Primary Care Physician Referral Patterns for Behavioral Health Diagnoses

Background: Referrals are an important component of patient care, particularly for primary care physicians (PCP). Appropriate and timely referrals are critical for individuals presenting with behavioral health conditions. Objective: To determine whether PCP visits with a behavioral health diagnosis are associated with the probability of referral to another physician, and whether this varies based on clinical condition. Design: Observational study of 1,367,021,401 PCP visits (weighted) nationally (2011-2015) Participants:Office based PCPs from National Ambulatory Medical Care Survey Main Measure: Visit resulted in a referral to another physician. Key Results:Approximately 1 of 7 visits to PCPs included behavioral health as a reason for visit and/or a diagnosis made during the visit. There was a 3.4 percentage point (pp; average marginal effect [AME]:0.034; 95% Confidence Interval [CI]: 0.008, 0.060) increased probability of referral to another physician for a PCP visit in which a behavioral health diagnosis was included versus a visit in which no behavioral health diagnosis was included, controlling for patient, insurance, physician, and organizational characteristics. The probability of referral varied by clinical diagnosis within behavioral health conditions, with an increased probability of referral of 9.3pp (adjusted AME: 0.093; 95% CI: 0.022, 0.164) associated with SUDs (excluding opioid use disorders [OUD]) relative to visits without a behavioral health diagnosis. A visit with a diagnosis of OUD was associated with a decreased probability of referral of 7.2pp (adjusted AME: -0.072; 95% CI: -0.129,-0.014) relative to visits without a behavioral health diagnosis. Visits with diagnoses of depression or other behavioral health diagnoses were not associated with a change in the probability of referral relative to visits without a behavioral health diagnosis. Conclusions: Understanding PCP referral patterns for behavioral health diagnoses is an important component of high-quality primary care. Optimizing PCP referral patterns is a key way to improve coordination of care and resource allocation.