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Psychology in Primary Care: An Examination                  of Best PracticesRashmita Basu, Ph.D.Karon M. Phillip, Ph.D.Al...
Background/Objective• Integrating psychology and mental health professionals  into primary care settings to improve access...
Types of Care Delivery ModelsThe three main models of interfacing psychological services  with primary care:• Referral: re...
Attendance Patterns of Initial Appointment                                              Attandance Pattern By Clinic Site ...
Sample and Data Sources• 599 Patients (age 18 or higher) with following 2  conditions:    Depression (311, 300.4, 296.2, ...
Sample Demographics Demographic Characteristics of Study Sample by Model Type(N=599)                                 Care ...
AnalysisPredict the likelihood of initial attendance pattern.Outcome variable of Interest:• Attendance status at initial a...
Regression Results    Logistic regression results with the outcome variable of    Attendance status    Variables          ...
Discussions/Conclusions• Patients provided primary care services in a clinic where  primary care and mental health provide...
10   Wednesday, May 02, 2012
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Psychology in Primary Care An Evaluation of Best Practices BASU

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Psychology in Primary Care An Evaluation of Best Practices BASU

  1. 1. Psychology in Primary Care: An Examination of Best PracticesRashmita Basu, Ph.D.Karon M. Phillip, Ph.D.Alan B. Stevens, Ph.D.1
  2. 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.2
  3. 3. Types of Care Delivery ModelsThe 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.3
  4. 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 Site4
  5. 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.5
  6. 6. Sample Demographics Demographic Characteristics of Study Sample by Model Type(N=599) Care Delivery ModelsVariables Referral Co-located Co-located & Integrated (%) (%) (%)Male 43 39 41Race/Ethnicity White 78 49 84 Black 3 7 6 Hispanic .8 4 2 Other 17 3.8 7Diagnosis Anxiety 72 67 66Age: mean (SD) 43 (16.8) 39 (16.8) 41 (15.4)6
  7. 7. AnalysisPredict 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 appointments7
  8. 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] 0.048
  9. 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.9
  10. 10. 10 Wednesday, May 02, 2012

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