October 17, 2014 / 9:06 PM / 5 years ago

Psychiatric appointments scarce in major U.S. cities

NEW YORK (Reuters Health) – Patients calling to make appointments with psychiatrists in major U.S. cities may only be successful about a quarter of the time, says a new study.

“It’s unfortunately about what I expected given how many patients come into my office on a first visit and say they were on the phone over and over and over,” said senior author Dr. J. Wesley Boyd, a psychiatrist at Cambridge Health Alliance and Harvard Medical School in Boston.

For the new study, the researchers called 360 psychiatrists in Boston, Houston and Chicago listed in Blue Cross Blue Shield’s provider database.

Posing as patients with no insurance, private insurance or government-sponsored insurance, the researchers attempted to make appointments with 120 psychiatrists in each of the three cities.

Although many patients may think psychiatric appointments will be covered and accessible if they have insurance, Boyd and his coauthors were rarely able to make appointments.

On the first call attempt, the researchers successfully reached only a third of the psychiatrists. As the authors note in the journal Psychiatric Services, 16 percent of the numbers listed were wrong. Instead, the numbers connected to places like a McDonald’s restaurant, a boutique and a jewelry store. Another 15 percent of psychiatrists were not accepting new patients.

Of the more than 200 psychiatrists who missed the first call, only 35 called back.

After a second round of calling, researchers had secured appointments with 93 psychiatrists, about a quarter of the total number.

The caller’s purported payment method didn’t make a difference in the odds of landing an appointment.

Although the BCBS insurance database in the study was not accurate or updated, that is the way many patients go about trying to get appointments, Boyd said.

“It’s the norm for the patients I know who have a particular kind of insurance - either going online or getting an actual paper copy of a list of in network providers that supposedly accept their insurance,” he said.

Worsening the problem is a shortage of psychiatric providers in the U.S., Boyd said.

“We need to make sure we’re training adequate numbers of psychiatrists,” said Dr. Harsh K. Trivedi, chair of the American Psychiatric Association Council on Healthcare Systems and Financing.

“What the study did not look at is, right now, the providers providing most prescriptions are primary care doctors,” Trivedi told Reuters Health by phone. He was not involved in the new study.

Previous research found that even primary care doctors struggle to refer patients to psychiatrists. Instead, they often end up prescribing medications themselves. That’s actually not a bad system as long as primary care doctors and psychiatrists collaborate effectively, Trivedi said.

Primary care doctors are equipped to treat straightforward psychiatric cases, like that of an elderly person with diabetes and depression, he said.

“Many primary care providers don’t feel comfortable managing mental health issues,” but with more support and possibly more training, they are able to do so, he said.

Successful collaborative care models between primary care doctors and psychiatrists have already been implemented in some areas of the U.S, Trivedi said.

“The larger backdrop is we need to rethink the way psychiatric care is delivered here in the U.S.,” Boyd said.

As for patients, he said “if they are very, very persistent, hopefully they can get an appointment.”

SOURCE: bit.ly/1yIAB0M Psychiatric Services, October 15, 2014.

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