Re: A Successful Walk-In Psychiatric Model for Integrated Care
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* Ryan K. Brinn

*To the Editor:* The Kroll et al1 walk-in model for sustained psychiatric care was able to increase follow-up encounters, especially in vulnerable populations. The authors claim “waiting room time was usually shorter in the afternoon;” however, they did not thoroughly measure it.1 A primary or integrated care practice that serves these at risk groups may hesitate to use this model because of the fear of its effects on wait time.

Wait time and total time in office or clinic have a significant effect on patient satisfaction.2 Satisfaction is time limited, noted by the existence of a “golden hour” patients are willing to wait for a medical encounter.3 Positive satisfaction correlates with “improved medication adherence” in patients with mental health conditions.4 Practices may worry patient dissatisfaction could be exacerbated by unknown wait times in a patient population that is already prone to poor adherence and return visits as the authors recognize.

Failing to rigorously measure waiting room time limits the generalizability and applicability of this model. With the risk of patient dissatisfaction and worsened outcomes, practices may hesitate trying this model and will then miss out on its benefits of increased patient followup. Future research in this area should include rigorous measure of wait time to encourage uptake of this promising walk-in psychiatric model.

## Acknowledgements:

Jennifer L. Middleton, MD, MPH, FAAFP

## Notes

*   To see this article online, please go to: [http://jabfm.org/content/33/1/154.full](http://jabfm.org/content/33/1/154.full).

## References

1.  1.Kroll DS, Latham C, Mahal J, et al. Successful walk-in psychiatric model for integrated care. J Am Board Fam Med 2019;32:481–9.
    
    [Abstract/FREE Full Text](http://www.jabfm.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NToiamFiZnAiO3M6NToicmVzaWQiO3M6ODoiMzIvNC80ODEiO3M6NDoiYXRvbSI7czoyMjoiL2phYmZwLzMzLzEvMTUzLjEuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 

2.  2.Medway AM, de Riese WT, de Riese CS, Cordero J. Why patients should arrive late: the impact of arrival time on patient satisfaction in an academic clinic. Healthcare 2016;4:188–91.
    
    

3.  3.Spechbach H, Rochat J, Gaspoz JM, Lovis C, Ehrler F. Patients' time perception in the waiting room of an ambulatory emergency unit: a cross-sectional study. BMC Emerg Med 19:41, 2019.
    
    

4.  4.Fisher A, Manicavasagar V, Kiln F, Juraskova I. Communication and decision-making in mental health: a systematic review focusing on bipolar disorder. Patient Educ Couns 2016;99:1106–20.