How the VMAP Line Supports Repeat Callers

Between the VMAP Line’s first call in August 2019 through early March 2019, 1,100 Virginia primary care clinicians have called our line at least once. Of these, 60% have requested multiple consultations for their pediatric patients, and 31% have made five or more requests.

This May, we wanted to examine patient concerns when there are multiple consultations requested. Our VMAP Line consultations help clinicians learn how to treat specific issues that they’re seeing in their patients, with a return call from us within 30 minutes to provide same-day support.

One of the first things we work with clinicians on is screening for mental health conditions. Screening is useful for both diagnosing these conditions and assessing severity, but only 51% of the clinicians on their first consultation have used a screening tool in their assessment. However, on repeat consultations, we see this rate rise to:

• 60% for subsequent non-diagnostic consultations
• 64% for subsequent diagnostic consultations

This means that our repeat callers are increasing their screening tool usage, even though they’re not necessarily calling for the same type of patient each time.

Between their first and second consultations, we see diversity in patient clinical reasons given by clinicians.

• 42% give at least one different clinical reason
• 20% give entirely different clinical reason
• By their fifth consultation, every clinician has called for at least 2 different clinical reasons, and 2 out of 3 have called for at least 4 different reasons

After providing their patient’s clinical reasons, clinicians give details captured by 27 possible specific concerns in our data. We wanted to see how often specific concerns were cited across repeated consultations. From a clinician’s first consultation to their second with distinct patients, we see:

• 83% report at least one new specific concern
• 38% report an entirely new set of specific concerns

This means that by their second call, we’re seeing many clinicians utilize the VMAP Line for different mental health issues. As they complete more consultations, we wanted to know how often they repeat the same concerns. We find that when they have cited a specific concern at least once, most clinicians repeat…

• Anxiety or worries in the first three consultations
• Depressed or low mood in the first three consultations
• Hyperactivity or impulsivity in the first five consultations

The most common outcome for any one specific concern is that it is only cited once in a clinician’s first five consultations. The lack of repeated patient concerns suggests that clinicians may have less need to call again for the same situation in different patients, inferring that they feel more equipped to handle it themselves. All clinicians with at least five calls have called for five different specific concerns by their fifth consultation. Additionally, over half of clinicians have called for 10 or more different specific concerns.

The data continues to demonstrate that the VMAP Line is a valuable resource for timely consultation on a variety of mental health needs for patients. We can also observe from call patterns with repeated consultations by the same clinician that the VMAP Line serves as a supplement to our existing educational opportunities, shifting clinician behavior and confidence in handling their patient’s care.