Pathways to Specialty Psychosis Care: Referral Outcomes to Massachusetts Largest Safety Net Hospital
BreeOna C. Namukowa, MD, MSPH 1,2, Ellie Reagan 1, Rayah Touma Sawaya 1, Amelia Blanton 1, Temitope Ogundare 1, Brittany Gouse, MD, MPH 1,2, Hannah E. Brown, MD 1,2
1: Wellness & Recovery After Psychosis Program, Boston Medical Center, Boston, MA
2: Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
Background: Individuals with schizophrenia have a 13-15 year reduction in life expectancy compared to the general population; much of this premature mortality is due to preventable cardiovascular risk and other unmet physical health needs. “Reverse integration” of primary care into specialty care has the potential to reduce disparities in physical health outcomes in patients with schizophrenia. Here, we describe the first year of a pilot of the Psychiatric Reverse Integration for Medical Expertise (PRIME) clinic run by Family Medicine and Psychiatry combined residents embedded within the specialty outpatient psychiatry setting at Boston Medical Center.
Methods: We retrospectively analyzed the utilization of PRIME clinic services between July 2023-August 2024. We used descriptive statistics to describe visit utilization as well as common conditions diagnosed and treated.
Results: There were 238 patient visits in PRIME between July 2023 to August 2024. There was a show rate of 81% of scheduled visits. Patients are referred from several sources including the general outpatient psychiatry department, the Wellness and Recovery After Psychosis (WRAP) program, addiction psychiatry, consult-liaison psychiatry, and the Boston Outpatient Assisted Treatment (BOAT) program. Examples of conditions diagnosed and treated included management of hypertension, diabetes, memory evaluations, anemia, asthma/COPD, pregnancy, cellulitis, erectile dysfunction, GERD, and Hepatitis C.
Conclusions: The relatively high show rate for PRIME clinic suggests that reverse integration is feasible and desired by patients receiving outpatient psychiatric care at a safety net hospital. Next steps include examining effectiveness outcomes, such as the longitudinal impact of PRIME on objective measures of healthcare maintenance.