• David S Kroll, Carol Latham, Janice Mahal, Meagan Siciliano, Laura S Shea, Lisa Irwin, Bonnie Southworth, and David F Gitlin.
• From the Department of Psychiatry (DSK, LI, DFG), Division of Social Work (CL, JM, MS, LSS), and Department of Medicine (BS), Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA (DSK, BS, DFG). dskroll@bwh.harvard.edu.
• J Am Board Fam Med. 2019 Jul 1; 32 (4): 481-489.

PurposeAccommodating walk-in psychiatry visits in primary care can improve access to psychiatric care for patients from historically underserved groups. We sought to determine whether a walk-in psychiatry model embedded within an integrated care practice could be sustained over time, and to characterize the patients who accessed care through it.MethodsWe reviewed electronic health records linked to 811 psychiatry encounters in an integrated care practice between October 1, 2015 and September 30, 2017. Primary outcomes were the initial and return psychiatry encounters per month. Secondary outcomes were the demographics and diagnoses of patients who accessed their initial visits through walk-in sessions and scheduled appointments.Results490 initial psychiatry evaluations and 321 return encounters took place over the 2-year study period. The volume of initial psychiatry evaluations per month did not significantly change, but the volume of psychiatry follow-up encounters significantly increased after the walk-in session expanded. Medicaid recipients (OR, 1.9; 95% CI, 1.2 to 3.0); individuals without a college degree (OR, 1.7; 95% CI, 1.1 to 2.5); individuals who were single, divorced, or separated (OR, 1.7; 95% CI, 1.1 to 2.5); and individuals who identified as Black or Hispanic (OR, 2.5; 95% CI, 1.7 to 3.6) were more likely to access an initial psychiatry evaluation through a walk-in session as opposed to a scheduled appointment.ConclusionsProviding psychiatric care on a walk-in basis in integrated care is sustainable. Patients from historically underserved groups may access psychiatric care disproportionately through a walk-in option when it is available.© Copyright 2019 by the American Board of Family Medicine.

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