The TEAMcare nurse has weekly supervision meetings with a team consisting of a psychiatrist and primary care physician (PCP) to review new cases and patient progress. Caseload supervision by specialists helps provide decision support to the PCPs when patients experience treatment resistance or side-effects to medications. In addition, it is useful for nurses to meet with a psychologist on the project once a month intially to review difficult patient encounters in order to enhance motivational interviewing, problem-solving and behavioral activation skills. The nurse, psychiatrist and primary care supervisors review patient adherence to medication and lifestyle recommendations, progress on PHQ-9, blood glucose, blood pressure and low-density lipid targets in weekly supervision meetings. When the psychiatrist and primary care supervisor recommended medication changes, the nurse discusses or e-mails these recommendations to the PCP, who orders changes on all medications. It is essential for caseload supervision to have a registry that allows tracking of dates of appointments, initial and subsequent PHQ-9, LDL, SBP and HbA1c levels and medication dosages.
The supervision team and nurse care manager access the resources in the next column to monitor each patient's condition and care.