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Why Patients Do Not Follow Through With Behavioral Health Referrals: Patient-Perceived Barriers in a Community Health Care Setting

CP13 - Why Patients Do Not Follow Through With Behavioral Health Referrals: Patient-Perceived Barriers in a Community Health Care Setting

Poster Type: Research

Track/Topic: A. T. Still University; Behavioral Health Services; Quality of Care and Quality Improvement; Social Determinants of Health

Research Objectives: The purpose of this project was to determine the obstacles which prevented patients from scheduling or attending behavioral health sessions after a referral was made. Identification of perceived barriers may allow the community health center to address gaps within the continuum of care for patients in need of such services.

Research Study Design/Methods: Inclusion criteria included a behavioral health referral made between the dates of March 1, 2020 and September 31, 2020. This project focused on patients and families who failed to schedule or attend appointments after receiving the referral. A list of patients was assembled from five Family Health Centers (FHCs) within the NYU Langone system. Patients were contacted via telephone. After verbal consent was received, participants were asked about barriers they encountered which kept them from scheduling or attending sessions. Qualitative data were collected as anecdotes and the patient-perceived barriers were sorted into general categories, such as transportation, finances, etc.

Research Principal Findings and Quantitative/Qualitative Results: 827 patients met the inclusion criteria. Of 116 contact attempts made, 68 patients were reached and 57 consented to participate (response rate of 83.8%). Analysis of completed interviews reveals a range of reasons why appointments were not scheduled or kept, including, but not limited to: provider failure to contact patients to schedule sessions; lack of communication regarding the referral itself; personal belief that they did not require behavioral health services; concerns about in-person visits during a pandemic; scheduling conflicts; non-coverage by insurance; forgetfulness; lengthy gap between referral and available appointments; dissatisfaction from prior encounters; and choosing to use outside providers.

Research Conclusions on Impact on Health Centers: While there was no singular reason behind the absenteeism, certain themes became apparent in the data. Chief among them was a breakdown in communication between providers and patients. Many patients were not aware that they had been given a behavioral health referral in the first place and there seems to be a perceived lack of follow-up done by the provider regarding appointment scheduling. In addition, other factors such as financial worries, misconceptions about behavioral health, and systemic disruptions due to the COVID-19 pandemic also played a role. The findings will be provided to the Quality Improvement team at the FHCs.

Authors:

Edmund To, OMS-II, A.T. Still University - School of Osteopathic Medicine in Arizona