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Unread March 8th, 2005, 10:42 AM
James Pretzer James Pretzer is offline
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Join Date: Jun 2004
Posts: 283
Default Treating More Than Depression in Primary Care (medical) settings

Obviously, CBT can be used to treat more than depression in medical settings. An abstract of an article in the current edition of Archives of General Psychiatry regadring the treatment Panic Disorder in primary care settings can be found at: http://archpsyc.ama-assn.org/cgi/con.../62/3/290?etoc

The conclusion: “…Delivery of evidence-based CBT and medication using the collaborative care model and a CBT-naïve, midlevel behavioral health specialist is feasible and significantly more effective than usual care for primary care panic disorder…”

Note that in this study and some of the others, mental health professionals are providing the CBT, not the physicians. From my experience on the faculty of the Department of Family Medicine at Case Western Reserve, my sense is that anyone who can make it through med school can be taught to do CBT but there are several drawbacks to having the physicians do CBT:
  1. If they don't already have psychotherapy training, they'll need basic therapy training, not just training in CBT. This would be a significant amount of training.
  2. In the U.S. medical system, most primary care physicians simply don't have the time to provide more than a few minutes of counseling.
  3. If the physician spends a significant amount of his or her time doing counseling, this would result in a significant drop in income.
  4. In most settings, it would be more cost effective to have a social worker or psychologist providing counseling. Doing this would generate additional income for the practice and improve patient care.

So why don't primary care practices have social workers and/or psychologists on staff to provide treatment? Actually, some do. However, there is extra administrative complexity in doing this and the fragmentation of health care funding in the U.S. complicates things. If the physician is a provider for some insurance companies and not others, while the therapist is a provider for some of those incurance companies but not all of them, referrals from the physician to the therapist become much more complex. Unfortunately, most insurance companies are not accepting new providers so the therapist is not likely to be able to get on the same panels as the physician.
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