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Hugunin J, Khan S, McPhillips E, Davis M, Larkin C, Skehan B, Lapane KL. Pediatrician and Child Adolescent Psychiatrist Perspectives of Coordinated Care for Emerging Adults. J Adolesc Health 2023; 72:770-778. [PMID: 36604207 PMCID: PMC10121759 DOI: 10.1016/j.jadohealth.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 11/03/2022] [Accepted: 12/01/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE To explore pediatrician and child/adolescent psychiatrists' perspectives of the role of coordinated care for emerging adults with serious mental health conditions, particularly as they transition to adult care. METHODS Semi-structured individual interviews of a purposive sample of 10 pediatricians and 11 child/adolescent psychiatrists in Massachusetts were used to explore coordinated care for emerging adults. Following verbatim transcription and double coding, we conducted a thematic analysis to identify key themes. Care coordination concepts explored included a case discussion, teamwork, communication methods, medication management, transition to adult care, the healthcare home, and youth and family role. Organizational and societal barriers were also discussed. RESULTS Providers described key barriers to continuous, coordinated care for youth with serious mental health conditions, including poor communication systems between providers, no organized process for the transition from pediatric to adult care, state licensing laws (particularly impacting college-age youth), inadequate connection to community supports, and poor reimbursement rates for psychiatric care. Termination of primary care in young adults and inadequate medication side effect monitoring were described as key gaps in care. DISCUSSION The current system of coordinated care for emerging adults with serious mental health conditions is a perfect storm of challenges that creates a vicious cycle of interconnected barriers which lead to fragmented, discontinuous, and sub-par care for this population.
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Affiliation(s)
- Julie Hugunin
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts.
| | - Sara Khan
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Emily McPhillips
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Maryann Davis
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Celine Larkin
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, Massachusetts; Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Brian Skehan
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, Massachusetts; Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Kate L Lapane
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts
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Hugunin J, Davis M, Larkin C, Baek J, Skehan B, Lapane KL. Established Outpatient Care and Follow-Up After Acute Psychiatric Service Use Among Youths and Young Adults. Psychiatr Serv 2023; 74:2-9. [PMID: 36223162 PMCID: PMC9812848 DOI: 10.1176/appi.ps.202200047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE This study explored follow-up after hospitalization and emergency room (ER) use for mental health among youths and young adults with private insurance. METHODS The IBM MarketScan commercial database (2013-2018) was used to identify people ages 12-27 with a mental health hospitalization (N=95,153) or ER use (N=108,576). Factors associated with outpatient mental health follow-up within 7 and 30 days of discharge were determined via logistic models with generalized estimating equations that accounted for state variation. RESULTS Of those hospitalized, 42.7% received follow-up within 7 days (67.4% within 30 days). Of those with ER use, 28.6% received follow-up within 7 days (46.4% within 30 days). Type of established outpatient care predicted follow-up after hospitalization and ER use. Compared with people with no established care, the likelihood of receiving follow-up within 7 days was highest among those with mental health and primary care (hospitalization, adjusted odds ratio [AOR]=2.81, 95% confidence interval [CI]=2.68-2.94; ER use, AOR=4.06, 95% CI=3.72-4.42), followed by those with mental health care only (hospitalization, AOR=2.57, 95% CI=2.45-2.70; ER use, AOR=3.48, 95% CI=3.17-3.82) and those with primary care only (hospitalization, AOR=1.20, 95% CI=1.15-1.26; ER use, AOR=1.22, 95% CI=1.16-1.28). Similar trends were observed within 30 days of discharge. CONCLUSIONS Follow-up rates after acute mental health service use among youths and young adults were suboptimal. Having established mental health care more strongly predicted receiving follow-up than did having established primary care. Improving engagement with outpatient mental health care providers may increase follow-up rates.
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Affiliation(s)
- Julie Hugunin
- Clinical and Population Health Research doctoral program, Morningside Graduate School of Biomedical Sciences (Hugunin, Davis, Larkin, Baek, Lapane); Department of Psychiatry (Davis, Larkin, Skehan); Department of Emergency Medicine (Larkin); Department of Population and Quantitative Health Sciences (Baek, Lapane); and Department of Pediatrics (Skehan), University of Massachusetts Chan Medical School, Worcester
| | - Maryann Davis
- Clinical and Population Health Research doctoral program, Morningside Graduate School of Biomedical Sciences (Hugunin, Davis, Larkin, Baek, Lapane); Department of Psychiatry (Davis, Larkin, Skehan); Department of Emergency Medicine (Larkin); Department of Population and Quantitative Health Sciences (Baek, Lapane); and Department of Pediatrics (Skehan), University of Massachusetts Chan Medical School, Worcester
| | - Celine Larkin
- Clinical and Population Health Research doctoral program, Morningside Graduate School of Biomedical Sciences (Hugunin, Davis, Larkin, Baek, Lapane); Department of Psychiatry (Davis, Larkin, Skehan); Department of Emergency Medicine (Larkin); Department of Population and Quantitative Health Sciences (Baek, Lapane); and Department of Pediatrics (Skehan), University of Massachusetts Chan Medical School, Worcester
| | - Jonggyu Baek
- Clinical and Population Health Research doctoral program, Morningside Graduate School of Biomedical Sciences (Hugunin, Davis, Larkin, Baek, Lapane); Department of Psychiatry (Davis, Larkin, Skehan); Department of Emergency Medicine (Larkin); Department of Population and Quantitative Health Sciences (Baek, Lapane); and Department of Pediatrics (Skehan), University of Massachusetts Chan Medical School, Worcester
| | - Brian Skehan
- Clinical and Population Health Research doctoral program, Morningside Graduate School of Biomedical Sciences (Hugunin, Davis, Larkin, Baek, Lapane); Department of Psychiatry (Davis, Larkin, Skehan); Department of Emergency Medicine (Larkin); Department of Population and Quantitative Health Sciences (Baek, Lapane); and Department of Pediatrics (Skehan), University of Massachusetts Chan Medical School, Worcester
| | - Kate L Lapane
- Clinical and Population Health Research doctoral program, Morningside Graduate School of Biomedical Sciences (Hugunin, Davis, Larkin, Baek, Lapane); Department of Psychiatry (Davis, Larkin, Skehan); Department of Emergency Medicine (Larkin); Department of Population and Quantitative Health Sciences (Baek, Lapane); and Department of Pediatrics (Skehan), University of Massachusetts Chan Medical School, Worcester
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