From the Department of Psychiatry (DSK, LI, DFG), Division of Social Work (CL, JM, MS, LSS), and Department of Medicine (BS), Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA (DSK, BS, DFG).
J Am Board Fam Med. 2019 Jul-Aug;32(4):481-489. doi: 10.3122/jabfm.2019.04.180357.
Accommodating walk-in psychiatry visits in primary care can improve access to psychiatric care for patients from historically underserved groups. We sought to determine whether a walk-in psychiatry model embedded within an integrated care practice could be sustained over time, and to characterize the patients who accessed care through it.
We reviewed electronic health records linked to 811 psychiatry encounters in an integrated care practice between October 1, 2015 and September 30, 2017. Primary outcomes were the initial and return psychiatry encounters per month. Secondary outcomes were the demographics and diagnoses of patients who accessed their initial visits through walk-in sessions and scheduled appointments.
490 initial psychiatry evaluations and 321 return encounters took place over the 2-year study period. The volume of initial psychiatry evaluations per month did not significantly change, but the volume of psychiatry follow-up encounters significantly increased after the walk-in session expanded. Medicaid recipients (OR, 1.9; 95% CI, 1.2 to 3.0); individuals without a college degree (OR, 1.7; 95% CI, 1.1 to 2.5); individuals who were single, divorced, or separated (OR, 1.7; 95% CI, 1.1 to 2.5); and individuals who identified as Black or Hispanic (OR, 2.5; 95% CI, 1.7 to 3.6) were more likely to access an initial psychiatry evaluation through a walk-in session as opposed to a scheduled appointment.
Providing psychiatric care on a walk-in basis in integrated care is sustainable. Patients from historically underserved groups may access psychiatric care disproportionately through a walk-in option when it is available.
在初级保健中容纳随到随诊的精神病就诊可以改善历史上服务不足群体患者获得精神病护理的机会。我们试图确定在综合护理实践中嵌入随到随诊精神病模式是否能够持续一段时间，并描述通过该模式获得护理的患者特征。
我们回顾了 2015 年 10 月 1 日至 2017 年 9 月 30 日期间，在综合护理实践中与 811 次精神病就诊相关的电子健康记录。主要结果是每月的初始和复诊精神病就诊次数。次要结果是通过随到随诊和预约就诊途径接受初始就诊的患者的人口统计学和诊断特征。
在 2 年的研究期间，共进行了 490 次初始精神病评估和 321 次复诊。每月初始精神病评估次数没有显著变化，但随到随诊扩展后，精神病随访次数显著增加。医疗补助（Medicaid）受保人（OR，1.9；95%CI，1.2 至 3.0）；没有大学学历的个体（OR，1.7；95%CI，1.1 至 2.5）；单身、离婚或分居的个体（OR，1.7；95%CI，1.1 至 2.5）；以及自认为是黑人和西班牙裔的个体（OR，2.5；95%CI，1.7 至 3.6）更有可能通过随到随诊而不是预约就诊接受初始精神病评估。
在综合护理中提供随到随诊的精神科护理是可持续的。历史上服务不足的群体患者可能会通过随到随诊选项不成比例地获得精神科护理。
