390 - Consults with a child psychiatry access program: Comparison of physician and advanced practice primary care clinicians

Child psychiatry access programs (CPAPs) provide primary care clinicians (PCPs) with timely consults from child psychiatrists and referral assistance for patients with mental health conditions by telephone or electronic, asynchronous platform. Primary care physicians and advanced practice clinicians (physician assistants and nurse practitioners) train through separate channels, and therefore consults from each group may differ in content, outcome and clinical severity.

Objective:

We aimed to compare consults from physicians and advanced practice clinicians with Colorado’s CPAP. 

Design/Methods:

We analyzed data from consults between PCPs and the CPAP from Sept 2019- Dec 2022. Clinicians were categorized through self-report of professional degree as a physician, nurse practitioner, or physician assistant. We compared elements of consults (types of questions, content discussed, outcomes of consults, diagnoses and clinical severity) from physicians and advanced practice clinicians using bivariate and multivariate techniques, adjusted for patient age, gender, insurance and geographic status.

Results:

There were 1794 consults; 31% were from advanced practice clinicians. Consults with advanced practice clinicians were more likely to be for patients who were female (57% vs 51%, p=0.02), older (mean age 13.5 years vs 13.0 years, p=0.02), with Medicaid (48% vs 34%, p< 0.001), and from a rural area (16% vs 9%, p< 0.001). Despite calling about patients with demographic differences, advanced practice clinicians had consults that were remarkably similar in content to physicians. Physicians were more likely to discuss mental health resources (13% vs 9% of consults, p=0.01; adjusted odds ratio (AOR) 1.5, 95% confidence interval (CI) 1.1-2.2) and OCD (5% vs 2%, p=0.006; AOR 2.4, 95% CI 1.2-4.6) and less likely to discuss bipolar disorder (2% vs 5%, p=0.004; AOR 0.4, 95% CI 0.2-0.8). There was a trend toward advanced practice clinicians receiving advice to clarify diagnoses more frequently than physicians (38% vs 33%, p=0.06). No meaningful differences were found in clinical severity, diagnoses of more common mental health conditions, discussion of medication, or outcome, including the likelihood of the patient’s mental healthcare remaining in primary care.   

Conclusion(s):

Advanced practice primary care clinicians consult the CPAP for different patient profiles compared to physician peers. However, the content and clinical severity of consults are similar. Clinicians of different training backgrounds can likely be approached by CPAPs similarly in terms of education and expectations around managing mental health.