Skip to main content

Main menu

  • Home
  • Current Issue
  • Content
    • Current Issue
    • Early Access
    • Multimedia
    • Podcast
    • Collections
    • Past Issues
    • Articles by Subject
    • Articles by Type
    • Supplements
    • Plain Language Summaries
    • Calls for Papers
  • Info for
    • Authors
    • Reviewers
    • Job Seekers
    • Media
  • About
    • Annals of Family Medicine
    • Editorial Staff & Boards
    • Sponsoring Organizations
    • Copyrights & Permissions
    • Announcements
  • Engage
    • Engage
    • e-Letters (Comments)
    • Subscribe
    • Podcast
    • E-mail Alerts
    • Journal Club
    • RSS
    • Annals Forum (Archive)
  • Contact
    • Contact Us
  • Careers

User menu

  • My alerts

Search

  • Advanced search
Annals of Family Medicine
  • My alerts
Annals of Family Medicine

Advanced Search

  • Home
  • Current Issue
  • Content
    • Current Issue
    • Early Access
    • Multimedia
    • Podcast
    • Collections
    • Past Issues
    • Articles by Subject
    • Articles by Type
    • Supplements
    • Plain Language Summaries
    • Calls for Papers
  • Info for
    • Authors
    • Reviewers
    • Job Seekers
    • Media
  • About
    • Annals of Family Medicine
    • Editorial Staff & Boards
    • Sponsoring Organizations
    • Copyrights & Permissions
    • Announcements
  • Engage
    • Engage
    • e-Letters (Comments)
    • Subscribe
    • Podcast
    • E-mail Alerts
    • Journal Club
    • RSS
    • Annals Forum (Archive)
  • Contact
    • Contact Us
  • Careers
  • Follow annalsfm on Twitter
  • Visit annalsfm on Facebook
Research ArticleResearch Brief

Warm Handoffs and Attendance at Initial Integrated Behavioral Health Appointments

Christine A. Pace, Katherine Gergen-Barnett, Alysa Veidis, Joanna D’Afflitti, Jason Worcester, Pedro Fernandez and Karen E. Lasser
The Annals of Family Medicine July 2018, 16 (4) 346-348; DOI: https://doi.org/10.1370/afm.2263
Christine A. Pace
1Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
MD, MSc
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: Christine.pace@bmc.org
Katherine Gergen-Barnett
2Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Alysa Veidis
3Commonwealth Care Alliance, Boston, Massachusetts
RN, MSN, NP-BC
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Joanna D’Afflitti
1Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
MD, MPH
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Jason Worcester
1Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Pedro Fernandez
4Department of Psychiatry, University of Texas Southwestern, Dallas, Texas
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Karen E. Lasser
1Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
MD, MPH
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • eLetters
  • Info & Metrics
  • PDF
Loading

Article Figures & Data

Tables

  • Additional Files
    • View popup
    Table 1

    Characteristics of Patients Referred to the Integrated Behavioral Health Program in Primary Care, July 1, 2015 to December 31, 2016 (N = 2,690)

    CharacteristicPercent of TotalAttended Initial Appointment No. (%)
    Age, y
     18-4050.04514 (38.19)
     41-6444.68511 (42.51)
     ≥655.2862 (43.66)
    Female sex58.74611 (38.67)
    Race/ethnicity
     Non-Hispanic black/African-American47.14472 (37.19)
     Non-Hispanic white24.05292 (45.13)
     Other or missing race9.44113 (44.49)
     Hispanic/Latino (any race)19.33210 (40.38)
    Primary language
     English81.00877 (40.25)
     Non-English19.00210 (41.10)
    Insurance
     Medicaid58.10601 (38.45)
     Medicare13.64147 (40.05)
     Commercial21.08254 (44.80)
     Other4.9157 (43.18)
    Behavioral health diagnosesa
     Depression28.74324 (41.91)
     Anxiety17.06186 (40.52)
     Bipolar disorder2.9036 (46.15)
     Panic disorder2.2321 (35.00)
     PTSD6.5882 (46.33)
     Schizophrenia9.44116 (45.67)
     Substance use disorder18.25192 (39.10)
    Medical comorbidities
     Type 2 diabetes15.43171 (41.20)
     Chronic obstructive pulmonary disease19.29209 (40.27)
    Received warm handoff20.15221 (40.77)
    Time from referral to scheduled initial appointment
     Same day as referral6.80150 (81.97)
     >1 d, but ≤30 d after referral71.00766 (40.10)
     >30 d after referral21.97169 (28.60)
    • PTSD = posttraumatic stress disorder.

    • ↵a Taken from problem lists in the electronic health record.

    • View popup
    Table 2

    Analysis of Patient Characteristics Associated With Attendance at Initial Integrated Behavioral Health Appointments in Primary Care

