 |
 |
|
|
Technology to the Rescue:
Real-Time Information Helps Physicians Make the Mind/Body Connection
|
Physicians are becoming increasingly aware of the interrelationship between mind and body in caring for their patients. They are recognizing the importance of identifying psychological factors that may affect a patient’s response to treatment. Early detection of such issues can help ensure effective treatment planning, improve the productivity of the physician’s practice, and save long-term costs.
However, medical caregivers often face the question of how to integrate behavioral assessments efficiently and effectively into their practices. Many paper-and-pencil assessments are time-consuming for patients to complete, require hard-to-find physician and staff time and, because most assessments cannot be immediately scored, they do not provide the most up-to-date information on the patient.
Real-time administration for leading assessments
In response to these concerns, Pearson Assessments is working with Patient Tools, Inc. to make several of our well-respected, medically oriented psychological assessments available for administration on a hand-held, portable survey unit. Leveraging the latest technology, this screening approach offers medical practitioners onsite, real-time access to critical information about their patients’ psychological issues.
Here’s how the system works: The hand-held electronic survey units come with our screening assessments pre-loaded. The method requires minimal staff training and administrative time. Patients complete the assessment at the time of their visit on a large, easy-to-read display; on-screen instructions guide them step-by-step through the process. Then, with the use of a small docking station connected to the user’s PC, the data is downloaded from the survey unit and can be integrated through the Internet into the practitioner’s secure remote database housed on Patient Tools servers. Patient Tools maintains computer security across the Internet (using 128-bit encryption, locked-down servers, and digital certificates) that meets the current data security requirements for HIPAA compliance.
Within seconds, a complete report including graphs, mean scores, percentages, interpretive statements, and other features is printed. Thus, the physician receives up-to-the-minute information that pinpoints potential behavioral health issues—information that can be used immediately to initiate valuable discussion with the patient. In addition, the caregiver is able to track outcomes easily over time by running trended reports automatically.
BBHI™ 2 assessment now available on portable survey unit
 The BBHI™ 2 (Brief Battery for Health Improvement 2) instrument, a brief screener designed with physicians in mind that is appropriate for use with rehabilitation and chronic pain patients, is now available with hand-held survey unit administration.
Denver Pain Management, a leader in the treatment and relief of patients with chronic spinal pain, uses hand-held survey units to administer the BBHI 2 test to clinic patients as well as to individuals participating in clinical trials. The clinic reports that both patients and staff have appreciated the benefits of this easy-to-use system. In particular, they note that this method usually takes less of the patient’s time than a paper-and-pencil format and does not require staff time to enter the patient’s responses for scoring.1
Expanding on the solution
In addition to the BBHI 2 instrument, Pearson Assessments currently offers hand-held survey unit administration for another brief, medically oriented psychological assessment, the BSI® 18 (Brief Symptom Inventory 18) test. This well-respected screener is well-suited for evaluating general medical and oncology patients. In the near future, we also will offer hand-held survey unit administration for the P-3® (Pain Patient Profile) assessment, which helps screen for factors most frequently associated with chronic pain.
If you have questions, contact Kelly Robbins at (888) 627-7271.
1See “Denver Pain Management Forges New Frontier in Treatment of Chronic Spinal Pain,” Bridging the Gap, Fall 2002.
|
The MBMD™ Test in Practice:
The MBMD Assessment: A Tool for Chronic Medical Populations
|
Since the MBMD (Millon™ Behavioral Medicine Diagnostic) test was introduced in Fall, 2000, we have illustrated its application in various chronic medical populations. Recent issues of Bridging the Gap presented the test’s efficacy in pre-surgical psychological evaluations of candidates for organ transplant, implantable pain management devices, and bariatric surgery.
The following article revisits the research underlying the test’s development, specifically as it relates to patients diagnosed with HIV/AIDS or diabetes mellitus, and summarizes the test’s value for patients with chronic medical conditions requiring major lifestyle changes.
Overview
The MBMD test was developed for clinicians who work with physically ill and behavioral healthcare patients. The test was designed to help the practitioner in the psychological understanding of these patients and to facilitate the formulation of treatment and management plans.
With 165 true/false questions, the test takes approximately 20–25 minutes to complete and is valid for patients aged 18–85 years. The test is a psychosocial assessment that provides information about psychiatric status, coping styles, stress moderators, treatment prognostics, and negative health habits.
