psychology in primary care an evaluation of best practices basu
DESCRIPTION
Mental HealthTRANSCRIPT
Psychology in Primary Care: An Examination of Best Practices
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Rashmita Basu, Ph.D.Karon M. Phillip, Ph.D.Alan B. Stevens, Ph.D.
Background/Objective
• Integrating psychology and mental health professionals into primary care settings to improve access to mental health services (Blount, 2003; McDaniel&Hepworth, 2002).
Objective:
The overall purpose of this project was to compare appointment attendance patterns of
psychology/mental health services at selected Family Medicine clinics within Scott & White Healthcare to
explore the impact of care delivery and patient characteristics.
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Types of Care Delivery Models
The three main models of interfacing psychological services with primary care:
• Referral: referring a patient to a psychologist/mental health professional located in a facility outside of the primary care physician’s (PCP) office;
• Co-located: referring a patient to a co-located psychologist/mental health professional that does not interact with PCP;
• Co-located& Integrated: PCP and the psychologist/mental health professional discuss the patient’s health.
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Attendance Patterns of Initial Appointment
Co-located&Integrated
Referral Co-located0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
7765 62
2335 38
Attandance Pattern By Clinic Site
UnattendedAttended
Clinic Site
Att
anda
nce
Patt
ern
Sample and Data Sources
• 599 Patients (age 18 or higher) with following 2 conditions: Depression (311, 300.4, 296.2, 296.3); and Anxiety disorder (308.3, 300.00)
• Study time: January 2004 to June 2010.• EMR, which included clinician dictated notes.
Excluded: Patients with dementia, delirium, severe psychotic symptoms or any other severe conditions.
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Sample Demographics
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Demographic Characteristics of Study Sample by Model Type (N=599)
Care Delivery Models
Variables Referral Co-located Co-located & Integrated
(%) (%) (%)
Male 43 39 41
Race/Ethnicity
White 78 49 84
Black 3 7 6
Hispanic .8 4 2
Other 17 3.8 7
Diagnosis
Anxiety 72 67 66
Age: mean (SD) 43 (16.8) 39 (16.8) 41 (15.4)
Analysis
Predict the likelihood of initial attendance pattern.
Outcome variable of Interest: • Attendance status at initial appointment with psychologists
(binary variable).
List of Independent covariates:• clinic site dummy variable;• age, gender, race, ethnicity, • time between referral and scheduled appointments
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Regression Results
Logistic regression results with the outcome variable of Attendance status
Variables OR [95% CI] p-value
Age 1.02 [1.006, 1.03] <0.001
Male 1.14 [0.77, 1.68] 0.51
White 1.32 [0.77, 2.28] 0.96
Black 0.72 [0.30, 1.73] 0.52
Hispanic 0.39 [0.11, 1.36] 0.14
Integrated Care 1.79 [1.12, 2.84] 0.01
Co-located 1.07 [0.55, 1.17] 0.83
Referral time 0.98 [0.96, 0.99] 0.04
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Discussions/Conclusions
• Patients provided primary care services in a clinic where primary care and mental health providers interact (integrated and co-located model) were more responsive to mental health referrals
• Being older is positively associated with the likelihood of appointment status, while longer referral time decreases the odds of attending the first appointment.
• Limitations include the availability of a single co-located and integrated Family Medicine clinic
• Further analyses are needed to explore long term health care utilization patterns associated with these three models.
Thursday, April 13, 202310