Does Primary Care Fill the Gap in Access to Specialty Mental Health Care? A Mixed Methods Study

Kyanko, Kelly A.; Curry, Leslie; Keene, Danya E.; Sutherland, Ryan; Naik, Krishna; Busch, Susan H.

doi:10.1007/s11606-021-07260-z

Cited by 17 publications

(6 citation statements)

References 20 publications

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“…Nearly a third of our respondents did not choose psychiatry as their first-choice career path (Figure 1), with family medicine being the most commonly pursued specialty among them. With mental health now recognized as fundamental to overall health and productivity throughout the lifespan, family physicians are expected to deal with many mental health disorders in the primary care setting [51,52]. They share a similar holistic patient-centered approach to patient care as psychiatrists [53].…”

Section: Discussionmentioning

confidence: 99%

Motivations and Limitations of Pursuing a Career in Psychiatry: A Cross-Sectional Study from the United Arab Emirates

et al. 2023

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Background. The global burden of mental disorders continues to grow with significant health, social, and economic consequences. Unfortunately, the gap between the need for mental healthcare and its provision remains wide all over the world. The recruitment and retention of psychiatrists is a long-standing concern in the United Arab Emirates, with social stigma playing a potential role. This study is aimed at investigating the factors that affect psychiatrists’ choice of psychiatry as an area of practice in the United Arab Emirates. Methods. This cross-sectional study was undertaken using an anonymized 30-item online questionnaire. Ethical approval was obtained from the United Arab Emirates University Social Sciences Research Ethics Committee prior to participant recruitment. We recruited qualified psychiatrists currently working in the United Arab Emirates. The structured questionnaire assessed the participants’ sociodemographic factors and reasons for choosing psychiatry. Statistical analysis, including Pearson correlations and chi-square tests, was performed using the statistical package for the social sciences (SPSS) version 26. Results. We found that the doctors trained in the United Arab Emirates were statistically more likely to face opposition to specializing in psychiatry ( p value < 0.001). Participants with a family member or friend as a psychiatrist were more likely to choose psychiatry as a first-choice specialty ( p value 0.01). Psychiatrists below the age of 35 were more statistically likely to face opposition to their decision to specialize in psychiatry ( p value 0.006). Psychiatrists who regretted their decision to specialize in psychiatry were statistically more likely to feel this way in their first year of residency ( p value < 0.001). Conclusions. Multiple sociodemographic factors influence responses to the decision to specialize in psychiatry in the United Arab Emirates. Younger people and people who studied in or were a citizen of the United Arab Emirates were more likely to face opposition to their decision to specialize in psychiatry, indicating why there are such high rates of psychiatrists from overseas in the United Arab Emirates and shortages in the profession.

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Section: Discussionmentioning

confidence: 99%

Motivations and Limitations of Pursuing a Career in Psychiatry: A Cross-Sectional Study from the United Arab Emirates

et al. 2023

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“…However, there is some evidence that consultations involving psychological problems in standard care have already increased durations [ 41 ]. Other arguments for considering those interventions despite higher time investment comes from research showing that not addressing psychological concerns leads to higher health care utilisation [ 42 ], missing opportunities to address emotional concerns comes with longer visits [ 43 ], and issues with moving care onto more specialised mental health care providers [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

Structured communication methods for mental health consultations in primary care: a scoping review

