Psychiatry Consultation Clinic: A Model that Improves Access to Care and Corresponds to Decreased Anxiety and Depressive Symptoms

Abstract

Access to outpatient psychiatric care is often delayed, with many patients unable to obtain timely specialty evaluation. Integrated care models such as Collaborative Care Management (CoCM) and co-located care improve outcomes but have not been widely adopted due to resource and structural barriers. Direct outpatient psychiatric consultation may offer a feasible alternative, yet its effectiveness remains understudied.

We conducted a retrospective review of the Psychiatry Consultation Clinic (PCC) at a large academic medical center. The PCC provides diagnostic clarification and treatment recommendations to primary care providers (PCPs) rather than longitudinal psychiatric care. Adult patients (≥18 years) referred between October 2019 and October 2022 from family and internal medicine practices were included (N = 545). Primary outcomes were: (1) time to implementation of consult recommendations; (2) rate of psychotropic medication implementation; and (3) changes in anxiety (Gretrospective review of the Psychiatry Consultation AD-7) and depression (PHQ-9) scores. Secondary outcomes included psychiatric diagnoses and subsequent referrals for specialty care.

The median time from referral to consultation was 5 weeks, substantially shorter than the average 6-month wait for traditional psychiatry appointments within the same system. Most patients (88.1%) were seen once, and 83.1% of visits were conducted via telemedicine. Pharmacotherapy was recommended for 81.8% of patients, and 81.4% had at least one recommendation implemented, typically within 1–3 weeks. Antidepressants accounted for two-thirds of recommendations. For patients with pre- and post-consultation data, mean GAD-7 and PHQ-9 scores decreased significantly (−2.9 and −5.0 points, respectively; both p < 0.0001), with clinically meaningful improvements observed in depression symptoms. Nearly one-quarter of patients were referred for longitudinal specialty psychiatric care, with 70% establishing follow-up within six months.

The direct consultation model was feasible, resulted in high uptake of recommendations by PCPs, and was associated with improvements in patient symptoms, particularly depression. Compared with integrated models, this approach may be easier to implement in primary care settings with limited behavioral health infrastructure. Prospective controlled studies are warranted to establish the efficacy of this outpatient consultation model and compare it to other paradigms within the continuum of psychiatric care.