Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass.
Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, Mass.
Acad Pediatr. 2018 Apr;18(3):266-272. doi: 10.1016/j.acap.2017.11.007. Epub 2017 Nov 29.
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. We sought to examine PCPs' decision-making process to use or not use MCPAP when encountering mental health problems.
We analyzed data regarding calls from PCPs to MCPAP from October 1, 2010, to July 31, 2011, and interviewed 14 PCPs with frequent use (≥7 calls) and infrequent use (≤4 calls). PCPs were asked about recent patients with mental health problems, and they were asked to describe 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.
PCPs (n = 993) made 6526 calls (mean = 6.6; median = 3). Factors influencing calling included: 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; and MCPAP's assistance helps 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, have fear of being asked to manage more than they are comfortable, or have misperceptions of MCPAP's offerings.
MCPAP enhanced PCPs' ability to deliver mental health care 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.
马萨诸塞州儿童精神病学接入项目（MCPAP）为初级保健提供者（PCP）提供心理健康专家的电话支持。了解 PCP 使用 MCPAP 的决策过程可能为类似项目的实施提供信息。我们试图研究 PCP 在遇到心理健康问题时使用或不使用 MCPAP 的决策过程。
我们分析了 2010 年 10 月 1 日至 2011 年 7 月 31 日期间 PCP 向 MCPAP 拨打的电话数据，并对频繁使用（≥7 次）和不频繁使用（≤4 次）的 14 名 PCP 进行了访谈。询问 PCP 最近遇到心理健康问题的患者，并要求他们描述拨打或不拨打 MCPAP 的原因。频繁来电者被问到是什么维持了他们的使用；不频繁来电者被问到替代管理策略。在定性分析中比较了这两组之间的差异。
PCP（n=993）共拨打了 6526 个电话（平均=6.6；中位数=3）。影响拨打电话的因素包括：MCPAP 的指导是及时的，且符合个人实践范围；MCPAP 安排治疗转诊的能力超过 PCP 的能力；在护理点提供计划可以缓解焦虑的家庭；MCPAP 的帮助有助于满足家庭将心理健康纳入初级保健的偏好。一些不频繁的来电者在 2010 年之前通过 MCPAP 获得了技能，现在只在遇到复杂病例时才会打电话。不频繁打电话的其他原因包括：PCP 有其他咨询来源，担心被要求管理超出自己舒适范围的问题，或对 MCPAP 的服务有误解。
MCPAP 增强了 PCP 提供符合家庭偏好的心理健康护理的能力。PCP 将从电话中获得的知识应用于后续患者。通过外展活动推广 MCPAP 组件，并根据 PCP 的实践范围调整指导，可能会吸引更多的使用。
