Challenges to Effective Primary Care-Specialty Communication and Coordination in the Mental Health Referral and Care Process for Publicly Insured Children

OBJECTIVE: To investigate mental health dropout rates in secondary care and to identify possible associations between this variable and social, demographic, psychopathologic, and health care process-related variables. METHOD: This prospective, observational study included 994 patients referred to a secondary service by four primary care units and evaluated by a specialist mental health team between 2004 and 2008. The dependent variable was treatment dropout. Bivariate analyses investigated possible associations between treatment dropout and 57 independent variables. RESULTS: The overall dropout rate from specialist mental health treatment was relatively low (mean = 25.6%). Only four independent variables were associated with dropout: one socioeconomic, two psychopathological, and one health care process variable. All associations were marginally significant (p < 0.1). CONCLUSION: Our findings suggest that family members, patients, and health care professionals are well engaged in this mental health care system based on a model of primary care. The use of this mental health model of care should be extended to other regions of our country.

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When Help Becomes a Hindrance: Mental Health Referral Systems as Barriers to Care for Primary Care Physicians Treating Patients With Alzheimer's Disease

American Journal of Geriatric Psychiatry ◽

10.1097/jgp.0b013e3181a76df7 ◽

2010 ◽

Vol 18 (7) ◽

pp. 576-585 ◽

Cited By ~ 13

Author(s):

Carol E. Franz ◽

Judith C. Barker ◽

Kathleen Kim ◽

Yvette Flores ◽

Cecily Jenkins ◽

...

Keyword(s):

Mental Health ◽

Alzheimer’S Disease ◽

Primary Care ◽

Alzheimer's Disease ◽

Primary Care Physicians ◽

Barriers To Care ◽

Mental Health Referral ◽

Referral Systems

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Development of a Telehealth-Coordinated Intervention to Improve Access to Community-Based Mental Health

Ethnicity & Disease ◽

10.18865/ed.28.s2.457 ◽

2018 ◽

Vol 28 (Supp) ◽

pp. 457-466 ◽

Cited By ~ 1

Author(s):

Sandra Contreras ◽

Lorena Porras-Javier ◽

Bonnie T. Zima ◽

Neelkamal Soares ◽

Christine Park ◽

...

Keyword(s):

Mental Health ◽

Primary Care ◽

Los Angeles ◽

Qualitative Interviews ◽

Medication Management ◽

Primary Care Providers ◽

Care Process ◽

Care Providers ◽

Community Mental Health Clinics ◽

Transition Points

Objective: To develop an intervention to improve the mental health referral and care process for children referred by primary care providers (PCPs) to community mental health clinics (MHCs) using a community partnered approach.Design: A Project Working Group (PWG) with representatives from each partner organization met monthly for 6 months.Setting: Multi-site federally qualified health center (FQHC) and two community MHCs in Los Angeles county.Participants: 26 stakeholders (14 FQHC clinic providers/staff, 8 MHC providers/staff, 4 parents) comprised the PWG.Data Sources: Qualitative interviews, PWG meeting notes, intervention processes and workflow reports.Intervention: The PWG reviewed qualitative data from stakeholders (interviews of 7 parents and 13 providers/staff). The PWG met monthly to identify key transition points where access to and coordination of care were likely compromised and to develop solutions.Results: Three critical transition points and system solutions were identified: 1) Parents refuse initial referral to the MHC due to stigma regarding mental health services. Solution: During initial referral, parents watch a video introducing them to the MHC. 2) Parents don’t complete the MHC’s screening after referral. Solution: A live videoconference session connecting parents at the FQHC with MHC staff ensures completion of the screening and eligibility process. 3) PCPs reject transfer of patients back to primary care for ongoing psychotropic medication management. Solution: Regularly scheduled live videoconferences connect PCPs and MHC providers.Conclusions: A community partnered approach to care design utilizing telehealth for care coordination between clinics can potentially be used to address key challenges in MHC access for children.Ethn Dis. 2018;28(Suppl 2):457-466; doi:10.18865/ed.28.S2.457.

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Primary Care Physician Responses to a Panic Disorder Vignette: Diagnostic Suspicion and Clinical Management

The International Journal of Psychiatry in Medicine ◽

10.2190/3ath-c9f4-2rta-pxha ◽

1998 ◽

Vol 28 (2) ◽

pp. 179-188 ◽

Cited By ~ 4

Author(s):

James E. Aikens ◽

Lynne I. Wagner ◽

Alex J. Lickerman ◽

Marshall H. Chin ◽

Amber Smith

Keyword(s):

Mental Health ◽

Primary Care ◽

Panic Disorder ◽

Primary Care Physicians ◽

Cardiovascular Disorder ◽

Care Physician ◽

Medical Testing ◽

Likelihood Rating ◽

Mental Health Referral ◽

Cardiac Disorders

Objective: To study current patterns of panic disorder (PD) recognition and management by primary care physicians (PCPs). Method: We administered a vignette describing a female PD patient to 189 PCPs. Results: Three-quarters of respondents believed that PD was at least 50 percent probable, and the mean PD likelihood rating was 63 percent. Diagnostic suspicion was significantly higher for PD than for other anxiety disorders, major depressive disorder, and cardiac disorders. Medication was rated as significantly more necessary than medical testing and mental health referral. A benzodiazepine was suggested by 78 percent of respondents, while 35 percent suggested a serotonin reuptake inhibitor (SRI). Under half rated the patient as requiring medical testing, mostly for hyperthyroidism (70%) and/or cardiovascular disorder (62%), and half felt that the patient required mental health referral. Conclusions: The data suggest that most PCPs are able to recognize PD. However, they may be excessively inclined to prescribe benzodiazepines rather than more appropriate medications.

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