Van Cleave J, Holifield C, Perrin JM. Acad. Pediatr. 2018; 18(3): 266-272.
Affiliation
Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, MA. Address: 125 Nashua Street, #860, Boston, MA 02114; Department of Pediatrics, Harvard Medical School, Boston, MA.
BACKGROUND: The Massachusetts Child Psychiatry Access Project (MCPAP) provides telephone support from mental health specialists to primary care providers (PCPs). Understanding PCPs' use may inform implementation of similar programs.
OBJECTIVE: To examine PCPs' decision-making process to use or not use MCPAP when encountering mental health problems.
METHODS: We analyzed data regarding calls from PCPs to MCPAP from 10/1/2010-7/31/2011 and interviewed fourteen PCPs with frequent use (≥7 calls) and infrequent use (≤4 calls). PCPs were asked about recent patients with mental health problems, describing reasons for calling or not calling MCPAP. Frequent callers were asked what sustained use; infrequent callers were asked about alternative management strategies. Comparisons were made between these groups in qualitative analysis.
RESULTS: PCPs (n=993) made 6526 calls (mean=6.6; median=3). Factors influencing calling: MCPAP's guidance is timely and tailored to individual scope of practice; MCPAP's ability to arrange therapy referrals exceeds PCPs' ability; providing a plan at point-of-care relieves anxious families; MCPAP's assistance helps to accommodate families' preference to keep mental health in primary care. Some infrequent callers had gained skills through MCPAP before 2010 and now called only for complex cases. Other reasons for infrequent calling: PCPs have other consultation sources, fear being asked to manage more than they are comfortable, or have misperceptions of MCPAP's offerings.
CONCLUSIONS: MCPAP enhanced PCPs' ability to deliver mental healthcare consistent with families' preferences. PCPs applied knowledge gained from calls to subsequent patients. Promoting MCPAP components through outreach and tailoring guidance to PCPs' scope of practice may entice greater use. WHAT'S NEW: Tailored and timely advice from a child psychiatry support program promotes PCPs' use. Infrequent users are wary about receiving advice they are uncomfortable implementing, are not aware of the full scope of offered services, or have other sources for assistance.