A Novel Approach for Patients with Risky Drinking or Tobacco Smoking and Comorbid Cardiovascular Concerns: Applying Interdisciplinary Conjoint Appointments in an Integrated Primary Care Setting.

Abstract

Complex concerns, such as tobacco use and risky drinking in patients with cardiovascular disease (CVD) who report not being ready to change, may require multi-dimensional approaches to intervention. In this Notes from the Field, an interdisciplinary, integrated conjoint appointment is described wherein primary care providers (PCPs) and behavioral health providers (BHPs) meet together briefly with the patient, bringing varying expertise in an effort to increase readiness to change and cessation of problem behaviors such as smoking. First, the protocol for this appointment, which is part of an intervention, which will be referred to as CARE-PACT (CardiovAscular Risk Education in Patient-Aligned Care Teams), will be described, including the evidence-informed components and choices made to increase feasibility and implementation of conjoint appointments across primary care clinics. Next, using an illustrative case example, the authors describe the flow, content, and logistics of CARE-PACT conjoint appointments, and the follow-up after the conjoint portion. CARE-PACT was examined as part of a small research pilot, and feasibility data, acceptability, satisfaction, and perception of usefulness was collected. Ten patient participants responded favorably to CARE-PACT, rating helpfulness and satisfaction a 4.1-4.7 on a 5-pt scale (5 signifying best). With the exception of some technological issues, qualitative data revealed patients found conjoint appointments were informative, patient-centered, and a good way to introduce a BHP. Altogether, this work supports the use of brief, interprofessional conjoint appointments in primary care in order to improve care processes for patients who have complex needs and who may need more than standard primary care interventions.