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Effectiveness of Telephone-Based Referral Care Management, a Brief Intervention to Improve Psychiatric Treatment Engagement

Dr. Zanjani is affiliated with the Department of Gerontology, University of Kentucky, 900 S. Limestone, 306b Wethington Building, Lexington, KY 40536-0200 (e-mail: f.zanjani{at}uky.edu). Ms. Miller, Ms. Ross, and Dr. Oslin are with the Mental Illness Research, Eduation and Clinical Center, Philadelphia Veterans Affairs Medical Center. Mr. Turiano is with the Department of Child Development and Family Studies, Purdue University, West Lafayette, Indiana. This study was presented in part at the Health Services Research and Development Service meeting, February 2007, Crystal City, Virginia, and at the annual meeting of the Gerontology Society of America, November 2007, Dallas.

OBJECTIVE: This study examined the effectiveness of a telephone-based referral care management (TBR-CM) intervention for improving engagement in psychiatric treatment. METHODS: From September 2005 to May 2006, 169 primary care patients at the Philadelphia Veterans Affairs Medical Center completed a psychiatric diagnostic interview and were identified as needing psychiatric care. From this total of eligible patients, 113 (67%) gave informed consent and were randomly assigned to receive either usual care or the intervention. Usual care consisted of participants' being schedule for a behavioral health care appointment, followed by a letter and reminder by telephone. The intervention group received the same, plus one or two brief motivational telephone sessions. Participant interviews and medical records provided study data. RESULTS: Research participants were primarily African American and 22–83 years old. In the sample, 40 patients (39%) had severe depression, 40 (39%) had substance use problems, and 33 (22%) had co-occurring severe depression and substance abuse. Overall, 40 participants (70%) in the intervention group compared with 18 (32%) in the usual care group engaged in at least one psychiatric treatment appointment (p<.001). Analyses also indicated that on average the intervention group attended more appointments (more than three) compared with the usual care group (less than two) (p=.008). CONCLUSIONS: The TBR-CM intervention program was effective at improving psychiatric treatment engagement. Future research is necessary to examine effectiveness of TBR-CM in more heterogeneous and larger samples and to evaluate economic benefits versus costs of intervention delivery.

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