Availability of Outpatient Care From Psychiatrists: A Simulated-Patient Study in Three U.S. Cities

Malowney, Monica; Keltz, Sarah; Fischer, Daniel; Boyd, J. Wesley

doi:10.1176/appi.ps.201400051

Cited by 69 publications

(48 citation statements)

References 7 publications

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“…Among the 230 psychiatrists who have clinical practices in Vancouver, only 6 were available to provide a consultation in a timely manner. This study 15 has been replicated in the United States with very similar findings. Finally, a recent study 16 of regional psychiatrist supply and associated practice patterns in Ontario revealed that as the number of psychiatrists increases regionally, the average psychiatrist's outpatient volume decreases.…”

supporting

confidence: 67%

Choosing Wisely? Let’s Start with Working Wisely

2016

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There is an increasing emphasis on quality and, relatedly, cost-effectiveness as it relates to the delivery of health care. Choosing Wisely is an initiative adopted by numerous specialties with the goal of starting a dialogue about efficient use of health care resources. People need to be able to access care to have an opportunity to choose wisely. There is a considerable amount of evidence that access to care is poor for specialty mental health care, particularly access to psychiatrists. Consequently, we suggest that psychiatrists and the broader mental health system need to consider working wisely, and in our paper outline key issues (for example, implementation of wait times and objective measures of need in a centralized referral management system; incorporation of performance indicators with longitudinal monitoring for continuous quality improvement) that need to be addressed to develop a mental health system that would allow people to access care to choose wisely. Abré géOn met de plus en plus l'accent sur la qualité et, corollairement, sur la rentabilité de la prestation des soins de santé. « Choisir avec soin » est une initiative adoptée par un certain nombre de spécialités dans le but d'amorcer un dialogue sur l'utilisation efficace des ressources de soins de santé. Les personnes doivent être capables d'accéder aux soins pour avoir la possibilité de « choisir avec soin ». Des données probantes en quantité considérable indiquent que l'accès aux soins est mauvais pour les soins de santé mentale de spécialité, particulièrement l'accès aux psychiatres. Par conséquent, nous suggérons que les psychiatres et le système de santé mentale en général devraient envisager de « Travailler avec soin », et nous présentons dans cet article les principaux enjeux (p. ex., la mise en oeuvre des temps d'attente et des mesures objectives des besoins dans un système de gestion d'aiguillage centralisé; l'incorporation des indicateurs de rendement avec la surveillance longitudinale de l'amélioration continue de la qualité) qui doivent être abordés afin de mettre au point un système de santé mentale qui permettrait aux gens d'accéder aux soins afin de « choisir avec soin ».Keywords access to care, health service delivery, evidence-based medicine, Choosing WiselyThere is an increasing emphasis on quality and, relatedly, cost-effectiveness as it relates to the delivery of health care.

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supporting

confidence: 67%

Choosing Wisely? Let’s Start with Working Wisely

2016

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“…After two rounds of phone calls 2 weeks apart, more than one half of 360 psychiatrists could not be reached or were not taking new patients. 16 Appointments could be obtained with only 93 (26%), with an average additional wait of 25 days. 16 The overall scarcity of psychiatrists is magnified when seeking a psychiatrist trained in managing patients with medical illness and comorbid psychiatric disorders.…”

Section: Discussionmentioning

confidence: 99%

“…16 Appointments could be obtained with only 93 (26%), with an average additional wait of 25 days. 16 The overall scarcity of psychiatrists is magnified when seeking a psychiatrist trained in managing patients with medical illness and comorbid psychiatric disorders. However, there are several limitations that influence the interpretation of the results.…”

Section: Discussionmentioning

confidence: 99%

“…Yet oncologists lack training in this area, and a referral to a mental health provider can be met with resistance or be seen by patients as disruptive for this aspect of care. 16 Many patients resist referral to a psychiatrist because of the stigma and expense and prefer to follow-up with their oncologist. 17 Although patients prefer to follow-up with their oncologists for survivorship or cancerrelated care, 17 this practice is changing on the basis of the growing number of survivors, and the role for primary care physicians in cancer care is increasing.…”

Section: Introductionmentioning

confidence: 99%

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ReCAP: Would Women With Breast Cancer Prefer to Receive an Antidepressant for Anxiety or Depression From Their Oncologist?

