Abstract
Background/Aims Integrating psychology and mental health professionals into primary care settings has emerged as a means to improve the access to and utilization of mental health services. Three models linking psychology to primary care are:
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referring a patient to a psychologist located in a facility outside of the primary care physician’s (PCP) office;
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referring a patient to a co-located psychologist who is not integrated into the PCP;
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integrated model where the PCP and the psychologist are co-located and communicate regarding the patient’s health.
The overall purpose of this project was to investigate predictors of patients’ initial response patterns to their primary care physicians’ referrals to psychologists across the Scott & White Healthcare system in the context of the models delineated.
Methods Using clinician notes and claims data housed within the S&W electronic medical records (EMR), we identified patients with ICD-9 codes for depression (311, 300.4, 296.2, 296.3,) and anxiety disorder (308.3, 300.00) referred to mental health clinics those satisfy one of the three main psychology models mentioned above. Our main outcome variable of interest was patients’ attendance at their initial appointment with psychologists (binary outcome variable yes/no). Patients’ demographics (age, gender, race, ethnicity), clinics from which patients were referred, and the number of days between referral and scheduled appointment were included in the logistic regression model.
Results Our preliminary results indicated that older patients were likely to attend initial appointments after being refereed by their PCP (odds ratio estimate=1.01, 95% CI: 1.006, 1.032). Patients that were seen by psychologist or mental health professional in a facility was integrated into the PCP practice were more likely (odds ratio estimate= 1.79, 95% CI: 1.12, 2.84) to attend their initial appointments compared to the other two models of care. Finally, patients with the greatest time between referral and time of scheduled appointments were less likely to attend their initial appointments.
Discussion Results of this study provide useful information about how patients can receive effective mental healthcare services when the primary care physicians and psychologists work within an integrated co-located environment and communicate about the patient’s health.
