Bridging the Chasm: The Current State of the Art

Abstract

For many multiply-disadvantaged patients, the likelihood of their adhering to a medical regimen is correlated with their experience of the caring and support coming from their healthcare providers. The best of team-based patient-centered care is required to develop a successful interaction pattern in the care of these patients. A robust approach combines what is known about caring for these patients in multiple literatures, joining the care management and team approach of the “complex” patient literature with the respect and cultural competence of the low-income patient literature and the support and refusal to be directive and re-traumatizing of the trauma-informed care (TIC) literature. The delivery of integrated primary care, including behavioral health clinicians and care enhancers, is particularly crucial in the success of patient-centered care for these patients. In addition, using skills learned from primary care behavioral health practice can help promote a culture in the team that generates the new mental models of care and the corresponding routines of practice needed for developing true partnership with these challenging patients. Two successful programs are presented. Finally, a brief discussion of what is still missing sets the stage for the next section of the book.