PCPs Challenged to Obtain Mental Health Referrals

May 18, 2009

About two-thirds (66.8%) of primary care physicians (PCPs) in the United States have difficulty obtaining outpatient mental health services for their patients-a rate more than twice as high as rates for other services-according to study findings published online April 9 in Health Affairs. The study was conducted by Peter J. Cunningham, PhD, senior fellow at the Center for Studying Health System Change (HSC), Washington, DC, and funded by the Commonwealth Fund.

About two-thirds (66.8%) of primary care physicians (PCPs) in the United States have difficulty obtaining outpatient mental health services for their patients-a rate more than twice as high as rates for other services- according to study findings published online April 9 in Health Affairs. The study was conducted by Peter J. Cunningham, PhD, senior fellow at the Center for Studying Health System Change (HSC), Washington, DC, and funded by the Commonwealth Fund.

Cunningham analyzed results of HSC’s 2004-2005 Community Tracking Study Physician Survey to estimate the number of mental health providers, levels of insurance coverage, existence of state mental health parity requirements, and HMO penetration in 60 communities across the country. The survey had a 52% response rate and included information from 2900 PCPs (general internists, family/general practitioners, and pediatricians).

Although sections of the survey were completed before passage of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, which mandates mental health parity in private insurance benefits nationally, Cunningham determined that existing state mental health parity laws had only a modest effect on reducing disparities in accessing mental health services. PCPs were also asked about obtaining referrals to nonmental health specialists, diagnostic imaging services, and nonemergency hospital admissions. About one-third (33.8%) of PCPs were unable to get specialist referrals, 29.8% could not get diagnostic imaging services, and 16.8% could not get nonemergency hospital admissions for their patients.

Cunningham also found that of PCPs who reported problems obtaining mental health services for their patients, more than half cited lack of or inadequate insurance coverage (59%), shortages of mental health providers (58.9%), and health plan barriers (51.1%) as “very important” reasons their patients were unable to get care.

“From the perspective of PCPs, the study findings suggest that lack of access to mental health services is a serious problem, is alarming, and should be of great concern to policymakers,” Cunningham said.

Modafinil May Reduce Antipsychotic-Associated Weight Gain
Modafinil (Provigil), which is approved by the FDA to improve wakefulness in persons with narcolepsy, obstructive sleep apnea, or shift-work sleep disorder, has pharmacological effects that may reduce the weight gain associated with atypical antipsychotic medications, according to researchers led by James L. Roerig, PharmD, associate professor, department of clinical science, University of North Dakota School of Medicine and Health Sciences, Fargo. Findings were published in the April 1 issue of Biological Psychology.

The weight gain associated with the use of atypical antipsychotics, including olanzapine, risperidone, and quetiapine, is a significant adverse effect that causes many patients to stop taking their medications. To evaluate the potential of an add-on treatment to reduce antipsychotic-associated weight gain, the team conducted a 3-week, randomized, double-blind, placebo-controlled trial. All 40 subjects received 10 mg/d of olanzapine; half also received 200 mg/d of modafinil and half received placebo. Weight and feeding laboratory assessments were conducted at baseline and end point.

The primary outcome variable was a change in the body mass index (BMI) (normal range, 18.5 to 24.9 kg/m2) during the study period. The olanzapine/placebo group had a greater increase in BMI at end point compared with the olanzapine/modafinil group (0.89 ± 0.59 kg/m2 vs 0.47 ± 0.50 kg/m2; P < .05).

Although the results of this study should not be extrapolated to clinical practice at this time, the data support further evaluation in a patient population to determine whether the modifying effect of modafinil on olanzapine-associated weight gain can be demonstrated over a longer period, the authors concluded.