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Integrated Care for Complicated Patients: A Role for Combined Training and Practice

  • Gregg A. Robbins-Welty
    Correspondence
    Send correspondence and reprint requests to Gregg Alan Robbins-Welty, M.D., M.S., Combined Internal Medicine & Psychiatry Residency Program, Duke University Hospital, Box 3837, 2301 Erwin Rd., Durham, NC 27710
    Affiliations
    Department of Psychiatry and Behavioral Sciences, Duke University Medical Center (GAR-W, JPG), Durham, NC

    Department of Medicine, Duke University Medical Center (GAR-W, JPG), Durham, NC
    Search for articles by this author
  • Jane P. Gagliardi
    Affiliations
    Department of Psychiatry and Behavioral Sciences, Duke University Medical Center (GAR-W, JPG), Durham, NC

    Department of Medicine, Duke University Medical Center (GAR-W, JPG), Durham, NC
    Search for articles by this author
Published:November 05, 2022DOI:https://doi.org/10.1016/j.jagp.2022.10.008

      Highlights

      • What is the primary question addressed by this study?
        Patients with comorbid medical and psychiatric illness suffer poorer outcomes due to a siloed healthcare system in the United States and new models of care, but do integrated behavioral models, combined medicine-psychiatry services, or complexity intervention units better serve these patients?
      • What is the main finding of this study?
        Integrated behavioral models of healthcare are designed to provide whole-patient care, addressing health disparities, and reducing barriers for patients with comorbid psychiatric illness. We describe integrated behavioral healthcare models with an emphasis on the combined medicine-psychiatry (med-psych) service at Duke University Hospital as well as detail the Duke University combined internal medicine-psychiatry residency training program.
      • What is the meaning of the finding?
        The Duke University Hospital med-psych service and residency training program may serve as an archetype for those interested in developing combined services or training programs elsewhere as a means providing integrated care for complex patients with comorbid illness.

      Abstract

      Patients with chronic medical disease frequently have comorbid psychiatric illness, yet mental and physical healthcare is frequently siloed in the United States. Integrated behavioral healthcare models, such as medicine-psychiatry services, are feasible, improve patient outcomes, and reduce costs. The Duke University Hospital medicine-psychiatry service provides holistic patient care and serves as a model for those interested in developing combined services or training programs elsewhere. Combined residency training in psychiatry is a way to provide a workforce of physician-scientist educators adept at providing coordinated, integrated care for complex patients with comorbid illness.

      Keywords

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