Documentations of Advanced Heath Care Directives Where Are They TAI_SEALE
Psychology in Primary Care An Evaluation of Best Practices BASU
1. Psychology in Primary Care: An Examination
of Best Practices
Rashmita Basu, Ph.D.
Karon M. Phillip, Ph.D.
Alan B. Stevens, Ph.D.
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2. 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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3. 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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4. Attendance Patterns of Initial Appointment
Attandance Pattern By Clinic Site
100%
90% 23
Attandance Pattern
35 38
80%
70%
60%
50%
40% 77 Unattended
65 62
30% Attended
20%
10%
0%
Co-located&Integrated Referral Co-located
Clinic Site
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5. 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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6. Sample Demographics
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)
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7. 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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8. 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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9. 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.
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