Integrated Care

Peter ForsterAbout GPS, Best Practices

integrated careWe have a passion for providing the most effective treatment at Gateway and that passion is illustrated by the efforts that we make to ensure that we deliver integrated care.

Integrated care is a very simple idea. In fact it is probably something that you expect your treatment providers are already delivering.

  • It means that the different providers who are taking care of you communicate with each other so that the treatment they are giving you works together.
  • It means that if one provider notices something important about how you are doing that information is communicated to the rest of the treatment team.
  • It means that all of this communication is designed to enhance the way that treatment meets your goals.

In fact it is far from common. Even in a setting, such as a medical center, where you might rightly assume that communication takes place, doctors and other therapists often don’t work together. An orthopedic surgeon refers you for physical therapy but doesn’t communicate his or her findings to the physical therapist. The nursing staff on one shift don’t really share the same view of what care a patient should be receiving with the staff on another shift.

And in other settings it is, I am sorry to say, rare for integrated treatment to happen. Therapists don’t generally communicate with psychiatrists, and vice versa. And substance use care and other types of treatment (yoga therapy, nutrition counseling) is even less likely to be provided in coherent way.

Why is this?

Frankly it is because it takes a great deal of effort to deliver care in this way.

And that extra effort is not usually reimbursed for.

So busy providers don’t do it.

We do.

This begins with the fact that all of us share the same clinical record. But it is much more profound than that.

We communicate with each other in real time all day long using a secure messaging system.

We meet formally and informally several times a week.

We have regular clinical case conferences where we learn from each other and work to eliminate barriers to effective collaboration.

And we all share a similar philosophy of care.

And when we have to make a referral for care outside the clinic we communicate with those providers. If we refer to a higher level of care (residential or partial hospital care, for example) we stay in touch with the treatment team there and with the patient and try to make sure that the return to treatment at Gateway is seamless.

Our passion for this approach to treatment is why you may get some “push back” from us if you want to see a psychiatrist at Gateway and a therapist elsewhere.

It isn’t because we don’t value your autonomy, but because it isn’t possible to provide integrated treatment in collaboration with all other clinicians. It is not a model that all outside therapists are comfortable with. Or know how to deliver.

And “un-integrated” treatment is easy to arrange outside of our clinic.

So we will work with you if there is a reason you want to seek care outside the clinic, but we will also try to communicate with you about the hidden value of collaboration.