Evidence - Based Practice Change Model: Improved Access to Psychiatric Care: A Colloborative Care Practice Model

Early detection of mental illness and treatment of psychiatric disorders delivered by a psychiatric nurse practitioner (NPP) can increase patient participation in seeking psychiatric care and improve adherence with treatment.  Having an NPP on site in the primary care setting improves access to psychiatric care; decreases the burden on primary care providers (PCPs) of treating psychiatric disorders, and increases patient safety and satisfaction.  The purpose of this evidence-based practice (EBP) change project was to implement a strategy for increasing access to psychiatric care for patients by integrating psychiatric care into the primary care setting.  The NPP accepted (in-house) referrals from PCPs and provided psychiatric diagnostic evaluation and treatment planning, brief psychotherapy, and medication management, for a maximum of six visits.  Efficacy of the EBP change project was based on the outcomes, which were: 1) improved access to care, measured by a decrease of 15% in the percentage of patients referred for psychiatric care who do not follow through with referral, and a decrease in length of wait time between referral to initial appointment; 2) patient satisfaction, measured by perceived convenience and 3) decreased burden on PCPs, measured by PCP satisfaction.  The percentage of patients who were referred to the collaborative care practice model, but did not follow through was reduced to 22%, representing a 28% improvement in the rate of patients who followed through with referral.  Thus, the goal of improved access to psychiatric care was met.  Patient, PCP, and office staff surveys all indicated that they highly valued the collaborative care practice model.