Many integrated care psychiatrists have done a variety of interventions to improve patient access to psychiatric expertise and medical providers comfort with treating mental health patients. Some include:

Access Lines

Access programs provide primary care clinicians with telephonic consultations from psychiatric specialists, typically focusing on pediatric and perinatal patients. These services help with the diagnosis and management of mental health and substance use concerns. Many programs also offer one-time consultations with patients and families, care navigation, educational resources, and other integrated care services.

E-consultation

E-consultations are an asynchronous consultation model based in the electronic medical record that allows the PCP to ask a psychiatrist specific questions about psychiatric management for their patient. If the psychiatrist accepts the consultation, they provide recommendations based on the consultation question and thorough chart review. There is an option to decline the consultation if the question is unclear or the psychiatrist believes the patient requires psychiatric assessment.

Direct One-time Consults/ Collaborative Psychopharmacology

Like other specialists in medicine, psychiatrists offer full evaluations, detailed options and contingency management plans in a one-time visit specifically written to help guide the primary care physician to continue the psychiatry management. This technique can greatly increase the number of unique patients a psychiatrist can see in one year and offer case-based learning to the referring provider. The one-time consult strategy usually is used to avoid over-burdening limited psychiatry capacity.

ECHO (Extension for Community Healthcare Outcomes) Model

This program originated at the University of New Mexico and is described as a hub and spoke model connecting multidisciplinary teams of specialists (the hub) with community-based clinicians (the spokes) via virtual meetings. Its distinguishing features are case-based learning, didactic education and empowerment of local clinicians. Sessions are typically held at regular intervals and involve community clinicians presenting real patients to the team who assist with diagnosis and treatment and provide brief focused teaching on topics relevant to the subspecialty being covered. Clinicians learn from their peers and receive ongoing mentoring through the meetings. This program expands the reach of specialty care, eliminates the need for patients to travel long distances for care, and enables local clinicians to provide evidence-based care to their patients in their own offices. Learn more about the ECHO Model here.

Other Approaches

In their Psychiatric Services article, Consultative Approaches to Leveraging the Psychiatric Workforce for Larger Populations in Need of Psychiatric Expertise, authors identify further approaches to "extend psychiatric reach to primary care populations," including didactic presentations, psychiatric access lines, store-and-forward (asynchronous) telepsychiatry, case review, and direct patient visits.