Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA.
Mills-Peninsula Health Services, San Mateo, CA, USA.
Transl Behav Med. 2019 May 16;9(3):549-559. doi: 10.1093/tbm/ibz049.
Approximately 49.5% of the adolescents report a mental health disorder; only about half of the children and adolescents with mental health disorders seek treatment from a mental health professional. Stigma and poor access to behavioral health providers are leading barriers to care. A large ambulatory health system implemented a BH navigation program to facilitate referrals from primary care physicians (PCPs), including pediatricians and family physicians, to BH providers. We studied PCP adoption of BH navigation services over a 4-year period, from July 2014 to June 2018. We retrieved operational data regarding service utilization, patient information from electronic health records and PCP information from administrative data, and surveyed PCPs for their appraisals of navigation services. Four thousand five hundred and fifty-five referrals were made for 3,912 patients from 290 PCPs (71% of PCPs in the health system). Depression (39%), anxiety (25%), and attention-deficit hyperactivity disorder (7%) were the most frequent reasons for referral. Referrals increased dramatically in the first half of the study period and decreased afterwards. Ninety-one percent of the PCPs agreed or strongly agreed that navigation enhanced their clinical care at 12-month survey. More than 90% of the PCPs rated the referral process, communication with navigation staff, and the overall experience as above average or excellent at 12 months. There was a decrease in these evaluation indicators after 2.5 years. The initial high referral volume reflects a need for BH navigation services. However, challenges remain to maintain positive PCP assessment in the face of such demand.
约 49.5%的青少年报告存在心理健康障碍；仅有大约一半的儿童和青少年心理健康障碍患者会寻求心理健康专业人员的治疗。耻辱感和获得行为健康服务提供者的机会有限是导致护理不足的主要障碍。一个大型的门诊医疗系统实施了 BH 导航计划，以促进初级保健医生（PCP），包括儿科医生和家庭医生，向 BH 提供者转介。我们研究了 PCP 在 4 年期间（2014 年 7 月至 2018 年 6 月）采用 BH 导航服务的情况。我们从电子健康记录中检索了有关服务利用、患者信息和行政数据中的 PCP 信息，并对 PCP 进行了导航服务评估调查。从 290 名 PCP 中为 3912 名患者进行了 4555 次转介（占医疗系统内 PCP 的 71%）。转诊的最常见原因是抑郁（39%）、焦虑（25%）和注意力缺陷多动障碍（7%）。在研究期间的前半段，转诊量急剧增加，随后减少。91%的 PCP 在 12 个月的调查中同意或强烈同意导航增强了他们的临床护理。超过 90%的 PCP 对转诊流程、与导航工作人员的沟通以及整体体验在 12 个月时评价为高于平均水平或优秀。在 2.5 年后，这些评估指标有所下降。最初的高转诊量反映了对 BH 导航服务的需求。然而，在面对如此大的需求时，仍然存在保持 PCP 积极评估的挑战。
