TY - JOUR
KW - Appointments and Schedules
KW - Continuity of Patient Care/economics
KW - Depression/epidemiology/therapy
KW - Emergency Service, Hospital
KW - Health Services Accessibility
KW - Health Services Research
KW - Humans
KW - Insurance Coverage
KW - Medicaid
KW - Mental Health Services/economics/utilization
KW - Referral and Consultation
KW - Telephone
KW - Time Factors
KW - United States/epidemiology
AU - K. V. Rhodes
AU - T. L. Vieth
AU - H. Kushner
AU - H. Levy
AU - B. R. Asplin
A1 - 
AB - STUDY OBJECTIVE: We examine access to care for acute depression by insurance status compared to access for acute medical conditions in 9 metropolitan areas in the United States. METHODS: Using an audit study design, trained research assistants posing as patients referred from a local emergency department (ED) for treatment of depression called each clinic twice, with differing insurance status. The main outcome measure was the ability to schedule a mental health appointment within 2 weeks of the ED visit. RESULTS: In 45% of 322 calls to mental health clinics, the research assistant reached an answering machine compared with 8% of calls to medical clinics. As a result, only 31% of callers with depression vignettes were able to determine whether they could get an appointment versus 78% of callers with medical complaints. When they reached appointment personnel by telephone, 57% of depression callers successfully arranged an appointment (39% within 14 days). Among depression callers who reached appointment personnel, 67% of privately insured and 33% of Medicaid callers were able to make an appointment, for overall appointment rates of 22% and 12%, respectively. Appointment success for the uninsured was comparable to that of Medicaid patients. The high percentage of callers who encountered answering machines prevented us from completing the designed analysis of paired calls to individual clinics. CONCLUSION: Our findings indicate that the process for obtaining urgent follow-up appointments is systematically different for patients seeking behavioral health care than for those with physical complaints. The use of voicemail, in lieu of having a person answer the telephone, is much more prevalent in behavioral than physical health settings. More work is needed to determine the effect of this practice on depressed individuals and vulnerable populations.
BT - Annals of Emergency Medicine
C5 - Financing & Sustainability
CP - 2
CY - United States
DO - 10.1016/j.annemergmed.2008.08.023
IS - 2
JF - Annals of Emergency Medicine
N2 - STUDY OBJECTIVE: We examine access to care for acute depression by insurance status compared to access for acute medical conditions in 9 metropolitan areas in the United States. METHODS: Using an audit study design, trained research assistants posing as patients referred from a local emergency department (ED) for treatment of depression called each clinic twice, with differing insurance status. The main outcome measure was the ability to schedule a mental health appointment within 2 weeks of the ED visit. RESULTS: In 45% of 322 calls to mental health clinics, the research assistant reached an answering machine compared with 8% of calls to medical clinics. As a result, only 31% of callers with depression vignettes were able to determine whether they could get an appointment versus 78% of callers with medical complaints. When they reached appointment personnel by telephone, 57% of depression callers successfully arranged an appointment (39% within 14 days). Among depression callers who reached appointment personnel, 67% of privately insured and 33% of Medicaid callers were able to make an appointment, for overall appointment rates of 22% and 12%, respectively. Appointment success for the uninsured was comparable to that of Medicaid patients. The high percentage of callers who encountered answering machines prevented us from completing the designed analysis of paired calls to individual clinics. CONCLUSION: Our findings indicate that the process for obtaining urgent follow-up appointments is systematically different for patients seeking behavioral health care than for those with physical complaints. The use of voicemail, in lieu of having a person answer the telephone, is much more prevalent in behavioral than physical health settings. More work is needed to determine the effect of this practice on depressed individuals and vulnerable populations.
PP - United States
PY - 2009
SN - 1097-6760; 0196-0644
SP - 272
EP - 278
EP - 
T1 - Referral without access: For psychiatric services, wait for the beep
T2 - Annals of Emergency Medicine
TI - Referral without access: For psychiatric services, wait for the beep
U1 - Financing & Sustainability
U2 - 18950898
U3 - 10.1016/j.annemergmed.2008.08.023
VL - 54
VO - 1097-6760; 0196-0644
Y1 - 2009
ER -