Psychology's Role in an Outpatient Primary Care Medical Clinic

Richard Suinn, a former president of the American Psycho­logical Association has stated that "it is past time for psycho­logists to expand their services into primary health care". Currently, Health Psycho­logists at the Cleveland VA Medical Center provide professional services in an array of clinical settings including cardiology, organ transplants, spinal cord injury, infectious diseases, oncology, geriatrics, pain management, and primary care medicine, among others.

In primary care medicine the Health Psycho­logist works with an interdisciplinary team including physicians, nurse practitioners, clinical pharmacists, nurses, and social workers. This innovative team approach to patient care has been in place at the Cleveland VA since 1994. Referrals to the psycho­logist can come from any team member and may include the following questions: depression/anxiety, obesity, pain, post traumatic stress, sexual dysfunction, coping with physical health problems, smoking cessation, and treatment nonadherence to name a few.

Within the last two years the Health Psycho­logist has facilitated Shared Medical Appointments (SMAs) for Diabetes and Hypertension. The SMAs are interdisciplinary group meetings for patients with those specific diagnoses. Generally 8-18 patients meet together with the team members to discuss problems associated with the diabetes or high blood pressure. Information about the diseases is offered to the patients such as what is a hemoglobin A1c (an average of one's blood sugars over the past three months), what is a normal blood pressure, what are normal cholesterol levels, etc. However, the major thrust of the SMA is to foster discussion among the patients about how they cope with the disease, what works (and doesn't work) in improving their blood sugars and blood pressures, and how they solve problems in self-management of the diseases. Patients learn and take advice better from their peers than from providers. This is evident in our study of outcomes in the SMAs. We found that patients whose hemoglobin A1c and blood pressures had been elevated for months, if not years, while following with their primary care providers had statistically significant reductions in A1cs and blood pressures after only 1-4 visits in the SMA. These improvements clearly reduce the risk for heart disease, stroke, blindness, kidney disease, and amputation.

The evidence suggests that Clinical Health Psycho­logists play an important role in prevention and treatment of physical as well as mental health problems. Although Western Reserve Psychological Associates is a psychology based practice we can certainly help our patients with more physically challenging concerns, as cited above, in addition to their mental health needs.

Gerald J. Strauss, Ph.D.
Section Chief, Health Psychology
Louis Stokes, Cleveland, Department of Veterans Affairs Medical Center
and
Clinical Assistant Professor of Medicine
School of Medicine
Case Western Reserve University