Bringing Psychiatry to Primary Care and Other Specialties BY K A R E N G . R E N TA S , P H D
There is growing recognition of the importance of identifying and treating mental health conditions as patients connect with their primary care physician (PCP) and other specialists. Some have asked if universal mental health screenings are leading to increased rates of intervention and treatment or an uptick in mental health-related visits in primary care. Two recent national studies that examined data from the Medical Expenditure Panel Survey (MEPS) suggest that in the last 10 years, there has been an increase in intervention and treatment for mental health concerns in outpatient settings.1-2
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Psychiatry eConsults present a unique value and investment for healthcare.”
The results were surprising, as data showed that the increase was mostly stemming from visits with specialty mental health providers, non-physicians such as nurse practitioners and physician assistants, and physicians outside of primary care. Moreover, a first study published in 2019 found that adults with less serious psychological distress accounted for most of the absolute increase in outpatient mental health service utilization.2
A PROMISING ALTERNATIVE How are physicians responding to patients’ varying levels of psychological stress and psychiatric needs, while maximizing the already limited access to mental health specialty care? In December 2018, Facey Medical Group (FMG)—a Los Angeles-based multispecialty physician group affiliated with Providence, a Catholic not-forprofit health system based in Renton, Washington—launched psychiatry eConsults as one of several initiatives to respond to the behavioral health needs of patients presenting in primary care and other specialty settings. While integrating behavioral health and primary care has garnered great attention from researchers and practitioners,3-5 the most recent literature is starting to highlight psychiatry eConsults as a promising alternative to optimize the role of psychiatric consultants. Goals and outcomes include improving access to specialty level care, reducing delays in high-quality care, standardizing curbside consults, and increasing physicians’ capacity to respond to patients with mental health disorders.6-9 “A small effort on our part overshadows whatever residual resentment we have as primary care providers about taking on everyone’s mental load,” says Ana Lopes, MD, a family medicine physician with FMG. “A fragmented healthcare system can make physicians feel like air traffic controllers, but that feeling dissipates when the patient is given the right treatment plan by an experienced psychiatrist. I have even kept content from eConsults for my future reference.”
44 l JOURNAL OF AMERICA’S PHYSICIAN GROUPS
Spring 2022
