TY - JOUR
T1 - Severity of mental health concerns in pediatric primary care and the role of child psychiatry access programs
AU - Platt, Rheanna
AU - Pustilnik, Sean
AU - Connors, Elizabeth
AU - Gloff, Nicole
AU - Bower, Kelly
N1 - Funding Information:
The BHIPP project is supported by the Maryland Department of Health and Mental Hygiene under grant number 16-14685G. All phases of this study were supported. This publication was also supported by the Johns Hopkins Institute for Clinical and Translational Research (ICTR) which is funded in part by Grant Number KL2TR001077 from the National Center for Advancing Translational Sciences (NCATS) a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research.
Funding Information:
The BHIPP project is supported by the Maryland Department of Health and Mental Hygiene under grant number 16-14685G. Maryland BHIPP is a collaboration among University of Maryland School of Medicine, Johns Hopkins Bloomberg School of Public Health, and Salisbury University. We are grateful to David Pruitt, MD and Larry Wissow, MD, program co-directors, for their review and comment on the manuscript. This publication was also supported by the Johns Hopkins Institute for Clinical and Translational Research (ICTR) which is funded in part by Grant Number KL2TR001077 from the National Center for Advancing Translational Sciences (NCATS) a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the Johns Hopkins ICTR, NCATS or NIH. The authors thank David Lenis for his assistance with statistical analyses, Jennifer Stevenson and Kristen Wigand for their assistance with formatting and copy editing, and Julia Kim, MD and Sarah Polk, MD for their review of the manuscript.
Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2018/7/1
Y1 - 2018/7/1
N2 - 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.
AB - 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.
KW - Behavioral health integration
KW - Mental health
KW - Primary care
KW - Psychiatry access program
KW - Telehealth
UR - http://www.scopus.com/inward/record.url?scp=85046008525&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85046008525&partnerID=8YFLogxK
U2 - 10.1016/j.genhosppsych.2018.02.010
DO - 10.1016/j.genhosppsych.2018.02.010
M3 - Article
C2 - 29702377
AN - SCOPUS:85046008525
VL - 53
SP - 12
EP - 18
JO - General Hospital Psychiatry
JF - General Hospital Psychiatry
SN - 0163-8343
ER -