Delivering mental health services within primary care: Best practices

http://www.ncbi.nlm.nih.gov/pubmed/22090609

Clin Med Res. 2011 Nov;9(3-4):171.
PS1-32: Psychology in Primary Care: An Evaluation of Best Practices.
Phillips K, Smith E, Stevens A.

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 main delivery models of psychology in primary care settings have emerged: referring a patient to a psychologist/mental health professional located in a facility outside of the primary care physician's (PCP) office; referring a patient to a co-located psychologist/mental health professional who does not directly interface with PCP; integrated and co-located model where the PCP and the psychologist/ mental health professional discuss the patient's health. The overall purpose of this project was to compare patient utilization of psychology/mental health services across the Scott & White Health care system.

Methods
Using electronic medical records and the virtual data warehouse (VDW), mental health clinics/facilities were categorized into one of the three main psychology models. Patients that had depression, anxiety or ADHD DRG codes in their EMR and were aged 18 and older (n=37,310) were included in the analysis. The following additional variables were controlled for: gender, race/ethnicity, and chronic physical health conditions (i.e. arthritis, lung disease, heart disease, diabetes, hypertensive disease, and osteoporosis). ANOVA/ANCOVA analyses were performed to determine the differences across the three models in the length of time between the PPC referral and the first appointment with the psychologist/mental health professional.

Results
Patients that were seen by psychologist in facilities with integrated co-located models of care experienced a shorter amount of time between their referral and their first appointment with the psychologist/mental health professional, compared to the other two models of care.

Conclusions
These initial results begin to inform best practices for delivering mental health services within primary care and provide physicians and health care systems with data on issues that facilitate integrated, person-centered care.