Integrating psychiatry and primary care improves acceptability to mental health services among Chinese Americans

Yeung, Albert; Kung, Winnie W.; Chung, Henry; Rubenstein, Grace; Roffi, Pamela A.; Mischoulon, David; Fava, Maurizio

doi:10.1016/j.genhosppsych.2004.03.008

Cited by 52 publications

(58 citation statements)

References 9 publications

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“…26,28,30,42,43 Previous studies have found that colocation improved access to mental health care 30,44 and engagement with mental health care providers 31,45 and improved patient satisfaction and outcomes. 46,47 We hypothesized that colocation would result in increased diagnosis and prescribing by bringing expertise with these conditions to the practice and potentially drawing additional children needing these services.…”

Section: Discussionmentioning

confidence: 99%

“…In response to family difficulties in accessing mental health specialists, 24,25 primary care practices increasingly include colocated mental health providers, [26][27][28][29][30] a model that may improve access, identification, and treatment. 26,31 Second, practices with higher numbers of patients in foster care may manage more mental health care owing to prevalent psychotropic medication use. 18,32 Finally, practices located in communities where mental health providers, particularly psychiatrists, are not available may need to fill this gap by providing psychotropic medication management.…”

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confidence: 99%

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Variations in Mental Health Diagnosis and Prescribing Across Pediatric Primary Care Practices

Mayne¹,

Ross

Song³

et al. 2016

Pediatrics

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BACKGROUND: Primary care pediatricians increasingly care for children’s mental health problems, but little is known about practice-level variation in diagnosis and psychotropic medication prescribing practices. METHODS: This retrospective review of electronic heath records from 43 US primary care practices included children aged 4 to 18 years with ≥1 office visit from January 1, 2009, to June 30, 2014. We examined variability in diagnosis and psychotropic prescribing across practices using logistic regression with practice fixed effects and evaluated associations of the availability of colocated or community-based mental health providers or the proportion of children in foster care with diagnosis and prescribing using generalized linear mixed models. RESULTS: Among 294 748 children, 40 932 (15%) received a mental health diagnosis and 39 695 (14%) were prescribed psychotropic medication. Attention deficit/hyperactivity disorder was most commonly diagnosed (1%–16% per practice). The proportion of children receiving any psychotropic medication (4%-26%) and the proportion receiving ≥2 medication classes (1%-12%) varied across practices. Prescribing of specific medication classes also varied (stimulants, 3%–18%; antidepressants, 1%–12%; α-agonists, 0%–8%; second-generation antipsychotics, 0%–5%). Variability was partially explained by community availability of psychiatrists (significantly higher odds of a diagnosis or prescription when not available) but not by colocation of mental health professionals or percentage of children in foster care. CONCLUSIONS: The prevalence of mental health diagnosis and psychotropic medication prescribing varies substantially across practices and is only partially explained by psychiatrist availability. Research is needed to better define the causes of variable practice-level diagnosis and prescribing and implications for child mental health outcomes.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Variations in Mental Health Diagnosis and Prescribing Across Pediatric Primary Care Practices

Mayne¹,

Ross

Song³

et al. 2016

Pediatrics

View full text Add to dashboard Cite

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“…Developing more effective networks among different community agencies and providers, including mental health providers, general practitioners, and churches may improve access to psychiatric care. In particular, development of a general practitioner referral network may facilitate access to mental health providers, especially for psychiatrists embedded in primary care group practice (Kates 2000;Yeung et al 2004). The Association of Korean American Psychiatrists has proposed one model recognizing clergy as the main point of initial contact with general practitioners as a second albeit less common gatekeeper for connecting congregants to specialty mental health services (Lee et al 2008).…”

Section: Discussionmentioning

confidence: 99%

Community Mental Health Allies: Referral Behavior Among Asian American Immigrant Christian Clergy

Yamada

Lee

Kim

2011

Community Ment Health J

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Asian American Christian faith leaders support and provide an array of services within their communities. However, little is known about their response to congregants' mental health concerns. This study examined correlates of mental health referral behavior among 103 Asian American Christian clergy in California who completed an anonymous mail survey. Using multiple regression analyses, we found that clergy's prior mental health education, knowledge of mental illness, education level, time spent providing individual counseling and referral to general practitioners were positively associated with making mental health referrals. Outreach efforts (including mental health education, and mental health referral information) to facilitate clergy's support of congregants with mental health needs are discussed.

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“…A collaborative care model can be viewed as a complex combination of various interventions in the treatment of disorders, and various care providers – GPs as well as psychiatrists – could provide this care in the general practice setting. The feasibility of this type of collaborative care model has been established in several countries [10, 11]. In this study, we assessed whether collaborative care combining a psychiatric consultation (PC) model similar to Katon et al’s [12] with GP training in case management based on Smith et al’s techniques [13] and reattribution techniques based on Gask and Goldberg’s training model [14, 15] improves the physical and psychological well-being and psychological functioning and influences the use of health care services by patients with persistent medically unexplained symptoms in general practice in comparison with care as usual (CAU) by the GP.…”

Section: Introductionmentioning

confidence: 99%

Randomised Controlled Trial of a Collaborative Care Model with Psychiatric Consultation for Persistent Medically Unexplained Symptoms in General Practice

Feltz-Cornelis

Oppen²,

Adèr

et al. 2006

Psychother Psychosom

121

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Background: Patients with persistent medically unexplained symptoms often exhibit general dysfunction and psychiatric comorbidity and frequently resist psychiatric referral. The aim of this study was to evaluate the efficacy of a collaborative care model including training for general practitioners (GPs) and a psychiatric consultation model for patients with persistent medically unexplained symptoms in general practice. Method: Randomised controlled trial. Cluster randomisation at GP practices and multilevel analysis were performed. A total of 81 patients from 36 general practices completed the study. A collaborative care model of training and psychiatric consultation in general practice in the presence of the GP was compared with training plus care as usual by the GP. Outcome assessment on the patients’ well-being, functioning and utilisation of health care services was performed 6 weeks and 6 months later. Results: All the patients had somatoform disorders (Whitely Index 7.46), and 86% had comorbid psychiatric disorders. In the intervention group, the severity of the main medically unexplained symptoms decreased by 58%. The patients’ social functioning improved. The utilization of health care was lower than in the care as usual group. Conclusions: A collaborative care model combining training with psychiatric consultation in the general practice setting is an effective intervention in the treatment of persistent medically unexplained symptoms. Anxiety and depressive disorders are highly comorbid in this group. The findings warrant a larger study.

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Integrating psychiatry and primary care improves acceptability to mental health services among Chinese Americans

Cited by 52 publications

References 9 publications

Variations in Mental Health Diagnosis and Prescribing Across Pediatric Primary Care Practices

Variations in Mental Health Diagnosis and Prescribing Across Pediatric Primary Care Practices

Community Mental Health Allies: Referral Behavior Among Asian American Immigrant Christian Clergy

Randomised Controlled Trial of a Collaborative Care Model with Psychiatric Consultation for Persistent Medically Unexplained Symptoms in General Practice

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