title: Training community-based primary care physicians in the screening and management of mental health disorders among Latino primary care patients.
abstract: OBJECTIVE
  To evaluate a quality improvement intervention to improve the screening and management (e.g., referral to psychiatric care) of common mental disorders in small independent Latino primary care practices serving patient populations of predominantly low-income Latino immigrants.
  
  
  METHODS
  In seven practices, academic detailing and consultation/liaison psychiatry were first implemented (Stage 1) and then supplemented with appointment scheduling and reminders to primary care physicians (PCPs) by clinic staff (Stage 2). Acceptability and feasibility were assessed with independent patient samples during each stage.
  
  
  RESULTS
  Participating PCP found the interventions acceptable and noted that referrals to language-matched specialty care and case-by-case consultation on medication management were particularly beneficial. The academic detailing and consultation/liaison intervention (Stage 1) did not significantly affect PCP screening, management or patient satisfaction with care. When support for appointment scheduling and reminders (Stage 2) was added, however, PCP referral to psychiatric services increased (P=.04), and referred patients were significantly more likely to follow through and have more visits to mental health professionals (P=.04).
  
  
  CONCLUSIONS
  Improving the quality of mental health care in low-resourced primary care settings may require academic detailing and consultation/liaison psychiatric intervention supplemented with staff outreach to achieve meaningful improvement in the processes of care.
authors.affiliation: College of Physicians and Surgeons, Columbia University, New York, NY; The New York State Psychiatric Institute, New York, NY. Electronic address: sapatel@nyspi.columbia.edu.
authors.forename: Sapana R
authors.initials: SR
authors.lastname: Patel
authors.affiliation: LA-SER ANALYTICA, New York, NY.
authors.forename: Magdaliz
authors.initials: M
authors.lastname: Gorritz
authors.affiliation: College of Physicians and Surgeons, Columbia University, New York, NY; The New York State Psychiatric Institute, New York, NY.
authors.forename: Mark
authors.initials: M
authors.lastname: Olfson
authors.affiliation: Inwood Family Guidance & Psychological Services, PLLC, New York, NY.
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Bell
authors.affiliation: The New York State Psychiatric Institute, New York, NY.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Jackson
authors.affiliation: College of Physicians and Surgeons, Columbia University, New York, NY; The New York State Psychiatric Institute, New York, NY.
authors.forename: J Arturo
authors.initials: JA
authors.lastname: Sánchez-Lacay
authors.affiliation: College of Physicians and Surgeons, Columbia University, New York, NY.
authors.forename: César
authors.initials: C
authors.lastname: Alfonso
authors.affiliation: College of Physicians and Surgeons, Columbia University, New York, NY.
authors.forename: Eve
authors.initials: E
authors.lastname: Leeman
authors.affiliation: College of Physicians and Surgeons, Columbia University, New York, NY; The New York State Psychiatric Institute, New York, NY.
authors.forename: Roberto
authors.initials: R
authors.lastname: Lewis-Fernández
mesh_terms: D000328:Adult; D000368:Aged; D003156:Community Mental Health Services / Q000458:organization & administration; D019468:Disease Management; D005240:Feasibility Studies; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008403:Mass Screening; D001523:Mental Disorders / Q000175:diagnosis / Q000208:ethnology / Q000628:therapy*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D058007:Physicians, Primary Care / Q000193:education*; D011203:Poverty; D011320:Primary Health Care / Q000458:organization & administration*; D011570:Psychiatry / Q000193:education*; D058996:Quality Improvement; D012017:Referral and Consultation
keywords: Latinos; Mental health; Primary care; Quality improvement