title: Improving efficiency and access to mental health care: combining integrated care and advanced access.
abstract: OBJECTIVE
  To provide an example of implementation of a new program that enhances access to mental health care in primary care.
  
  
  METHODS
  A general and specialized mental health service was redesigned to introduce open access to comprehensive mental health care in a primary care clinic. Key variables measured before and after implementation of the clinic included numbers of completed referrals, waiting time for appointments and clinic productivity. Workload and pre/post-implementation waiting time data were gathered through a computerized electronic monitoring system.
  
  
  RESULTS
  Waiting time for new appointments was shortened from a mean of 33 days to 19 min. Clinician productivity and evaluations of new referrals more than doubled. These improvements have been sustained for 4 years.
  
  
  CONCLUSIONS
  Moving mental health services into primary care, initiating open access and increasing use of technological aids led to dramatic improvements in access to mental health care and efficient use of resources. Implementation and sustainability of the program were enhanced by using a quality improvement approach.
authors.affiliation: Mental Health and Behavioral Science Service, White River Junction VA Medical Center, White River Junction, VT 05009, USA. andrew.pomerantz@dartmouth.edu
authors.forename: Andrew
authors.initials: A
authors.lastname: Pomerantz
authors.forename: Brady H
authors.initials: BH
authors.lastname: Cole
authors.forename: Bradley V
authors.initials: BV
authors.lastname: Watts
authors.forename: William B
authors.initials: WB
authors.lastname: Weeks
mesh_terms: D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D017598:Efficiency, Organizational; D019538:Health Care Surveys; D006284:Health Plan Implementation / Q000458:organization & administration*; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D008605:Mental Health Services / Q000458:organization & administration*; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000458:organization & administration*; D011785:Quality Assurance, Health Care / Q000458:organization & administration; D012017:Referral and Consultation / Q000458:organization & administration; D012424:Rural Population; D014481:United States; D014728:Veterans; D014850:Waiting Lists