Van Cleave Jeanne, Le Thuy-Tien, Perrin James M
Division of General Academic Pediatrics/Center for Child and Adolescent Health Research & Policy, Massachusetts General Hospital for Children, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; and
Department of Internal Medicine and Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota.
Pediatrics. 2015 May;135(5):834-41. doi: 10.1542/peds.2014-0720. Epub 2015 Apr 20.
Since 2005, after a pilot program, the Massachusetts Child Psychiatry Access Project (MCPAP) has provided point-of-care psychiatry expertise and referral assistance by telephone to primary care providers. We examined its adoption and use and the practice characteristics associated with different adoption timelines and use patterns.
We merged data on calls to MCPAP in 2005 to 2011 with practice data (enrollment year, panel size, regional team assignment). We categorized practices' days from enrollment to first call (adoption) (0-100, 101-365, > 365 days) and quartile of call frequency (use) (annual highest, middle, and lowest quartiles of number of calls per 1000 empanelled patients). We determined associations between adoption and use and practice characteristics using multivariate models.
Among 285 practices, adoption and use varied: 55% called 0 to 100 days from enrollment and 16% called >365 days from enrollment. Practices in the highest quartile of use made a mean 15.5 calls/year per 1000 patients, whereas the lowest quartile made 0.4 calls/year per 1000 patients. Adoption within 100 days was associated with enrollment during or after 2007 (odds ratio [OR] 4.09, 95% confidence interval [CI] 2.23-7.49) and assignment to the team at the pilot site (OR 4.42, 95% CI 2.16-9.04 for central Massachusetts). Highest-quartile use was associated with team assignment (OR 3.58, 95% CI 1.86-6.87 for central Massachusetts) and panel size (OR 0.10, 95% CI 0.03-0.31 for ≥ 10,000 vs < 2000 patients).
Adoption and use of MCPAP varied widely. Timing of enrollment, assignment to the team from the program's pilot site, and panel size were associated with patterns of adoption and use. Findings may help other programs design effective implementation strategies.
自2005年一项试点项目开展以来，马萨诸塞州儿童精神病学接入项目（MCPAP）通过电话为初级保健提供者提供即时精神病学专业知识和转诊协助。我们研究了该项目的采用和使用情况，以及与不同采用时间线和使用模式相关的实践特征。
我们将2005年至2011年拨打MCPAP的电话数据与实践数据（注册年份、服务对象规模、区域团队分配）进行合并。我们将实践从注册到首次致电（采用）的天数进行分类（0 - 100天、101 - 365天、> 365天），并将致电频率分为四分位数（使用情况）（每1000名服务对象每年致电次数的年度最高、中间和最低四分位数）。我们使用多变量模型确定采用和使用情况与实践特征之间的关联。
在285个实践中，采用和使用情况各不相同：55%在注册后0至100天内致电，16%在注册后> 365天致电。使用频率最高的四分位数的实践中，每1000名患者每年平均致电15.5次，而最低四分位数的实践中，每1000名患者每年致电0.4次。100天内采用与2007年期间或之后注册相关（优势比[OR] 4.09，95%置信区间[CI] 2.23 - 7.49），以及被分配到试点地区的团队（马萨诸塞州中部的OR为4.42，95% CI 2.16 - 9.04）。最高四分位数的使用情况与团队分配相关（马萨诸塞州中部的OR为3.58，95% CI 1.86 - 6.87）和服务对象规模相关（≥ 10,000名患者与< 2000名患者相比，OR为0.10，95% CI 0.03 - 0.31）。
MCPAP的采用和使用情况差异很大。注册时间、从项目试点地区分配到团队以及服务对象规模与采用和使用模式相关。研究结果可能有助于其他项目设计有效的实施策略。
