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Medical versus nonmedical mental health referral: Clinical decision-making by telephone access center staff

  • Myron L. Pulier
  • Donald S. Ciccone
  • Cherie Castellano
  • Karen Marcus
  • Steven J. Schleifer
Brief Reports

Abstract

A database review investigated decisions of clinicians staffing a university-based telephone access center in referring new adult patients to nonpsychiatrists versus psychiatrists for initial ambulatory behavioral health care appointments. Systematically collected demographic and clinical data in a computer log of calls to highly trained care managers at the access center had limited predictive value with respect to their referral decisions. Furthermore, while 28% of the 610 study patients were initially referred to psychiatrists, billing data revealed that in-person therapists soon cross-referred at least 20% more to a psychiatrist. Care managers sent 56% of callers already taking psychotropic medications to nonpsychiatrists, 51% of whom were then cross-referred to psychiatrists. Predictive algorithms showed no potential to enhance efficiency of decisions about referral to a psychiatrist versus a nonpsychiatrist. Efforts to enhance such efficiency may not be cost-effective. It may be more fiscally efficient to assign less-experienced personnel as telephone care managers.

Keywords

Mental Health Behavioral Health Care Manager Psychotropic Medication Clinician Staffing 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© National Council for Community Behavioral Healthcare 2003

Authors and Affiliations

  • Myron L. Pulier
    • 1
  • Donald S. Ciccone
    • 2
  • Cherie Castellano
    • 3
  • Karen Marcus
    • 4
  • Steven J. Schleifer
    • 2
  1. 1.Department of PsychiatryNew Jersey Medical School, BHSB F-1560Newark
  2. 2.Department of Psychiatry at UMDNJ-New Jersey Medical SchoolNewark
  3. 3.Cop 2 Cop at UMDNJ-University Behavioral HealthCarePiscataway
  4. 4.Access Center at UMDNJ-University Behavioral HealthCareEdison

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