Efficient, Effective, and Insightful
Physicians, nurses, health psychologists, and other healthcare providers may save time and increase clinical effectiveness when they use the patient information gathered from the MBMD test to help them:
- identify patients with significant psychiatric problems and consider specific suggested interventions
- identify patients who may not comply with medication regimens so more explicit information can be communicated to those patients
- identify the personal and external assets that a patient can call upon during recovery to facilitate adjustment to physical limitations or lifestyle changes
- structure post-treatment plans and self-care responsibilities in the context of the patient’s social network
Research suggests that information the MBMD test provides on a patient’s coping style and attitudes toward health can be useful in predicting:
- initial psychological reactions to news of a life-threatening medical diagnosis
- ability to make lifestyle changes required by certain diseases
- likelihood of keeping appointments and responses to rehabilitation efforts
Appropriate for Use with a Variety of Patients
Validity research using the MBMD was conducted with patients diagnosed with HIV, cancer, diabetes mellitus, or heart disease. Conclusions drawn from research can also be applied to patients with other chronic diseases who must strictly comply with medical directives.
For example, among HIV patients, elevated scores on the Cognitive Dysfunction and Emotional Lability scales were associated with a greater percentage of missed medications and with an increased perception that the medications would cause toxic side effects.
Among diabetes patients, higher HbAc1 (glycosylated hemoglobin) levels were associated with higher scores on the Cognitive Dysfunction, Interventional Fragility, and Medication Abuse scales, suggesting the MBMD test may be useful for identifying patients who need to develop skills to better manage their glucose levels.
Many patients diagnosed with a chronic illness may experience social isolation or depression or have a difficult time accepting the realities of their illness and the subsequent medication regimens and required lifestyle changes. MBMD test results can help healthcare providers understand which patients are likely to have more difficulty accepting their situation and adjusting, which patients lack coping skills and support, as well as which patients will need additional education or are likely to require additional support from medical staff.
Healthcare providers can use this information to create treatment and management plans individualized to the needs of each patient.
Material for this article was taken from the MBMD Manual (NCS Pearson, Inc., 2001), authored by Theodore Millon, PhD, DSc; Michael Antoni, PhD; Carrie Millon, PhD; Sarah Meagher, PhD; and Seth Grossman, PsyD, and a presentation given by Michael Antoni at the 2002 Millon Conference on Personality and Psychopathology, held October 18, 2002 in Minneapolis, Minnesota, entitled “MBMD Theory, Research and Clinical Utility.”
Call Pearson Assessments at (888) 627-7271 for more information about the MBMD test or to place an order.
|
| MBMD™ Test Receives Favorable Reviews
|
The MBMD test received favorable reviews in the upcoming Fifteenth Mental Measurements Yearbook soon to be published by the Buros Institute of Mental Measurements (in press).
The two reviews comment positively on the broad scope of the instrument, its psychometric characteristics and its role in helping healthcare providers in their efforts to understand and treat the “whole patient.”
The reviews are currently available online at www.unl.edu/buros.
|
Research Demonstrates P-3® Test's
Utility to Pain Physicians
|
The P-3 (Pain Patient Profile) test “comes close to meeting all the requirements” of a pain physician for the psychological evaluation of patients, according to Laxmaiah Manchikanti, MD, et al., in an April, 2002 article in Pain Physician, the journal of the American Society of Interventional Pain Physicians.
Authors Manchikanti, Pampati, Beyer, Damron, and Barnhill from Pain Management Center of Paducah, Paducah, KY, conducted research to evaluate the psychological status of chronic low back pain patients in an interventional pain management setting in comparison to individuals without a history of pain or psychopathology. The researchers used the P-3 assessment to gather empirical data. In the article, the authors review research results and address the utility of the P-3 assessment for pain physicians.
Manchikanti selected the P-3 assessment after careful consideration of a pain physician’s needs for performing patient psychological evaluations. Referring to the considerable research literature, Manchikanti writes, “patient evaluation of psychological profile should be useful for classifying individual patients, determining treatment strategies, and predicting treatment response, apart from developing a better understanding of the psychological mechanisms mediating the [patient’s] pain experience.”
According to Manchikanti, a pain physician needs an objective psychological test that:
- can be easily administered by a nurse
- is short and can be completed within 15 minutes
- can be scored, interpreted, and available to the physician within minutes after test completion
- is normed on national samples of both patients in pain and community subjects
- provides high statistical reliability and validity
- is inexpensive (this is important because of the uncertainty of insurance reimbursement)
While acknowledging that services of a psychologist or psychiatrist should be used to perform a comprehensive psychological evaluation, Manchikanti found that as a brief screener, the P-3 assessment nearly meets all the requirements of a pain physician. The P-3 test, developed in 1993 by C.D. Tollison, PhD, and J.C. Langley, DC, consists of 44 items that collectively help the physician to assess the pain patient’s somatization, generalized anxiety disorder, and depression. According to Manchikanti, these are the three psychological factors most common in patients suffering chronic low back pain. A validity scale is also provided.
Referring to previous research results, Manchikanti explains that personality factors offer little clinical relevance for physicians working with patients with chronic pain. In contrast, the results of this study support previous research results that clearly indicate that anxiety, depression, and somatization often influence and are associated with chronic low back pain.