    VariableUnadjusted OR (95% CI)P ValueAdjusted OR (95% CI)aP Value
    Age, y
     18-401.001.00
     41-641.20 (1.02-1.40).031.31 (1.1-1.56)  .002
     ≥651.25 (0.88-1.78).201.42 (0.96-2.11)  .081
    Sex
     Female1.001.00
     Male1.19 (1.02-1.39).031.13 (0.96-1.33).15
    Race/ethnicity
     Non-Hispanic black/African-American1.001.00
     Hispanic (any race)1.14 (0.93-1.41).211.15 (0.93-1.43).20
     Non-Hispanic white1.39 (1.15-1.68)    .00081.35 (1.10-1.67)  .004
     Other/missing race1.35 (1.03-1.78).031.42 (1.07-1.88).016
    Insurance
     Medicaid1.001.00
     Medicare1.06 (0.84-1.33).640.95 (0.73-1.24).70
     Commercial1.28 (1.06-1.56).011.32 (1.07-1.61)   .008
     Other1.20 (0.84-1.72).311.26 (0.86-1.83).23
    Behavioral health diagnosisb
     Substance use disorder0.94 (0.77-1.14).520.75 (0.60-0.95)  .016
     Bipolar disorder0.79 (0.50-1.23).300.89 (0.55-1.46).66
     PTSD0.77 (0.57-1.05).100.74 (0.53-1.03)  .076
     Schizophrenia0.79 (0.61-1.02).070.80 (0.61-1.06).13
    Received warm handoff1.02 (0.84-1.23).850.96 (0.79-1.18).71
    Appointment scheduled on same day as referral7.62 (5.18-11.20)<.000111.66 (7.65-17.76)<.001
    Appointment within 1 mo0.96 (0.81-1.13).611.67 (1.37-2.05)<.001
    • OR = odds ratio; PTSD = posttraumatic stress disorder.

    • ↵a Adjusted for age, sex, race, insurance, substance use disorders, bipolar disorder, PTSD, schizophrenia, and days until next appointment.

    • ↵b Taken from problem lists in the electronic health record. Reference is not having each diagnosis.

Additional Files

  • Tables
  • The Article in Brief

    Warm Handoffs and Attendance at Initial Integrated Behavioral Health Appointments

    Christine A. Pace , and colleagues

    Background In programs that integrate behavioral health services into primary care, "warm handoffs," in which primary care clinicians introduce patients to behavioral health professionals, are commonly used. This study set out to determine if warm handoffs are associated with improved attendance at subsequent behavioral health appointments.

    What This Study Found Warm handoffs are not associated with improved attendance at behavioral health intake appointments. It has been theorized that warm handoffs could build patients' trust in behavioral health clinicians and reduce patients' stigma about behavioral health care, potentially translating to improved attendance at behavioral health appointments. Instead, researchers found that the most significant predictor of attendance at an initial intake was time from referral until appointment, consistent with other studies in specialty mental health and other clinical settings.

    Implications

    • The authors call for a prospective study comparing different types of warm handoffs to standard referrals to determine if warm handoffs improve attendance at initial intake appointments and which features are most beneficial. Such a study could also evaluate whether certain patient groups benefit more than others from warm handoffs, and if this type of referral can help address disparities in attendance across demographic groups and diagnoses.
    • In the interim, they suggest that making wait times for appointments as brief as possible is likely to improve attendance at integrated behavioral health intake appointments.
PreviousNext
Back to top

In this issue

The Annals of Family Medicine: 16 (4)
The Annals of Family Medicine: 16 (4)
Vol. 16, Issue 4
July/August 2018
  • Table of Contents
  • Index by author
  • Back Matter (PDF)
  • Front Matter (PDF)
  • In Brief
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on Annals of Family Medicine.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Warm Handoffs and Attendance at Initial Integrated Behavioral Health Appointments
(Your Name) has sent you a message from Annals of Family Medicine
(Your Name) thought you would like to see the Annals of Family Medicine web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
4 + 0 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
Citation Tools
Warm Handoffs and Attendance at Initial Integrated Behavioral Health Appointments
Christine A. Pace, Katherine Gergen-Barnett, Alysa Veidis, Joanna D’Afflitti, Jason Worcester, Pedro Fernandez, Karen E. Lasser
The Annals of Family Medicine Jul 2018, 16 (4) 346-348; DOI: 10.1370/afm.2263

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Get Permissions
Share
Warm Handoffs and Attendance at Initial Integrated Behavioral Health Appointments
Christine A. Pace, Katherine Gergen-Barnett, Alysa Veidis, Joanna D’Afflitti, Jason Worcester, Pedro Fernandez, Karen E. Lasser
The Annals of Family Medicine Jul 2018, 16 (4) 346-348; DOI: 10.1370/afm.2263
Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Abstract
    • INTRODUCTION
    • METHODS
    • RESULTS
    • DISCUSSION
    • Acknowledgements
    • Footnotes
    • References
  • Figures & Data
  • eLetters
  • Info & Metrics
  • PDF

Related Articles

  • PubMed
  • Google Scholar

Cited By...

  • In This Issue: Teachable Moments for Patients, Practices, and Systems
  • Google Scholar

More in this TOC Section

  • Genital Tucking Practices in Transgender and Gender Diverse Patients
  • Update to Gabapentinoid Use in the United States, 2002-2021
  • Implications of Overturning Roe v Wade on Abortion Training in US Family Medicine Residency Programs
Show more Research Brief

Similar Articles

Keywords

  • integrated behavioral health
  • behavioral health attendance
  • warm handoffs

Content

  • Current Issue
  • Past Issues
  • Early Access
  • Plain-Language Summaries
  • Multimedia
  • Podcast
  • Articles by Type
  • Articles by Subject
  • Supplements
  • Calls for Papers

Info for

  • Authors
  • Reviewers
  • Job Seekers
  • Media

Engage

  • E-mail Alerts
  • e-Letters (Comments)
  • RSS
  • Journal Club
  • Submit a Manuscript
  • Subscribe
  • Family Medicine Careers

About

  • About Us
  • Editorial Board & Staff
  • Sponsoring Organizations
  • Copyrights & Permissions
  • Contact Us
  • eLetter/Comments Policy

© 2025 Annals of Family Medicine