Monday, February 4th, 2013
Providing Patient Education Services
One of the most important roles the psychiatric nurses at PsychCoverage have is as educator. The vast majority of the calls that come in are from patients who are worried about their new medication, experiencing side effects, not experiencing a decrease in symptoms, or who need some reassurance. There are many reasons patients need additional education regarding the medications their treating psychiatrist has prescribed:
- Psychiatric patients do not have the same understanding of how medications work as their psychiatrists do, or understand how long they need to be taken in order to be effective.
- Most treating psychiatrists will discuss both of these things with their patients, but sometimes there isn’t enough time in an office visit to provide the patient with a full understanding.
- What may come as a natural understanding to a psychiatrist is not so natural for a patient, and certain things can be glossed over.
- A patient may not be in the most receptive or understanding of states in a psychiatrist’s office and may not fully retain the information they receive.
- Patients may have an unrealistic expectation of their medications and won’t think to discuss them until a few weeks in to treatment.
- Patients may walk out of their psychiatrist’s office with a full understanding of their treatment but forget a few weeks down the road and need additional education and reassurance.
All of these reasons are why PsychCoverage functions as an extension of their psychiatrist’s office. We are there for the patients when their psychiatrist is unavailable (like on weekends and during vacations) in order to provide them with a seamless, 24/7 resource. The goal is to keep psychiatric patients on their treatment course, especially medication. Too often a patient will be taking a new medication for a few weeks, not see the type of results they were hoping for (or experience a crisis during that time), and immediately want to go off it. Patients in this position want to talk with their doctor to be reassured of their decision; when their psychiatrist isn’t available the patient is forced to make that decision alone. PsychCoverage takes this burden away from both patient and psychiatrist; the patient can call in, talk to a trained psychiatric nurse, and come away with education about their particular course of treatment, why it’s important to continue treatment, and tips on getting them through until their next office visit with their treating psychiatrist.
The benefits of psychiatric patient education
The benefits this service provides are immense. First, patients do not see any interruptions in their time of need. Crises and questions often come at night, or when the patient is alone, and waiting to make an appointment can feel like an eternity. We remove this anxiety by providing evening and weekend availability so patients always have someone to talk to. Second, psychiatrists don’t experience an interruption in their counseling. When a treating psychiatrist to return to the office on a Monday and discover a patient has discontinued his medication over the weekend because it wasn’t doing what he thought it would do (or doubled the dosage), the psychiatrist has clean up work to do. Third, psychiatrists get a break. This is an immeasurable benefit because it allows psychiatrists to return to work refreshed and in a better position to treat their patients face to face.
Patient resources
A minimum amount of coaching, reassurance, and education go a long way in improving patient experiences. In fact, we have a very high success rate of getting patients to feel much better within 12 to 24 hours. We ask patients to call us back within 12 hours, and if they don’t we follow up with them. We also call patients in the morning before it’s time for their next dose. Keeping them on track with their treatment makes it much easier for them and their psychiatrist.
We have plans to grow our resource center for both psychiatrists and their patients by providing podcasts and literature. Psychiatrists will be able to download these from our website and distribute them to their patients so they can be educated in their own time. Topics will include typical medications, behavioral activation, relaxation and stress management, and sleep. The mobility of our podcasts will allow psychiatric patients to listen to them on whatever device is convenient and whatever time is convenient. We believe this strategy will also help psychiatrists treat their patients in a more complete manner. We also provide outside referrals and resources to patients and their family members; community resources, NAMI, and local resources are just a start to the services we can educate patients about to give them the power to make better decisions for their mental health.
Monday, January 28th, 2013
What is psychiatric coverage?
Because of the newness of the industry, psychiatric coverage is a phrase that is not yet well known in the mental health community. “Psychiatric Coverage” is on-call coverage for psychiatrists. Similar to an on-call nurse, available after-hours during times of patient need, psychiatric coverage is what private practice psychiatrists use when they want or need to take a break from the 24/7 availability requirement. Because the law does not dictate that the treating psychiatrist must be the one to answer when a patient calls outside of office hours (likewise, a psychiatric patient can seek help and treatment from any psychiatrist or nurse at will), psychiatric coverage fulfills a need to both patients and psychiatrists. We also have an introduction to PsychCoverage and founder Jack Coughlin.
What Psychiatric Coverage means to patients
Patients understand that their psychiatrist operates a practice with normal business hours, just like a doctor’s office – limited evening and weekend appointments (if any) and, despite the legal and ethical obligation, no guarantee that phone calls after-hours will be answered. Unfortunately, patients with anxiety and depression can learn to dread the evenings and weekends when they know the office is closed and don’t have the ability to call in and have a live person answer. Most patients also feel guilty calling their psychiatrist after hours, recognizing they’re real people with lives and families and will try to wait until office hours or their next appointment, which can exacerbate their illness. When a psychiatrist goes on vacation it can trigger symptoms in patients, just because they know their doctor is out of touch.