Mosler,

Packer,

Jerome

et al. 2023

BMC Prim. Care

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Background Majority of people with mental health problems attend primary care for support. Interventions that structure consultations have been found effective for physical health conditions and secondary mental health care. The aim of the review is to identify what tools or interventions exist to structure communication in primary care for appointments related to mental health problems and examine existing evidence for effectiveness for mental health and quality of life outcomes. Methods Quantitative and qualitative studies were eligible for inclusion if staff was based in a primary care setting and the intervention involved bi-directional communication with adult patients. Six databases were searched (MEDLINE, Web of Knowledge, EMBASE, PsycINFO, The Cochrane Library, CINAHL) with no time restriction. Search terms combined four concepts with key words such as “structured” and “interaction” and “mental illness” and “primary care”. Reference lists of eligible studies were searched. Results After removing duplicates, 3578 records were found and underwent further screening. A total of 16 records were included, representing eight different interventions from five countries. The majority were delivered by primary care doctors and focused on patients experiencing psychological distress. Similarities across interventions’ service delivery were that most were created for a broad patient population, used self-report assessments at the start and actions or plans as the end point, and employed group settings and didactic methods for training staff in the intervention. Booster and follow-up trainings were not offered in any of the interventions, and supervision was only part of the process for one. The evidence for effectiveness for mental health and quality of life outcomes was mixed with three out of five RCTs finding a positive effect. Conclusions Although the idea of structuring communication for mental health consultations has been around since the 1980s, relatively few interventions have attempted to structure the conversations within the consultation, rather than modifying pre-visit events. As the evidence-base showed feasibility and acceptability for a number of interventions, there is scope for those interventions to be developed further and tested more rigorously.

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“…Our study and other CoCM studies noted a series of barriers stemming from PCC's limited time, competing priorities in primary care, uncertainty of insurance costs, and misunderstandings about CoCM's ability to provide all evidence-based care options, including both medications and psychotherapies. Indeed, behavioral health programs in primary care often require clinicians and patients to navigate behavioral health treatment on their own, leaving many avenues to fail-to-link patients 41,42 . Individual patient factors such as low motivation to follow through, seen in our sample and often in individuals with depressive symptoms, further emphasize the need for systematic solutions.…”

Section: Discussionmentioning

confidence: 99%

Implementation Barriers and Experiences of Eligible Patients Who Failed to Enroll in Collaborative Care for Depression and Anxiety

Carroll

Rosenthal

et al. 2022

J GEN INTERN MED

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Background Effective and efficient implementation of the Collaborative Care Model (CoCM) for depression and anxiety is imperative for program success. Studies examining barriers to implementation often omit patient perspectives. Objectives To explore experiences and attitudes of eligible patients referred to CoCM who declined participation or were unable to be reached, and identify implementation barriers to inform strategies. Design Convergent mixed-methods study with a survey and interview. Participants Primary care patients at an academic medical center who were referred to a CoCM program for anxiety and depression by their primary care clinician (PCC) but declined participation or were unable to be reached by the behavioral health care manager to initiate care ( n = 80). Interviews were conducted with 45 survey respondents. Main Measures Survey of patients’ referral experiences and behavioral health preferences as they related to failing to enroll in the program. Interview questions were developed using the Consolidated Framework for Implementation Research version 2.0 (CFIR 2.0) to identify implementation barriers to enrollment. Key Results Survey results found that patients were uncertain about insurance coverage, did not understand the program, and felt services were not necessary. Referred patients who declined participation were concerned about how their mental health information would be used and preferred treatment without medication. Men agreed more that they did not need services. Qualitative results exhibited a variety of implementation determinants ( n = 23) across the five CFIR 2.0 domains. Barriers included mental health stigma, perceiving behavioral health as outside of primary care practice guidelines, short or infrequent primary care appointments, prioritizing physical health over mental health, receiving inaccurate program information, low motivation to engage, and a less established relationship with their PCC. Conclusions Multiple barriers to enrollment led to failing to link patients to care, which can inform implementation strategies to address the patient-reported experiences and concerns. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-022-07750-8.

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Does Primary Care Fill the Gap in Access to Specialty Mental Health Care? A Mixed Methods Study

Cited by 17 publications

References 20 publications

Motivations and Limitations of Pursuing a Career in Psychiatry: A Cross-Sectional Study from the United Arab Emirates

Motivations and Limitations of Pursuing a Career in Psychiatry: A Cross-Sectional Study from the United Arab Emirates

Structured communication methods for mental health consultations in primary care: a scoping review

Implementation Barriers and Experiences of Eligible Patients Who Failed to Enroll in Collaborative Care for Depression and Anxiety

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