Prevention Insights, Department of Applied Health Science, School of Public Health Bloomington, 1771Indiana University Bloomington, Bloomington, IN, USA.
Department of Applied Health Science, School of Public Health Bloomington, 1771Indiana University Bloomington, Bloomington, IN, USA.
Inquiry. 2022 Jan-Dec;59:469580221097428. doi: 10.1177/00469580221097428.
For decades, there has been a deficit of mental health services in rural areas of the United States. Beyond that longstanding need, the COVID-19 pandemic has reportedly increased the prevalence of unmet mental health needs among adults. Presently, many non-critical but urgent mental health concerns are first identified in rural emergency departments. This report describes the results of a 6-month feasibility case study of a program to integrate telepsychiatric triage "upstream" from emergency departments in rural primary care.
At routine primary care encounters in a single midwestern rural county, patients at risk for moderate-severe or severe depression, expressing thoughts of self-harm, or otherwise presenting in a way that raised clinical concern for mental or behavioral health, were referred to on-site telepsychiatric triage. Patients whose triage indicated further concern were provided six psychiatric and/or social work encounters for stabilization and treatment.
68 patients were referred to telepsychiatric triage during the pilot study (.85% of the estimated adult population in the county). Of those, only two had a documented mental/behavioral health diagnosis prior to triage, but 46 were diagnosed with at least one psychiatric disorder during the program.
This model of telepsychiatric triage was feasible in rural primary care and may support identification and mitigation of unmet mental health needs.
几十年来，美国农村地区一直存在心理健康服务不足的问题。除了这一长期存在的需求之外，据报道，COVID-19 大流行增加了成年人未满足的心理健康需求的流行率。目前，许多非关键性但紧急的心理健康问题首先在农村急诊科得到识别。本报告描述了一项为期 6 个月的可行性案例研究结果，该研究旨在将远程精神病学分诊“上游”整合到农村初级保健的急诊部门。
在中西部一个农村县的常规初级保健就诊中，有中度至重度或重度抑郁风险、表达自残想法或其他引起精神或行为健康临床关注的患者，将被转诊至现场远程精神病学分诊。分诊提示进一步关注的患者将接受六次精神病学和/或社会工作治疗以稳定和治疗。
在试点研究期间，有 68 名患者被转诊至远程精神病学分诊（占该县估计成年人口的 0.85%）。在这些患者中，只有两人在分诊前有记录的精神/行为健康诊断，但在该项目期间，有 46 人被诊断出至少患有一种精神障碍。
这种远程精神病学分诊模式在农村初级保健中是可行的，并可能支持识别和缓解未满足的心理健康需求。
