Archive for May 2016

HealthPath–FAQs

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Continuum’s HealthPath program is mentioned quite frequently on our website as well as all of our social media platforms—but what is it, really? We will begin breaking down the program to help you understand exactly what the program entails.

 

What is HealthPath?

HealthPath is an innovative team-based program designed to serve adults who have received psychiatric services or substance-use treatment more intensive than outpatient services (this can include inpatient, intensive outpatient, crisis stabilization, partial hospitalization, crisis intervention, or residential levels of care).  Individuals interested in the program must have Blue Cross Blue Shield of Rhode Island as their primary insurance. Healthpath offers community-based, wrap-around services, care, and support to all clients enrolled in the program.

What services does Healthpath offer?

Clients who are enrolled in HealthPath will have unlimited access to a range of services including:

  • Counseling
  • Psychiatry/Medication management
  • Vocational support
  • Peer support
  • Case management
  • Care coordination
  • Nursing staff
  • Transportation to and from medical appointments, if necessary
  • Group Therapy (DBT, Life Skills, Family Support, Women’s group, Early Recovery)
  • Internet-based access to team (telemedicine)
  • Specialized care in case of an emergency after hours or on weekends and holidays

How much does HealthPath cost?

Health Path services are covered by your benefit plan and are only available to adult members of Blue Cross & Blue Shield of Rhode Island who choose to enroll in the program.

HealthPath clients are responsible for one monthly co-payment while receiving services. This copay is maxed out at $40 per month. If the client’s plan has a deductible, the monthly co-payment will apply after they have met their deductible.

What will happen at the first appointment?

The initial intake will be with a HealthPath clinician who will gather past medical, family, and psychiatric information as well as speak with the client about why they are seeking help. After the intake, clients will be set up with a team of professionals, which includes a medication prescriber, case manager, therapist, and nurse.

How long does this program last?

The HealthPath program typically lasts between 6 months to 1 year, depending on the clients individual needs.

How can I find out more information?

For more information on becoming a HealthPath member, call us at 401-415-8868.

 

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Opioid Dependence: Addiction or Chronic Pain?

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This article, written by Catherine Degood, DO, was originally posted in the Rhode Island Family Medicine Spring 2016 issue.

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As primary care physicians when we encounter a patient requesting opioids for pain we ask ourselves, is this patient really benefiting from the medication or is there a larger problem? My goal is to help providers better understand the complex biopsychosocial nature of chronic pain.

Many of us will experience some degree of chronic pain as defined as pain lasting longer than 12 weeks by the NIH. It is not entirely known how acute pain develops into a more complex chronic pain syndrome. With acute pain there is an initial pain signal- whether visceral, somatic, or neuropathic- consistent with tissue damage. The central nervous system then interprets the pain signal to elicit a protective response. With repetition the pain signal can either be increased (sensitized) or be decreased (desensitized) by the individual’s central nervous system.   The increasing or decreasing of pain signals has a both an intrinsic component (think naturally occurring endorphins) and a behavioral component which can be learned (think Lamaze/hypnobirthing).

When working with chronic pain it is important to understand the interconnection of behaviors, emotions, medications and changes in activity level that patients experience as a reaction to their pain. These factors can all contribute to the sensitizing effect on the central nervous system and therefore the worsening of pain. We call this the chronic pain cycle:

cycle

Why does an individual’s pain system become sensitized or desensitized? While there are still many unknowns there are common psychosocial factors often associated with chronic pain: personality disorders, depression, anxiety disorders, somatoform disorders, substance use disorders and a history of growing up in family with substance, physical, emotional or sexual abuse. Other contributors can be chemical (for example opioid hyperalgesia), behavioral (belief systems or expectations about managing pain and stress), physical (deconditioning) and social (loss of income and resultant financial stress) which can all play a role in developing a chronic pain syndrome.

Maladaptive and illness-focused expectations frequently seen in patients with chronic pain include

  • Believing that medication is the only thing one can do for pain
  • Not recognizing the connection between emotion and pain
  • Feeling one has no control over their pain
  • Undergoing multiple procedures and tests looking for a cause and a “cure”
  • Feeling trapped in a sick role/seeing oneself as totally disabled because of pain
  • Feeling others are responsible for one’s pain and suffering
  • Fear that any movement will worsen pain

We may promote these unhelpful expectations in our primary care offices. Many of us feel inadequately trained and lack sufficient resources to manage chronic pain patients. The medical system has moved from the collaborative multidisciplinary pain clinics of the 1980s to the primary care physician directing the pharmaceutical and procedural treatments of today. But focusing only on biomedical and pharmacological management of pain disempowers patients and frequently worsens their chronic pain. This may be why they rarely seem to get better in our offices!   In addition to medication and procedural interventions, many patients require targeted behavioral interventions and a structured physical rehabilitation plan.

At Continuum Behavioral Health the most common pain scenario we see is an individual physically dependent on opioids who is significantly deconditioned and with a strong belief that opioid medications are the only thing they can do to improve their pain. We integrate a combination of Cognitive Behavioral Therapy, buprenorphine if needed, and encourage starting a gentle exercise program to develop pain management skills. Buprenorphine is a partial agonist at the opioid receptor with a favorable safety and side effect profile to the traditional full opioid agonists. The goals of treatment are improved physical and emotional functioning, increased effective strategies for managing pain, and reduced pain intensity.

If a patient has red flags for developing a more complex chronic pain issue consider referral to a behavioral based pain program. Even for the patient that refuses a referral there are many useful books, websites, physical therapists and individual counselors that can help people develop skills to manage their pain. For patients that you do prescribe narcotics utilize a pain contract that includes, as criteria for being prescribed medication, the patient’s involvement in efforts to manage their pain.

For more information or to refer a patient to Continuum for chronic pain feel free to call (401) 294-6170.

 

 

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