How to manage a patient with complex conditions who has a psychiatrist but doesn't follow through with referrals from their primary care physician (PCP)?

From the Guidelines

Managing a patient with complex conditions who has a psychiatrist but doesn't follow through with referrals requires a coordinated, patient-centered approach, focusing on integrated care models such as Primary Care Behavioral Health (PCBH) or care management, as these have shown effectiveness in improving outcomes for patients with anxiety and other behavioral health conditions 1. To address the issue of a patient not following through with referrals, it's essential to understand the barriers to follow-through, which might include transportation issues, financial constraints, fear, or misunderstanding of the referral's importance.

• Establishing open communication with the patient is crucial to identify these barriers.
• Implementing a care management system where a staff member follows up with the patient after referrals are made can offer assistance with scheduling and addressing concerns.
• Coordinating directly with the psychiatrist to ensure alignment of care plans and potentially leveraging that established relationship to encourage follow-through with other specialists is also beneficial. For medication management, maintaining clear documentation of all prescriptions across providers is vital to prevent interactions, particularly between psychotropic medications and those for physical conditions.
• Consider integrated care approaches where possible, such as bringing specialists into the primary care setting or utilizing telehealth options to reduce barriers.
• Motivational interviewing techniques can be effective in encouraging behavioral change; for example, asking "What would make it easier for you to see the cardiologist we discussed?" rather than expressing frustration about missed appointments. This approach respects patient autonomy while addressing complex medical needs and recognizes that managing multiple conditions requires both medical expertise and understanding of the patient's personal circumstances, as supported by the integration of care for mental health, substance abuse, and other behavioral health conditions into primary care 1.

From the Research

Managing Patient Care

To manage a patient with complex conditions who has a psychiatrist but doesn't follow through with referrals from their primary care physician (PCP), several factors should be considered:

• The importance of coordination across a patient's health needs and providers, as highlighted in 2
• The role of the PCP as a referral source and the benefit of continuity in care, as noted in 2
• The patient's experiences with coordination of care and the potential benefits of improving this aspect of their care

Improving Care Coordination

Strategies to improve care coordination include:

• Facilitating visit continuity between the patient and PCP, as suggested in 2
• Encouraging the use of the PCP as the referral source, as recommended in 2
• Enhancing communication between the PCP and specialists, as implied in 2

Treatment Considerations

When considering treatment options for patients with bipolar disorder, studies such as 3, 4, and 5 provide insights into the effectiveness of various medications, including:

• Quetiapine, lithium, and valproate, as discussed in 3 and 5
• The potential benefits of combination therapy, as noted in 3 and 6
• The importance of individualizing treatment based on patient characteristics and response patterns, as suggested in 4 and 5

Patient Engagement

Patient engagement and adherence to treatment plans are crucial for effective management of complex conditions:

• Patients who do not follow through with referrals may require additional support or guidance, as implied in the user's question
• Strategies to improve patient engagement and adherence, such as education and counseling, may be necessary to ensure optimal outcomes, although specific evidence is not provided in the given studies.