518 - Consults with a child psychiatry access program: Comparison of rural and non-rural primary care providers

Poster Number: 518
Publication Number: 518.422

Jeanne Van Cleave, University of Colorado School of Medicine, Aurora, CO, United States; David Keller, University of Colorado School of Medicine, Aurora, CO, United States; Susan E. Young, University of Colorado, Longmont, CO, United States; Ryan Asherin, Childrens Hospital Colorado; University of Colorado Anschutz, Aurora, CO, United States; Sandra L. Fritsch, Children's Hospital Colorado, Aurora, CO, United States

Background: Child psychiatry access programs (CPAPs) provide primary care providers (PCPs) with timely consults from child psychiatrists and referral assistance for patients with mental health conditions by telephone or an electronic, asynchronous platform. Resources for mental health are scarcer in rural areas; rural PCPs may have different needs than non-rural PCPs.

Objective: We aimed to compare consults from rural and non-rural PCPs with Colorado’s CPAP.

Design/Methods: We analyzed data from consults between PCPs and the CPAP from Sept 2019-Dec 2021. We created a comparator, rural vs non-rural, based on county-level location of the PCP’s practice, using the National Center for Health Statistics Urban-Rural Classification Scheme (non-rural: codes 1-3; rural: codes 4-6, comprising 20% of the state’s population). We tested associations of elements of consults (question type, content discussed, outcomes of consults, diagnoses and clinical severity) with PCP rurality using bivariate and multivariate techniques, adjusted for patient age/gender/insurance.

Results: There were 1079 consults; 16% were with rural PCPs. Consults with rural PCPs were more likely to be for patients with Medicaid (50.2% vs 25.5%, p< 0.001), more likely to involve patients with depression (adjusted odds ratio [AOR] 1.8, 95% confidence interval [CI] 1.2-2.7), psychosis (AOR 3.5, 95% CI 1.4-8.9), or post-traumatic stress disorder (AOR 2.1, 95% CI 1.3-3.5) and more likely to involve discussion of SSRIs (AOR 1.5, 95% CI 1.0-2.2) or atypical antipsychotics (AOR 2.4, 95% CI 1.4-4.1). Clinical severity was greater for consults from rural PCPs (AOR for moderate/severe illness 1.5, 95% CI 1.1-2.2).  Consults for substance use disorder were few (n=15) and none were from rural PCPs. Regarding reason for and outcome of consults, those with rural PCPs were less likely to be specifically for referral assistance (AOR 0.4, 95% CI 0.2-0.8) and more likely to result in clarification of diagnosis (AOR 1.8, 95% CI 1.3-2.6), recommendation for psychotherapy (AOR 1.5, 95% CI 1.0-2.1), and retention of management of the patient with the PCP (versus referral to specialist) (AOR 1.5, 95% CI 1.0-2.1), compared to non-rural PCPs.Conclusion(s): Rural PCPs consult the CPAP for different reasons and for different patient profiles compared to non-rural peers, and rural PCPs are more likely to continue managing patients with more complex mental health problems. Whether this reflects differences in mental health epidemiology, service availability, or PCP knowledge/comfort deserves further study. These findings also inform implementation and outreach of CPAPs to rural areas.
Characteristics of patients discussed in consults between PCPs and CPAPs
Association between rural PCP and content of consults to a child psychiatry access program*adjusted for age, gender, insurance type