Cardiac Behavioral Medicine Following Heart Transplant: A Novel Integrated Care Clinic Model

摘要

Objective: Life after transplant is often accompanied by a myriad of psychosocial and behavioral factors, such as medication adherence and depression, that impact quality of life and outcomes, including mortality. The current project sought to expand the breadth of psychosocial and behavioral care provided to heart transplant recipients during routine follow-up care within a heart transplant clinic housed within an urban academic medical center. Method: A weekly half-day model of Cardiac Behavioral Medicine clinic integration (CBM-CI) was developed and implemented within an ongoing heart transplant clinic based off the primary care behavioral health (PCBH) model. After meetings with key leadership, the model was developed during a 3-week pilot, after which, clinic providers' expectations for integration were assessed. After the development phase, the CBM-CI was implemented into the weekly heart transplant clinic and a quality improvement (QI) process was engaged for the first 6 weeks. Results: Across 6 weeks of clinic implementation, 19 patients engaged with a behavioral medicine provider during routine transplant follow-up, with a wide range of psychosocial/behavioral issues. Overall, the CBM-CI was well-received, the integration was in many ways feasible, and the QI process allowed for iterative improvement that addressed issues related to space, scheduling, selection of patient served, and communication. Conclusions: The CBM-CI for heart transplant enhances opportunity to address psychosocial and behavioral factors that negatively impact outcomes in all stages after heart transplant and highlights the unique role and contributions of clinical health psychologists in cardiology.