Psychiatric coverage eases these thoughts for the patient. When a patient knows he can call in any time and talk with a trained professional, he automatically feels more relaxed. We make a point to tell every patient that their call is not an inconvenience, that it’s what we’re there for. We reassure patients that we’re here whenever they need us, whatever time of day; if their doctor is unavailable and they need someone to talk to, we answer that call. And that alone tends to have a great effect on patients. 90% of the patients who call in were diagnosed with depression or anxiety and often just want someone to talk to who understands and can provide advice or encouragement. Many of the calls PsychCoverage gets are about medication: last minute refills, questions about side effects, and questions about discontinuing the medication are highly common. These are questions the treating psychiatrist doesn’t need to be the one to answer, but the patient still needs an answer to.
What Psychiatric Coverage means to psychiatrists
For the first time in California (and soon in other states), psychiatrists can turn off their phones on evening, weekends, and vacations and not feel one ounce of guilt and not have to play catch up later. Psychiatric coverage means psychiatrists have an alternative to being “at work” 24 hours a day, 7 days a week. While there’s no guarantee that every night or every weekend will involve a patient call, there’s also no guarantee that there will be no calls – which means psychiatrists have to always have their phone on, with them, and be available to take an emergency call (it doesn’t matter if a patient is calling for a medication refill, calling with a quick question about their new medication, or calling with an emergency situation, the call has to be answered). Just knowing the phone might ring, whether for a trivial reason or crisis, a psychiatrist can feel as if he is just waiting for a call when he should be resting or spending time with family.
Being able to turn the phone off and know patients will be taken care of if they need it can be immensely relaxing and comforting. We know this is a successful, if brand new, industry because our existing clients have had nothing but good things to say about our services and the relief it gives them on weekends. We remove the burden of asking colleagues for help (and returning the favor), and provide peace of mind, if nothing else. But that peace of mind can be a career saver. Very rarely, and only when the psychiatrist asks for it, do we need to contact the psychiatrist during a coverage period. During set up we gather all of the information we would need (notes on particular patients, standing refill orders, etc.) so that we can function as a seamless extension of their office.
Thursday, January 17th, 2013
In the second part of our series to introduce PsychCoverage and the novel services we provide, we’ll meet founder Jack Coughlin, RN, and discover how he decided to begin his unique business.
Hi, I’m Jack.
I’m a Registered Nurse. I became a Psychiatric Nurse in 1985 after completing my education at Hahnemann University and Temple in Philadelphia, and started my career in California in 1992. Since the early 2000s I have been working for a company called Status One, a cutting-edge management operation helping to pioneer disease management. Now it’s a trend in healthcare, but back then it was a novel idea. Part of my job was giving leadership training and care management training, focusing on mental health and teaching non-psychiatric nurses how to assess patients for risk, especially those who may be depressed or suicidal.
But on the side, my wife and I were covering for a local psychiatric practice part-time, taking on weekend calls. When their offices closed Friday evening, they forwarded any phone calls to us. After a while I realized we were really doing disease management for depression. Then we started to get phone calls from other psychiatrists who were interested in us covering for their practices, too. Now we’re covering for psychiatrists across California, and hopefully next year we’ll be providing these services to practices in Texas, Arizona and Nevada.
There currently is no other service that psychiatrists can rely on when they want a little break, or at least some separation between practice and home life. It’s well documented that the inability to get away from their practice has been a significant contributor to burnout, which is prevalent throughout the profession. Giving psychiatrists this break helps them with face-to-face patient care.
The number one service we provide is to psychiatrists, and that’s peace of mind. Patients may never call over the weekend but a psychiatrist has to always be available no matter what. Obviously this is mentally draining. We exist so the doctor never has to worry on the weekends about what he or she might miss because of a call. The other service we provide is to the patients, and that’s experienced, professional phone triage. The vast majority of our calls are from patients who are worried about their medication or who just need someone to talk to. We’ll give them more education on their medication and side effects and help them understand the recovery process a little better. We’re an extension of their doctor’s office that just happens to be available any time their doctor isn’t.
I’m able to do this because, and this may sound cliche, it really doesn’t feel like work to me. Whenever I get a call I just sit down and never feel like I have to cut it short or give a patient less than my full attention or a full response, even when the call comes at an inconvenient time. I just really love what I do. I do have other psychiatric nurses working for me now, but even if I didn’t I don’t see myself ever not doing this. And that is what keeps me going and keeps me excited about introducing this new field to other psychiatrists and really helping everyone to do what they do best.
You can read more about my practice, PsychCoverage, Inc., here, or visit our website to learn more about our psychiatric coverage services.
