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