Date of Completion

Spring 5-26-2025

Document Type

Open Access Project

Degree Name

Doctor of Nursing Practice (DNP)

Faculty Advisor

Eileen Stuart-Shor, PhD, ANP-BC, FAHA, FAAN

Practice Site Mentor

Amy Harrington, MD, CPE, FAPA

Committee Mentor

Maria Romanoff Rand, DNP, PMHNP-BC

Abstract

Background

The shortage of mental health professionals and the stigma associated with seeking mental health care has contributed to the need for primary care to provide mental health services. While primary care providers are well-placed to offer mental health treatment, they may not feel comfortable prescribing psychotropic medication in their practice. In the absence of full collaborative care models, consulting with psychiatric specialists can help primary care providers to manage mental health conditions in primary care.

Local Problem

At a community health center (CHC) in Worcester County, Massachusetts, primary care providers (PCP) provide mental health treatment for patients and have reported varying levels of comfort in prescribing psychotropic medication. There are existing resources and a referral system in place between the CHC and an affiliated academic psychiatric practice to support the CHC PCPs, but the demand for behavioral health access has been growing and the capacity to meet the demands of the system with the existing referral system does not meet the needs.

Methods

A systematic review of the literature was undertaken to identify effective strategies for collaboration between primary care providers and psychiatric specialists/prescribers in community health centers. E-consultation, direct consultation, and joint consultation emerged as effective strategies to support Primary care providers prescribing psychotropic medications. Root-cause analysis to better understand why the current referral process was inadequate was the primary focus of this project.

Intervention

A baseline assessment of the current state of provider satisfaction with the psychiatric referral system was carried out at both the CHC Primary Care partner site and the Academic Medical Center Psychiatric Practice site. In addition, based on the evidence reviewed in the literature and established best practices, a preliminary draft of a psychotropic medication consultation pathway was created. This draft pathway will serve as a starting place for the next PDSA cycle.

Results

Survey results revealed that 53% of respondents were satisfied with the referral pathway, but 69% were dissatisfied with the overall process, mainly due to delays in treatment recommendations. Additionally, 41% found it difficult to locate recommendations in the EMR system. Stakeholders noted barriers in the referral process and concerns about the system's capacity to manage the volume of referrals.

Conclusions

This baseline assessment provided insight of the current state and needs to help plan the next steps for a consultation pathway for psychotropic medications at a community health center. The project group has paused work on this pathway to focus on working with other groups to improve the existing referral system for primary care providers.

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