Project Title

Improving the Referral Process for Behavioral Health Using a Patient-Centered Approach

Authors' Affiliations

Mary Axelrad, MD, East Tennessee State University - Family Medicine Residency, Bristol, TN. Laurie Webb, LCSW, East Tennessee State University - Family Medicine Residency, Bristol, TN. Kimberly Mann, LCSW, Frontier Health, Bristol, TN. Amanda Stoltz, MD, East Tennessee State University - Family Medicine Residency, Bristol, TN.

Location

Mt Mitchell

Start Date

4-12-2019 9:00 AM

End Date

4-12-2019 2:30 PM

Poster Number

133

Faculty Sponsor’s Department

Family Medicine

Name of Project's Faculty Sponsor

Dr. Amanda Stoltz

Type

Poster: Competitive

Classification of First Author

Medical Resident or Clinical Fellow

Project's Category

Ambulatory Care

Abstract Text

Behavioral counseling is integral for the overall health of individuals with a mental health diagnosis. For instance, diabetic patients treated with cognitive behavioral therapy (“CBT”) for depression have been shown to have better glycemic control and patients with coronary artery disease treated with CBT for stress management have decreased risk for recurrent myocardial infarction. Above all, for nearly all mental health diagnoses, behavioral counseling is an effective treatment strategy for achieving remission.

In primary care, mental health therapy oftentimes starts with a referral to a counseling center or psychiatric professional. With strong patient commitment, behavioral therapy can ultimately improve health outcomes and the day to day functioning for that patient. Unfortunately, the initial step can be the most difficult and the journey never begins.

In our clinic, a residency clinic in a semi-rural area with a high percentage of underinsured, we noticed that a lower than preferred number of patients that we refer to our most accessible behavioral counseling center do not even schedule their first appointment. Additionally, we are limited by a scarcity of affordable psychiatric resources and this counseling center is often our only option for referral.

For this purpose, we implemented the following changes consecutively to the referral process. First, our in-house referrals coordinator made the first appointment, instead of the patient having to call themselves. Next, we took this a step further, and an employee from the counseling center came onsite to initiate the intake process on the day of the referral or at the patient’s convenience. We then measured their success by comparing the percentage of patients that completed the intake process before and after each implementation. There was a statistically significant increase in the mean percentage of intakes completed after each intervention.

We conclude that although the reason patients are unable to follow-up with a behavioral health referral is often multi-factorial, simplifying the process for the patient seems to help a great deal. While this is encouraging, more evaluation is needed to determine if patient outcomes are improved, and if these interventions are cost effective and sustainable options.

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Apr 12th, 9:00 AM Apr 12th, 2:30 PM

Improving the Referral Process for Behavioral Health Using a Patient-Centered Approach

Mt Mitchell

Behavioral counseling is integral for the overall health of individuals with a mental health diagnosis. For instance, diabetic patients treated with cognitive behavioral therapy (“CBT”) for depression have been shown to have better glycemic control and patients with coronary artery disease treated with CBT for stress management have decreased risk for recurrent myocardial infarction. Above all, for nearly all mental health diagnoses, behavioral counseling is an effective treatment strategy for achieving remission.

In primary care, mental health therapy oftentimes starts with a referral to a counseling center or psychiatric professional. With strong patient commitment, behavioral therapy can ultimately improve health outcomes and the day to day functioning for that patient. Unfortunately, the initial step can be the most difficult and the journey never begins.

In our clinic, a residency clinic in a semi-rural area with a high percentage of underinsured, we noticed that a lower than preferred number of patients that we refer to our most accessible behavioral counseling center do not even schedule their first appointment. Additionally, we are limited by a scarcity of affordable psychiatric resources and this counseling center is often our only option for referral.

For this purpose, we implemented the following changes consecutively to the referral process. First, our in-house referrals coordinator made the first appointment, instead of the patient having to call themselves. Next, we took this a step further, and an employee from the counseling center came onsite to initiate the intake process on the day of the referral or at the patient’s convenience. We then measured their success by comparing the percentage of patients that completed the intake process before and after each implementation. There was a statistically significant increase in the mean percentage of intakes completed after each intervention.

We conclude that although the reason patients are unable to follow-up with a behavioral health referral is often multi-factorial, simplifying the process for the patient seems to help a great deal. While this is encouraging, more evaluation is needed to determine if patient outcomes are improved, and if these interventions are cost effective and sustainable options.