Results of Manchikanti et al.’s research as reported in the Pain Physician article indicate that: 30% of chronic low back pain patients reported depression versus 5% of the control group; 20% of the pain group reported generalized anxiety disorder versus 0% of the control group; and 20% of the pain group reported somatization versus 0% of the control group.
In the article, Manchikanti reviews the advantages the P-3 assessment offers to pain physicians.
- With its simple format and content and 10- to 15-minute administration time, physicians or nurses can easily administer it.
- It can be utilized within an initial evaluation and re-administered to measure clinical progress or as a pre- and post-treatment objective measure of clinical effectiveness.
- The three clinical scales help measure depression, anxiety, and somatization.
- The validity scale helps assess the probability of random responding, inadequate reading comprehension, and symptom magnification.
- The P-3 test compares the patient’s levels of depression, anxiety, and somatization to those of the average pain patient and to a community sample. This comparison is important for the evaluator to understand. A patient may appear “average” compared to other pain patients on a clinical scale, but significantly “above average” compared to the community subject pool.
- The test has high test-retest reliability.
- Its scales carry a high correlation with corresponding MMPI-2™ scales.
Joseph F. Jasper, MD, from Advanced Pain Medicine Physicians, Tacoma, WA, reacted to the Manchikanti et al. article in a letter to the editor published in the July, 2002, issue of Pain Physician. Jasper writes,
“What is most important is the apparent utility of the P-3 test as a tool for rapidly and affordably assessing the chronic pain patient, and perhaps the acute/subacute pain patient….
“For those practices that routinely do not include psychological co-treatment, the test may help to early on identify individuals who would be better treated by or along with the psychologist.
”It promotes a less cumbersome way to assess the psychological status of patients,” Jasper continues. “I fore see this could be an important tool for interventional pain practices. Many pain clinics have found the psychology costs outweigh revenue. The P-3 may help preserve and promote psychological assessment of chronic pain patients.”
Manchikanti’s data supports his statement that “in a significant number of patients, there is a physical problem associated with emotional issues.” He suggests most, if not all, patients with chronic low back pain presenting to interventional pain management clinicians should be evaluated for psychopathology.
Call Pearson Assessments at (888) 627-7271 for a reprint of the full Manchikanti et al. research article.
|
| Denials Reversed: New CPT Health and Behavior Codes Gain Acceptance
|
Since six new CPT health and behavior codes (96150–96155) became effective in January, 2002, the American Psychological Association (APA) Practice Directorate has worked with the Centers for Medicare and Medicaid Services (CMS) and its local carriers to correct inappropriate denials of claims using the new codes.
While efforts initially focused on Medicare claims, the Practice Directorate has also helped to obtain reimbursement through private insurance under the Federal Employee Health Benefit Plan (FEHBP).
The following summarizes communications from the APA Practice Directorate, describing recent results the Practice Directorate has met in its effort to correct inappropriate denials. More details about the codes and reimbursement policies can be found in the Practice Directorate’s web pages at www.apa.org/practice/cpt_faq.html.
New York: The medical director of Empire Medical Services, the carrier for lower New York State, has confirmed that the carrier will reimburse under the code. The Practice Directorate continues to address problems with the Medicare carrier for upstate New York.
California: The medical director of the Northern California carrier confirmed that denials solely on the basis that the provider is a psychologist are inappropriate, that he would advise his staff, and that the practice should stop. The carrier for Southern California will accept the claims as long as the codes include the appropriate modifier (AH).
Texas, Maryland, Delaware, Virginia: Trailblazer, the Medicare carrier in Texas, as well as Maryland, Delaware, and Virginia, corrected its November 2001 notice, which said that the new codes would not be covered, and is now paying for services under the codes.
Georgia, Minnesota, Mississippi, Ohio: The carriers claimed computer problems caused initial denials and that the problems have now been corrected.
Maryland: Carefirst Blue Cross Blue Shield, private insurance through FEHBP, reversed a previous denial and reimbursed for behavioral intervention services following involvement by the Practice Directorate.
Florida: The Practice Directorate is continuing discussions with CMS and the local Medicare carrier to resolve reimbursement issues.
Pennsylvania, Washington State: The Practice Directorate is working with the local Medicare carriers to resolve previously denied claims.
The APA Practice Directorate encourages psychologists experiencing difficulties in receiving reimbursement for services billed under the new health and behavioral codes to request assistance by calling the Practice Directorate’s Government Relations Office at (202) 336-5889.
|
National Pain Foundation Spotlights
Test Author
|
The National Pain Foundation (NPF) recently spotlighted J. Mark Disorbio, EdD, on its public educational website, www.painconnection.org. The NPF website is “an online education and support community for persons in pain, their families and physicians; a source for treatment options and pain information that is peer reviewed by leading pain specialists.” The site offers forums and helps patients under stand that they are not alone in their pain and that help is available. Physicians are invited to encourage their patients to explore the website. It can help patients prepare for their doctor visits.