McFarland

Shen

Harris

et al. 2016

JOP

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QUESTIONS ASKED: Preferences of patients with breast cancer for provider-specific pharmacologic management of anxiety and depression are unknown. Use of patient-guided treatment preferences for the treatment of depression and anxiety are known to improve adherence and treatment outcomes in primary care settings, but these preferences are not known in women with breast cancer. This may be especially true shortly after the patient receives a diagnosis of cancer and is most psychologically symptomatic, yet committed to following through with her oncologic care. Do breast cancer patients have preferences regarding having their anxiety and depression assessed and treated by their oncologists versus being cared for by a psychiatrist or mental health provider? SUMMARY ANSWER: The majority of patients accepted antidepressant prescribing by their oncologist; only a minority preferred treatment by a mental health professional. These findings are consistent with previous data from medically ill patients that demonstrated a preference for medical providers to address and treat their depression or anxiety. Twenty percent of participants would not want any treatment. Patients who met depression criteria were less likely to prefer a mental health referral. Patients who were already taking an antidepressant or demonstrated higher levels of chronic stress were more likely to prefer a mental health referral. METHODS: Patients with breast cancer (stages 0-IV) were asked two questions: (1) “Would you be willing to have your oncologist treat your depression or anxiety with an antidepressant medication if you were to become depressed or anxious at any point during your treatment?” and (2) “Would you prefer to be treated by a psychiatrist or mental health professional for problems with either anxiety or depression?” In addition, the Distress Thermometer and Problem List, Hospital Anxiety and Depression Scale, Risky Families Questionnaire, and demographic information were assessed. BIAS, CONFOUNDING FACTORS, DRAWBACKS: This was a survey of only women who were asked to self-report hypothetical preferences. Although minimal differences were noted for the 16.8% of participants who were already taking an antidepressant medication, it is not clear how they might have interpreted the questions in a more realistic setting. REAL-LIFE IMPLICATIONS: These findings suggest a benefit for promoting education of oncologists to assess psychological symptoms and manage anxiety and depression as a routine part of an outpatient visit. It highlights a fertile opportunity for oncologists to integrate mental health treatment for their patients by beginning pharmacologic treatment, discussing their anxiety or depressive symptoms, and initiating or comanaging pharmacologic treatment of anxiety or depression. Early recognition and management of distress, anxiety, and depression would limit the delay in obtaining appropriate treatment, especially during the first year after a cancer diagnosis when patients are most symptomatic and have many difficult treatment decisions to make. The oncologist’s use of antidepressant medications to treat anxiety and depression may benefit patients most by following guidelines. A collaborative care model offers one potential solution that could establish ownership, expand resources, disseminate knowledge, and provide a system of integration for mental health and oncology providers. [Table: see text]

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“…22 This also appears to be the case in large American cities. 23 Moreover, private offices do not encourage consultation-liaison or collaboration with first-line services and with other health professionals. Instead of extending the reach of the specialist through shared care, 24 the private office can easily become a bunker that is inaccessible to the community.…”

Section: Beyond Office Practicementioning

confidence: 99%

Moving Out of the Office: Removing Barriers to Access to Psychiatrists

2015

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Our paper offers a perspective on barriers to access to psychiatric care. Research shows that access depends not simply on the total number of trained specialists but also on their kind of practice. In some large cities, some practitioners follow a small number of patients in long-term psychotherapy, a practice supported by government insurance, which places no limits on the number of sessions or treatment duration. The problem is that long-term psychotherapy, despite a rich tradition in psychiatry, is not an evidence-based treatment. This review recommends a model in which psychiatrists spend more time in consultation with primary care professionals, in acute care for patients with severe mental illness, and in briefer, more cost-effective forms of psychotherapy.

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Availability of Outpatient Care From Psychiatrists: A Simulated-Patient Study in Three U.S. Cities

Cited by 69 publications

References 7 publications

Choosing Wisely? Let’s Start with Working Wisely

Choosing Wisely? Let’s Start with Working Wisely

ReCAP: Would Women With Breast Cancer Prefer to Receive an Antidepressant for Anxiety or Depression From Their Oncologist?

Moving Out of the Office: Removing Barriers to Access to Psychiatrists

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