Analysis of sample data PAL conducted an analysis of 100 voluntary consultations (n=100) completed within
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30 25 20 15 10
Discontinuation
ED referral
Diagnostic evaluation
Dosage decrease
Dosage time/ frequency change
0
Medication addition
5
Source: Psychiatric Assistance Line Analysis, PrairieCare 2015
the first six months. Over 60 percent of the providers called PAL directly, while 40 percent accessed the service online by either scheduling directly or submitting a secure online inquiry. Almost all callers cited multiple reasons for calling PAL, with a majority asking questions about a medication protocol for a specific patient.
The PAL sample data (see Figure 1 on page 25) shows that 73 percent of the consultations were from pediatricians, 13 percent from nurse practitioners, and 6 percent from family practice physicians. The remaining 8 percent was comprised of other mental health providers and a parent/ guardian. PAL has also been accessed by a small number of nonmedical providers (psychologists and psychotherapists) as well as parents or guardians of children with mental illnesses.
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The patient ages ranged from 3 to 39. Seventy-seven percent of the cases were between the ages of 3 and 21, where 59 percent of the patients were male and 41 percent female.
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Figure 3. Recommendations for consultations about medications
Dosage increase
PAL is designed to be convenient by offering both on-demand phone and online services. Primary care providers can submit online inquiries that are answered by secure email. They can also schedule their own appointments online, and a PAL triage social worker will call them when it is convenient. PAL is beneficial to patients and families by allowing the assessment and management of mental illness to take place in their primary care provider’s office. This means more kids are getting help sooner and avoiding the cost and trauma of
Before launching PAL in 2014, administrators at PrairieCare Medical Group surveyed pediatricians in the Twin Cities metro area to gather input to help them design the service. Nearly 90 percent of survey respondents reported wanting help with questions about specific psychotropic medications and 83 percent wanted help with dosing. Another 66 percent wanted help with diagnosis or assessment and 44 percent wanted help with triage and referrals for other behavioral health services. About half of the respondents reported either “never” or “rarely” having access to CAP services, and 89 percent said they would be more likely to manage psychiatric conditions if access to a CAP was more readily available.
Therapy recommendation
waitlists, or the pediatrician would simply do his or her best to manage the case with limited training. While a few pediatricians are adept at managing diagnoses such as ADHD and depression, many are not comfortable treating those conditions and have to make referrals elsewhere.
untreated mental illnesses.
Medication change/alternative
Child and adolescent psychiatry from page 25
Each patient case had a stated primary working diagnosis relevant for each consultation (see Figure 2 on page 25). The top working diagnoses are
anxiety, followed by depression and ADHD. These three diagnoses comprised 68 percent of all consultations. This data is congruent with the overall prevalence of mental illness in the United States, with the Centers for Disease Control ranking ADHD (6.8 percent) and behavioral or conduct problems (3.5 percent) as the most common. Anxiety disorders are reported to affect 3 percent of children aged 3 to 17 and depression to affect 2.1 percent. Most medication consultation phone calls lasted approximately 10 to 20 minutes and included multiple suggestions for ongoing medication regimens from the CAP (see Figure 3 on this page). The most common suggestion was a medication change or alternative to the current treatment plan. Also, a type of therapy was recommended in almost every case where a therapist was not currently involved in treatment. Other recommendations for medication consults included medication titrations, tapers, and changes in dosing times or frequency. Two cases included the triage social worker recommending a crisis referral to an emergency department. Every CAP consultation supported the primary care