Disorbio, together with co-author Daniel Bruns, PsyD, developed assessment tools to help evaluate psychological factors that can impede treatment for chronic pain. “Pain medicine starts with assessment,” Disorbio is quoted on the NPF website. “Assessment helps determine what treatments will be the most effective, whether an individual is responding normally to pain, and helps clinicians get a better idea about an individual’s risk for depression, anxiety, and family problems.”
Disorbio also authored an article in the My Education section of the NPF website entitled “Psychological Factors Related to Pain,” which can be found at www.painconnection.org/cm/CMDisplayArticle.asp?ArticleId=149. The article explores the links between pain and psychological factors. Disorbio outlines the ways various psychological factors such as depression, anxiety, job dissatisfaction, doctor dissatisfaction, family dysfunction, or anger relate to pain. He notes that pain erodes one’s psycho logical defenses as well as one’s level of energy. He explains that these psychological fac tors increase arousal and response to pain and impede treatment.
In his article, Disorbio also discusses the range of treatments for pain management that are psychological in nature. For example, biofeedback training and hypnosis are often used to reduce pain. “Thought Stopping” is a technique that helps reduce fearful thoughts, which create physical tightening of the muscles, which in turn increases pain.
According to Disorbio, by learning to control their reactions to anxiety, tension, and depression, patients can better manage their pain, increase their functioning, and become directly involved to help with the healing process. These techniques help chronic pain patients regain some control over their lives by becoming active participants in the treatment and solution to their pain condition.
Disorbio is a nationally recognized expert in understanding the psychological factors related to chronic pain conditions and co-author of the BHI™ (Battery for Health Improvement), BBHI™ 2 (Brief Battery for Health Improvement 2) and BHI™ 2 (Battery for Health Improvement 2) tests. Disorbio is a licensed clinical psychologist and president of Integrated Therapies in Lakewood, CO, a multidisciplinary treatment facility for chronic pain patients.
Visit the National Pain Foundation’s website to read the spotlight article about Disorbio at www.painconnection.org/MyEducation/Spotlight_Disorbio.asp and the article written by Disorbio.
Contact Pearson Assessments at (888) 627-7271 to discuss how psychological assessments can help you in your practice.
|
Visit Our Website!
http://www.pearsonassessments.com/medical/index.htm
| Tradeshows
Visit with us at these upcoming tradeshows! Speakers of interest have been highlighted!
American Academy of Pain Medicine (AAPM)
February 18–23, 2003
New Orleans, LA
www.painmed.org
American Society of Pain Management Nurses (ASPMN)
February 20–23, 2003
Kansas City, MO
www.aspmn.org
Society for Pain Practice Management (SPPM)
March 1–7, 2003 Phoenix, AZ
www.sppm.org
Speaker: Donald W. Hinnant, PhD
Wednesday, March 5, 7:00 a.m.
“Psychosocial Screening, Red Flags and Mental Disorders in Pain Patients”
Speaker: Donald W. Hinnant, PhD
Wednesday, March 5, 10:15 a.m.
“Developing Cognitive Behavioral Treatment Approaches for Pain Patients”
American Pain Society (APS)
March 20–23, 2003
Chicago, IL
www.ampainsoc.org
American Society of Interventional Pain Physicians (ASIPP)
Third Semi-Annual Spring Meeting
March 21–23, 2003
San Diego, CA
www.asipp.org
Speaker: Donald W. Hinnant, PhD
Friday, March 21, 10:30 a.m–noon
“Evaluation of Psychological Aspects of Chronic Pain—
What an Interventionalist Needs to Consider”
Society of Behavioral Medicine (SBM)
March 19–22, 2003
Salt Lake City, UT
www.sbm.org
Speaker: Michael H. Antoni, PhD
Friday, March 21, 9:00–10:30 a.m.
“Toward a Better Understanding of Meaning and Benefit Finding
Following a Cancer Diagnosis”
|
Receive Our New 2003 Medical Catalog Electronically
Email your request to medical@pearson.com
Receive Bridging the Gap Electronically
We can send you this newsletter via email. Subscribe online or email your request to medical@pearson.com
Request a Print Version of Bridging the Gap
To request a print copy of this newsletter, please call 1-888-627-7271 and reference F12W03.
Back to top
|
|
To Reach a Customer Service Representative
|
Call 1-800-627-7271, ext. 3225 or
952-681-3225, 8 AM–6 PM CST |
Fax: 1-800-632-9011
or 952-681-3299 |
E-Mail: pearsonassessments
@pearson.com |
|
Winter 2003
