Linking Patients to Family Doctor, Intensive Follow-up Studied as Alternative for Psychiatric Emergencies

BUFFALO, N.Y. -- University at Buffalo family-medicine researchers, in a new four-year study, are testing whether linking people in a psychiatric emergency to a primary-care physician and then following them closely will improve patients' mental and physical health care and save money in the process.

Called the "Facilitated Connections Project," the research aims to determine if community case management, which will involve bringing individuals under the care of a family doctor and keeping them connected to the health-care system, is better and more cost effective than "treatment as usual." The latter involves addressing the psychiatric emergency and referring the patient to community mental health services for follow-up.

The project, developed by Kim Griswold, M.D., assistant professor of family medicine and psychiatry in the UB School of Medicine and Biomedical Sciences, is being funded by a four-year, $300,000 grant from The Robert Wood Johnson Foundation's Generalist Physician Faculty Scholars Program. Griswold, a former neurological nurse, holds a master's degree in public health.

The new grant is based on positive results of an 18-month pilot study conducted by Griswold and colleagues in UB's Family Medicine Research Institute.

With "treatment as usual," Griswold said, "I didn't feel we were listening to the needs and perceptions of patients themselves. Most patients didn't have a primary-care doctor to provide on-going care and, in many cases, patients had difficulty following through on emergency-room instructions."

The pilot study involved 35 patients who came to an emergency room with a psychiatric crisis. None had a primary-care physician and most had no health insurance. Patients were placed randomly in either an intervention group or a control group.

Patients in the intervention group were shepherded through the health system by a psychiatric nurse or social worker who linked them with a primary-care doctor near their home, assisted them with making and getting to appointments, and helped them sign up for insurance. The team met with patients frequently to iron out any problems.

"It was essentially case management, but with more intensity," said Griswold.

Patients in the control group were treated for their emergency and linked to on-going mental heath care.

Results of the pilot study showed that most patients in the intensive follow-up group were linked successfully to primary care, did better functionally and spent fewer days in the hospital than the control group, Griswold said.

The Robert Wood Johnson Foundation grant will allow Griswold and colleagues to conduct a randomized trial involving 250 patients over four years. Participants will be assigned to receive either facilitated management or usual care. Each patient will be followed for one year.

Griswold plans to incorporate two new elements into this larger study to test their feasibility: psychiatric patient peers and a primary-care liaison for each patient. Both peers and liaisons will help to solidify connections between primary and mental health care, she said.

The study team is composed of Sandra Beaty, a psychiatric nurse; Margaret A. Stephan, a research nurse; Christine Wagner, a social worker, and Mary Thrist, a research assistant, all in the UB Department of Family Medicine.