Hmmmm…and Just What is CoMeBeh at The University of Iowa?

Have you noticed those on-line comments from people who start a provocative remark or a question with “Hmmmm…”? For example, “Hmmmm…have you ever publicly denied selling tickets to the break-dancing koala bear act with Cirque du Soleil in Branson, Missouri?”

So how about, “Hmmmm…has anyone ever kicked up a notch the collaborative care model in which nurses trained in evaluating patients with comorbid depression and medical illness assist doctors in primary care clinics?”

Well…yeh.  We know that patients with both medical illness and depression tend to have improved outcomes both medically and psychiatrically as well as in quality of life from studies done by Wayne Katon and colleagues [1].

However, here in Iowa, doctors are kicking that up a notch and providing patients in the psychiatry clinic with primary care expertise. Dr. Alison Lynch, MD, a double-boarded family medicine physician and psychiatrist alerted me to CoMeBeh, which stands for Collaborative Medicine and Behavioral Health. CoMeBeh is in action in our adult psychiatry outpatient clinic and it’s a Department of Family Medicine Health Resources and Services Administration (HRSA)-funded project that, according to Dr. Lynch,

Dr. Alison Lynch, MD

“…includes a new primary care service within the Adult Psychiatry Clinic.  The goal of the project is to improve the health of people with serious mental illness, through collaboration of family medicine residents and psychiatry residents.  This collaboration is helping to bridge the gap between our patients’ mental and physical health care.”

“For over a month now, family medicine residents have been working with me in the psychiatry clinic on Tuesday mornings.  We are seeing patients with severe mental illness who come to establish primary care.  In this clinic, we have been doing pap smears, giving tetanus, diptheria, pertussis vaccine and pneumovax shots, and we even picked up a methicillin resistant staphylococcus aureus skin infection in a person who reported no concerns at the beginning of the visit! Our primary focus is health maintenance and preventive care, and we will develop a management plan for anyone who has acute or chronic conditions that warrant further follow-up.  It is really cool to be able to offer these services to people who are being seen regularly in psychiatry but do not have a primary care physician. ”

Dr. Lynch encourages psychiatrists to refer patients to CoMeBeh simply by sending a consultation request through our Epic electronic health record (EHR) to Family Medicine or by paging the associated case manager.

Hmmmm…and exactly what is the rationale and the end in mind regarding CoMeBeh? Well, in fact Dr. Lynch goes on to point out,

“People with serious mental illness have a shorter life expectancy, and chronic medical conditions such as cardiovascular diseases play a huge role in this population’s morbidity and mortality.  Our CoMeBeh project is helping us bring primary care services into the psychiatry clinic.  Now, patients seen in the psychiatry clinic can have one-stop shopping by establishing primary care here, too.  It is also facilitating better collaboration between healthcare providers in family medicine and psychiatry, and this collaboration will help us all provide more integrated care as our health care system changes to meet patient needs and control costs. ”

Hmmmm…and just what does all of this have to do with break-dancing koala bears?

1. Katon, W. J., E. H. B. Lin, et al. (2010). “Collaborative Care for Patients with Depression and Chronic Illnesses.” New England Journal of Medicine 363(27): 2611-2620. Collaborative Care for Patients with Depression and Chronic Illnesses — NEJM