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Collaborative and Integrated Care

Session: Poster Session

(046) Psychiatry Consultation Clinic: A Model that Improves Access to Care and Corresponds to Decreased Depressive Symptoms

Location: Griffin Hall

Trainee Involvement: Yes

Background/Significance: An outpatient Psychiatric Consultation Clinic (PCC) was established in 2019 at the University of North Carolina to provide specialty support to primary care clinicians through diagnostic clarification and treatment recommendations. To date, the characteristics and outcomes of an outpatient consultation model like PCC have not been well studied.



Methods: Adult patients seen in PCC from 2019 to October 2022 were included in this retrospective study. Primary patient care outcomes include mean time to implement recommendations, rate of implementation, and change in patients’ Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scores before and after consultation. A secondary objective is to characterize patients and clinicians based on referral data obtained from a warehouse of electronic health record data and manually via chart review. Statistical analysis will be completed in R and SPSS. The University of North Carolina IRB approved the study protocol.



Results: 553 referrals met inclusion criteria (mean age 42.2 years (SD 15.9); 69.3 % female; 69.8% white, 18.9% black/African American; 90.6% not Hispanic/Latino, and 8.9% Hispanic/Latino). Mean time from referral to index consultation was 39.6 days (SD 31.3). Mean PHQ-9 and GAD-7 scores before consultation were 13.8 and 12.1, respectively, corresponding to depression and anxiety symptoms of moderate severity. Of subjects whose depression and anxiety scores were documented before and after consultation (PHQ-9 n=225; GAD-7 n=112), the mean change in PHQ-9 was -4.99 points (SD 7.28, p< 0.001) and GAD-7 was -2.84 (SD 5.60, p< 0.001). Data obtained manually pertaining to clinical characteristics and recommendation implementation is incomplete at time of abstract submission.



Discussion: Broadly, our study goal is to better understand how the outpatient consultation model operates in real-world conditions. Our demographic data show we are serving a relatively diverse population consistent with published data about adults seeking mental healthcare in the US (SAMSHA, 2015). The mean time to referral of 40 days is shorter than the general wait to be seen in our specialty psychiatry clinics (~6 to 9 months), so this model may increase timely access to mental healthcare (Coombs, 2021). The changes in depression and anxiety scores were statistically significant. Additionally, the reduction of 5 points on the PHQ-9 corresponds to a clinically significant decrease in symptom severity (i.e.. from severe to moderate) (Kroenke, 2001).
Conclusion/Implications: Preliminary data from our study of an outpatient psychiatry consultation clinic suggest that a consultation model can improve timely and equitable access to specialty psychiatric care and improve clinical outcomes. Further research is required to establish whether the improvements in depression and anxiety symptoms observed in our study are reproducible and sustained over time.



References:
Coombs NC, Meriwether WE, Caringi J, Newcomer SR. Barriers to healthcare access among U.S. adults with mental health challenges: A population-based study. SSM Popul Health 2021; 15:100847.

Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001; 16(9):606-13.

Substance Abuse and Mental Health Services Administration, Racial/ Ethnic Differences in Mental Health Service Use among Adults. HHS Publication No. SMA-15-4906. SAMSA 2015; 21-29.