Subject(s)
Diffusion of Innovation , Geriatric Psychiatry/trends , Medical Laboratory Science/trends , Psychiatry/trends , Aged , Aged, 80 and over , Delivery of Health Care/trends , Expert Systems , Forecasting , Guideline Adherence/trends , Humans , Medical Records Systems, Computerized/trends , Monitoring, Physiologic , Patient Care Team/trends , Remote Consultation/trends , Therapy, Computer-Assisted/trends , United States , User-Computer InterfaceSubject(s)
Attitude to Health , Cybernetics/trends , Evidence-Based Medicine , Medical Informatics/trends , HumansABSTRACT
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.