Consultative Approaches to Leveraging the Psychiatric Workforce for Larger Populations in Need of Psychiatric Expertise
Abstract
Consultative Approaches in Primary Care Beyond “One Patient, One Provider”
Approach | Role of psychiatrist | Patient evaluationb | Responsibility for follow-up care | Psychiatrist available for backup | Improved access to psychiatrist by reducing referralsc | Benchmarks in literature for effectiveness | Covered by some insurance |
---|---|---|---|---|---|---|---|
Didactic presentations | Education only | None | PCP | No | Possible, if PCP practice changes | No | No |
Collaborative care model | Systematic caseload review and curbside consultation; may or may not include direct evaluation of more complex presentations | Indirect for the majority of patients, direct for a few with more complex conditions or when no other access is available | PCP | Yes | Yes | Yes, for multiple conditions | Yes |
Project ECHO (Extension for Community Healthcare Outcomes) | Consultant in expert “hub” provides recommendations and education to the multiple primary care “spoke” clinics | Indirect only for the select patients presented to the team | PCP | During the ECHO series only | Yes | Yes, for geriatric psychiatric disorders and hepatitis C | No |
Psychiatric eConsult | Written consultations for individual patients using an online platform | Indirect | PCP | For reviewed cases only | Yes | No | Yes |
Psychiatric access lines (child/adult) | Phone consultation; can include some education and care coordination | Indirect | PCP | Yes | Yes | No | No |
Store-and-forward (asynchronous) telepsychiatry | Psychiatrist views recorded interviews with patients and makes recommendations | Indirect | PCP | No | Yes | No | No |
Single, initial consultation (“one and done”) | Provides one-time direct evaluation with recommendations and contingency plans for PCP to implement | Direct | PCP | Sometimes | Yes | No | Yes |
Case review with primary care–based team | Remote psychiatrist available for case presentations and education for PCPs | Indirect | PCP | Sometimes | Yes | No | No |
Direct patient visits with psychiatrist in primary care | Traditional caseload of patients; direct evaluation of patients in person or by telehealth | Direct | Psychiatrist | Yes | Yes, for those seen, but access to psychiatrist fills quickly | Yes | Yes |
Case-Based Learning
Increasing Access to Traditional Psychiatric Care
Limitations and Policy Recommendations
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