Integrated Care Can Be Improved By Better Understanding of Culture

For many health professionals like Glenda Wrenn, M.D, M.S.H.P., that last element—culture—is essential. “Culture is inherent to understanding an individual,” she said. “It reflects who you feel you are as a patient, or who you feel you are as a provider. You cannot make culture an afterthought when trying to address health disparities.”

Wrenn, a psychiatrist who heads the Division of Behavioral Health at the Satcher Health Leadership Institute at Morehouse School of Medicine (MSM), is part of a group addressing this issue by working on a culturally centered model of integrated care for mental health.

“For many minorities, primary care is the first place, and sometimes the only place, they go to when they have a mental health concern,” Wrenn said. “Primary care physicians, though, are still more comfortable referring someone to a cardiologist than to a psychiatrist. So we need to foster a clinical environment that engages both the patient and provider in addressing mental health.”

The proposed model, described in more detail in an article published in Psychological Services, borrows principles from two other integrated care approaches known as CRASH (considering Culture, showing Respect, Assessing/affirming differences, showing Sensitivity/self-awareness and to do it all with Humility) and PCMH (Patient-Centered Medical Home model).

CRASH, which was also developed at MSM, was designed as a course for physicians to improve their cultural competency in primary care settings and give physicians confidence to communicate with a diverse patient population, often within an environment with limited time for each patient. PCMH focuses more on the patient and providing a setting in which the patient and family are the center of the medical home; PCMH offers ideas like having a personal point of contact, open scheduling practices, and flexible payment systems.

The two approaches offer complementary benefits and ideally create an environment in which patients can build a culturally sensitive rapport with their personal physician; in turn, the physician, as part of an integrated team, can provide the patient with the most appropriate type of care.

Wrenn and her colleagues hope to begin testing a version of their model targeted to African-American patients in a pilot study this month.

At the same time, Meyer and other researchers will continue to work at identifying potential causes of disparites in the mental health setting. While this recent study examined patients in a clinical setting, she is hoping to learn more about those people without regular access to care.

“I’d like to look into social and geographic contexts of neighborhoods and see how that influences access,” Meyer said. “We need to certainly address potential biases once someone reaches a primary care setting, but for so many people, even getting to a doctor is the hurdle to overcome.”

Kisha Holden, Ph.D., M.S.C.R., a psychologist and deputy director for the Satcher Health Leadership Institute at MSM, believes a combination of efforts from professionals in various sectors is critical for achieving progress toward reducing health disparities.

“We need research, clinical practice, and health policy entities to collaborate in order to build a better, and more equitable, system of mental health care, and health care in general” she told Psychiatric News. “I’m optimistic, in part because of implementation of the Affordable Care Act, in which comprehensive care is valued and relevant parties are committed to discussing disparities more openly, and committed addressing them.” ■