphany” for him, the doctor said after the visit.

Before SBIRT, he might have missed the signs that his patient was depressed, being habitually focused on the complaint that brought her in, he said.

Before SBIRT, if a patient presented sufficient signs of a mental health or substance abuse problem, despite his focus on the main problem, he might have simply handed her a list of “people to call,” Gates said.

Now, with SBIRT, his practice can assume the proper primary care “entry point” function for mental health and drug and alcohol problems that it has always done for physical problems like diabetes, Gates said.

SBIRT thus helps get those suffering with mental health and substance abuse issues into proper treatment early, before those issues grow and become catastrophic, he said.

It’s just like early intervention with diabetes in the physical realm, with similar benefits, he said.

“We’re (too often) treating stuff way after the fact,” Gates said. “We’re treating the guy who’s out shooting people, or the (person) who’s so depressed she can’t go to work.”

“You’ve got to get to them before they get to that point,” he said.

SBIRT has also helped Gates realize more clearly that people with those kinds of problems can’t cure themselves.

“It’s not a willpower thing,” he said.

Telling them, for example, simply to stop using drugs is like telling a diabetic to start producing insulin, he said. “They can’t,” he stated.

SBIRT is designed to “change the culture” in primary care, so it becomes normal for patients to discuss embarrassing and difficult topics like their drug or alcohol use, said Judy Rosser, executive director of Blair County Drug and Alcohol Partnerships, which is providing the care coordinators to Empower3, UPMC Altoona Family Physicians and Healthy Beginnings Pregnancy Care Clinic.

“We want people to know that it’s OK to talk to their physicians about this,” Rosser said.

The program seeks to allay fears that doctors won’t treat them if they disclose problems with drugs, she said.

“We try to normalize it,” and to make it clear that support, not rejection, is on the way, she said.

The White House official, Anne Hazlett, was particularly interested during her visit Monday in the corollary problems of patients who could benefit from SBIRT, including the frequent issue of a lack of transportation to and from appointments, Rosser said.

Helping patients overcome those kinds of corollary problems are part of the care coordinators’ responsibilities, Rosser said.

SBIRT seeks not only to help patients feel comfortable talking about substance abuse and mental health issues with their doctors, but also to help doctors feel comfortable talking about those problems with patients — giving them confidence that there’s a process through which those patients can get the help they need, Rosser said.

The program has the added effect of helping to ensure that patients with mental health or substance abuse problems will comply with treatment for whatever physical ailment brought them to the doctor in the first place, Rosser said.

The screening questionnaire only takes a couple of minutes to fill out, Rosser said.

It generates a finding of “low, medium or high risk,” for mental health or drug and alcohol problems, she indicated.

“It’s a really good intercept,” Rosser said. “(The primary care office) is a natural setting for it.”