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