Medical versus nonmedical mental health referral: clinical decision-making by telephone access center staff.
A database review investigated decisions of clinicians staffing a university-based telephone access center in referring new adult patients to nonpsychiatrists versus psychiatrists for initial ambulatory behavioral health care appointments. Systematically collected demographic and clinical data in a computer log of calls to highly trained care managers at the access center had limited predictive value with respect to their referral decisions. Furthermore, while 28% of the 610 study patients were initially referred to psychiatrists, billing data revealed that in-person therapists soon cross-referred at least 20% more to a psychiatrist. Care managers sent 56% of callers already taking psychotropic medications to nonpsychiatrists, 51% of whom were then cross-referred to psychiatrists. Predictive algorithms showed no potential to enhance efficiency of decisions about referral to a psychiatrist versus a nonpsychiatrist. Efforts to enhance such efficiency may not be cost-effective. It may be more fiscally efficient to assign less-experienced personnel as telephone care managers.
Pulier
Myron L
ML
Department of Psychiatry, New Jersey Medical School, BHSB F-1560, 183 South Orange Ave, Newark, NJ 07103-3000, USA. pulierml@umdnj.edu
Ciccone
Donald S
DS
Castellano
Cherie
C
Marcus
Karen
K
Schleifer
Steven J
SJ
D000046:Academic Medical Centers / Q000458:organization & administration; D000328:Adult; D000368:Aged; D000465:Algorithms; D003661:Decision Support Techniques; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D008403:Mass Screening; D001523:Mental Disorders / Q000145:classification; D008605:Mental Health Services / Q000145:classification* / Q000706:statistics & numerical data; D008875:Middle Aged; D009515:New Jersey; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011570:Psychiatry / Q000706:statistics & numerical data*; D011586:Psychology, Clinical / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012940:Social Problems / Q000145:classification; D012949:Social Work, Psychiatric / Q000706:statistics & numerical data*; D013689:Telephone; D014218:Triage