According to The American Academy of Family Physicians (AAFP), “Primary care physicians [PCPs] are the primary managers of psychiatric disorders in one-third of their patients... and two-thirds of patients with depression receive treatment for their depression in the primary care setting.”1 The number of PCPs supporting patients with mental health continues to grow as there was a 7% increase in PCPs treating behavioral health concerns in 2022. A Fair Health report revealed 42% of PCPs now treat patients’ mental health conditions.2
Depression, anxiety and other mental health challenges, however, are still going untreated. 77% of U.S. counties are designated Mental Health Provider Shortage Areas and many states are feeling the effects of physician shortages.3,4
Virtual primary care can combat these shortages and effectively diagnose, treat and offer continuous mental health support for employees. Here’s how:
Diagnosis
Diagnosis of depression, anxiety and other mental health conditions is performed through detailed history taking with a patient and using the Diagnostic Statistical Manual (DSM) criteria for diagnosis.
Additionally, there is a screening questionnaire for depression called the Patient Healthcare Questionnaire (PHQ-9). It has 9 questions related to feelings, mood, thoughts and behaviors associated with depression. Patients are asked to rate how frequently these symptoms occur ranging from not at all to nearly every day over the past two weeks.
Each answer is given a score and the total score is tallied. A score of 0-4 suggests the patient may not need depression treatment. A score of 5-14 is intermediate and a clinician should use their judgment to determine if treatment is warranted. A score of greater than 14 indicates a need for treatment with medication, counseling or a combination of these treatments.
Annual wellness checkups with a virtual primary care doctor include mental health screenings, as recommended the United States Preventive Services Task Force (USPSTF). These guidelines assess depression using DSM criteria and administer the PHQ-9 questionnaire, all in a virtual setting that is convenient to the patient.
Treatment
Virtual primary care physicians can treat depression, anxiety and other mental health conditions with a variety of prescription medications that are safe and effective.
- SSRIs – Selective Serotonin Reuptake Inhibitors
Examples of these medications include fluoxetine (generic version of Prozac), sertraline (generic version of Zoloft), escitalopram (generic version of Lexapro). All these medications have been in use for a long time and cost less than $10 per month.
2. SNRIs – Serotonin and Norepinephrine Reuptake Inhibitors
Examples of these medications are venlafaxine (generic version of Effexor) and Duloxetine (generic version of Cymbalta). Similarly, these medications have been in use for a long time and cost less than $10 per month as well. There are additional classes of medications that can be used to treat depression beyond the medications mentioned above.
Counseling
Many patients benefit from counseling in addition to medication treatment for their depression, anxiety or other mental health condition. Virtual primary care and virtual mental health services can offer dual therapy which leads to better whole-person health guidance.
One of the most familiar challenges for patients today is accessing counseling services – high costs, wait times of more than 6 weeks and geographic limitations are some of the biggest barriers to care. Offering virtual care services that are carved-out and a stand-alone benefit can breakdown these barriers for employees.
Integration with Physical Health
Mental health and physical health are intricately interwoven — which is why it is so common and beneficial for primary care physicians to treat mental health conditions alongside physical conditions such as diabetes and hypertension.
For example, if a patient has depression and diabetes, it is extremely hard for that person to take care of themselves, eat right, exercise and take their diabetes medication correctly. As a result, their diabetes worsens. However, virtual primary care physicians can treat a patient’s depression and in doing so, improve the patient’s adherence to the lifestyle and medication regimen needed to control their diabetes.
Due to its convenience, virtual primary care doctors and patients can connect longer and more frequently. This allows patients to stay on top of their health concerns and stay engaged in their healthcare journey.
First Stop Health (FSH) Virtual Care Solutions
FSH Virtual Primary Care, Virtual Urgent Care (Telemedicine) and Virtual Mental Health solutions deliver patient-first care to members where and when they need it. Virtual Primary Care consists of preventive and chronic care to help coordinate and manage the many touchpoints of members’ healthcare journeys. With Virtual Urgent Care, members have access to 24/7 urgent care for episodic health concerns. Virtual Mental Health provides counseling to members, and in conjunction with Virtual Primary Care guidance and medication management, can lead to better whole-person health.
- https://www.uhhospitals.org/blog/articles/2021/03/your-primary-care-provider-can-help-treat-your-mental-health-too
- https://s3.amazonaws.com/media2.fairhealth.org/whitepaper/asset/A%20Window%20into%20Primary%20Care%20-%20A%20FAIR%20Health%20White%20Paper.pdf?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosvitals&stream=top
- https://www.merritthawkins.com/uploadedFiles/Merritt_Hawkins_Incentive_Review_2020.pdf#page=29
- https://www.ama-assn.org/practice-management/sustainability/doctor-shortages-are-here-and-they-ll-get-worse-if-we-don-t-act