Rheanna Platt1, Sean Pustilnik2, Elizabeth Connors3, Nicole Gloff3, Kelly Bower4. 1. Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine/Johns Hopkins Bayview Medical Center, 5500 East Lombard Street, Room 1214, Baltimore, MD 21224, United States. Electronic address: rplatt1@jhmi.edu. 2. Medstar Georgetown Department of Psychiatry, Medstar Georgetown University Hospital, 2115 Wisconsin Avenue NW, suite 200, Washington, DC 20007, United States. Electronic address: Sean.D.Pustilnik@gunet.georgetown.edu. 3. University of Maryland School of Medicine, 737 West Lombard Street, 426, Baltimore, MD 21201, United States. 4. Johns Hopkins School of Nursing, 525 N. Wolfe Street, Pinkard Bldg 452, Baltimore, MD 21205, United States. Electronic address: Kbower1@jhu.edu.
Abstract
OBJECTIVE: To describe the clinical severity of patients for whom Primary Care Providers (PCPs) requested consultation from Maryland's Child Psychiatry Access Program (CPAP), and examine the proportion and associated characteristics of severe cases being managed alone by PCPs versus co-managed with mental health specialists. METHODS: Data were collected for 872 cases based on calls received between October 2012 and December 2016. Severity was measured by consultant-assigned Clinical Global Impression-Severity (CGI-S) score. The unadjusted odds of a PCP managing a case alone for select patient and provider characteristics was calculated in a sub-sample of 229 severe cases. RESULTS: 73.8% of cases were categorized as mild-moderate (CGI-S 1-4) and 26.3% as severe (CGI-S 5-7). 67.3% of severe cases were managed by a PCP alone; 32.8% were co-managed. The unadjusted odds of a severe case managed alone was lower for cases with greater numbers of psychotropic medications (OR 0.76, 95% CI 0.6, 0.96), prescription of antidepressants (OR 0.51, 95% CI 0.28, 0.95), or antipsychotics (OR 0.45, 95% CI 0.22, 0.94) compared to co-managed cases. CONCLUSIONS: PCPs manage patients with severe mental health concerns, often without assistance from specialists. CPAPs should systematically consider how to support the PCPs' role managing clinically severe cases.
OBJECTIVE: To describe the clinical severity of patients for whom Primary Care Providers (PCPs) requested consultation from Maryland's Child Psychiatry Access Program (CPAP), and examine the proportion and associated characteristics of severe cases being managed alone by PCPs versus co-managed with mental health specialists. METHODS: Data were collected for 872 cases based on calls received between October 2012 and December 2016. Severity was measured by consultant-assigned Clinical Global Impression-Severity (CGI-S) score. The unadjusted odds of a PCP managing a case alone for select patient and provider characteristics was calculated in a sub-sample of 229 severe cases. RESULTS: 73.8% of cases were categorized as mild-moderate (CGI-S 1-4) and 26.3% as severe (CGI-S 5-7). 67.3% of severe cases were managed by a PCP alone; 32.8% were co-managed. The unadjusted odds of a severe case managed alone was lower for cases with greater numbers of psychotropic medications (OR 0.76, 95% CI 0.6, 0.96), prescription of antidepressants (OR 0.51, 95% CI 0.28, 0.95), or antipsychotics (OR 0.45, 95% CI 0.22, 0.94) compared to co-managed cases. CONCLUSIONS: PCPs manage patients with severe mental health concerns, often without assistance from specialists. CPAPs should systematically consider how to support the PCPs' role managing clinically severe cases.
Authors: Sarah Sweeney; Kelly Coble; Elizabeth Connors; Kathleen Rebbert-Franklin; Christopher Welsh; Eric Weintraub Journal: Subst Abus Date: 2020-08-19 Impact factor: 3.716
Authors: Amie F Bettencourt; Rebecca A Ferro; Jami-Lin L Williams; Kainat N Khan; Rheanna E Platt; Sarah Sweeney; Kelly Coble Journal: Acad Psychiatry Date: 2021-03-30