Abstract
BackgroundMental health problems are commonly encountered in primary care, with primary care providers (PCPs) experiencing challenges referring patients to specialty mental health care. Electronic consultation (eConsult) is one model that has been shown to improve timely access to subspecialty care in a number of medical subspecialties. eConsults generally involve a PCP-initiated referral for specialty consultation for a clinical question that is outside their expertise but may not require an in-person evaluation.ObjectiveOur aim was to describe the implementation of eConsults for psychiatry in a large academic health system.MethodsWe performed a content analysis of the first 50 eConsults to psychiatry after program implementation. For each question and response, we coded consults as pertaining to diagnosis and/or management as well as categories of medication choice, drug side effects or interactions, and queries about referrals and navigating the health care system. We also performed a chart review to evaluate the timeliness of psychiatrist responses and PCP implementation of recommendations.ResultsDepression was the most common consult template selected by PCPs (20/50, 40%), followed by the generic template (12/50, 24%) and anxiety (8/50, 16%). Most questions (49/50, 98%) pertained primarily to management, particularly for medications. Psychiatrists commented on both diagnosis (28/50, 56%) and management (50/50, 100%), responded in an average of 1.4 days, and recommended in-person consultation for 26% (13/50) of patients. PCPs implemented psychiatrist recommendations 76% (38/50) of the time.ConclusionsFor the majority of patients, psychiatrists provided strategies for ongoing management in primary care without an in-person evaluation, and PCPs implemented most psychiatrist recommendations. eConsults show promise as one means of supporting PCPs to deliver mental health care to patients with common psychiatric disorders.
Highlights
Mental and behavioral health problems are among the most common and costly conditions in the United States [1,2]
Patients are often informed of the eConsult as they would be for a traditional consultation. eConsults are associated with shorter wait times for specialty care, improvement in provider communication and referral quality, and high levels of primary care providers (PCPs), specialist, and patient satisfaction [13,14,15,16,17,18,19,20]. eConsults have been successfully implemented in a number of settings, including academic medical centers, the Department of Veterans Affairs, and safety net health systems [21]
Depression was the most common consult template selected by PCPs with 40% (20/50) of consults, followed by the generic template with 24% (12/50) of consults, anxiety with 16% (8/50), psychosis with 14% (7/50), and bipolar with 6% (3/50)
Summary
Mental and behavioral health problems are among the most common and costly conditions in the United States [1,2]. 1 (page number not for citation purposes) more robust systems for mental health care within the primary care setting [9] These models build on existing evidence that collaborative management between PCPs and behavioral health providers can improve care and access, reduce stigma, and be cost effective [10]. EConsults are associated with shorter wait times for specialty care, improvement in provider communication and referral quality, and high levels of PCP, specialist, and patient satisfaction [13,14,15,16,17,18,19,20]. EConsults generally involve a PCP-initiated referral for specialty consultation for a clinical question that is outside their expertise but may not require an in-person evaluation Electronic consultation (eConsult) is one model that has been shown to improve timely access to subspecialty care in a number of medical subspecialties. eConsults generally involve a PCP-initiated referral for specialty consultation for a clinical question that is outside their expertise but may not require an in-person evaluation
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