Meeting Patients With Schizophrenia 'Where They Are'

(Part 1 of 3)

In Part 1 of this video, Meagan Thistle, associate digital editor, Psych Congress Network interviews Amber Hoberg, NP, Centric Physicians Group, San Antonio, Texas, on-site at Psych Congress​​​​​​, to discuss meeting her patients with schizophrenia where they are to provide treatment, therapy, and medication. Hoberg classifies this as a different type of telepsychiatry, in which she is able to connect with her patients in their own environment to provide the best level of care she can.

In Part 2 and Part 3, Hobert will discuss medication adherence, family involvement, and crisis response planning.

Read the transcript:

Meagan Thistle:  Welcome. We're sitting at Psych Congress with Amber Hoberg. Amber, if you'd like to introduce yourself.

Amber Hoberg:  Hi, my name is Amber Hoberg. I'm a psychiatric nurse practitioner here in the San Antonio, Texas area. I primarily work with chronically mentally-ill patients, as well as with group-home patients in the telepsych and inpatient setting.

Meagan:  We know that a lot of patients with schizophrenia might have trouble coming to visit on-site, might not be able to get to the office for various reasons. How do we meet them where they are? How can clinicians meet these patients where they are?

Amber:  That's a great question because it's exactly what I do in my practice every day. Through telepsychiatry, I can be everywhere, which is nice. I see patients in many different areas, and we send out case managers to visit with these patients, and they meet the patient where they are.

It could be under a bridge if they're a homeless patient, or if they're living at the Salvation Army or one of those places where they can stay for a period of time, we meet them there. We meet them at food pantries, or sometimes, they'll get in the caseworker's car, and we see patients there.

We would meet them where they are. We bring them into the appointments. We talk to them about how their treatment is going, and then we provide the care to them. Some of these patients, they don't have places to house their medications. Giving them 30 days of their medications can be very dangerous for the patient.

One is they quit taking it, or it gets stolen, or something happens. We also provide that ability for us to manage patients' medications on a weekly basis. I make the changes in their medications. We have a nurse at the practice that puts together their medications in little pill containers, and then we take it to the patients.

Then, the caseworker's follow-up with those patients multiple times a week. One, to make sure they're taking their medicines. Two, to make sure that it's working for them, they're not having any side effects. We work together as a team approach to wrap our arms around these patients and take care of them.

Meagan:  You mentioned following up. How do you go ahead and follow up with those patients if they might not be at a home address? How do we find them?

Amber:  Again, that's why the case managers go out and see them frequently, because one, we try to figure out if they're still living at the same shelter.

Have they moved shelters? These patients have our case managers' numbers so they can call them at any point in time if there's issues or problems or if they're changing locations so that we can try to maintain that consistency to improve that adherence for our patients.

There's occasional patients that might fall through the cracks where we don't know where they go or something happens, and then we have to try to go find them, but that's very few and far in between with the practice that we have. My patients follow-up pretty consistently.

I work with my patients to make sure...I don't like to dictate to my patients what they take. I'm like, "OK, let's talk about what's working, what's not working. You quit taking this medication. Why? Why did you quit taking it? Is there a side effect reason? Is there something you don't like about it?"

Then, try to work with the patient on something they will take or will be consistent with, because if you partner with your patients and work together with them, you're more successful in, one, them taking their medications into having those consistent follow-ups. Patients want to be seen when they're heard.