Referrals for medication evaluation

There are many reasons that a therapist or patient will consider a medication evaluation (see Table 9.1). Even when one or more indicators are present, therapists at all levels of experience know that getting a patient on the path toward a medication evaluation is not always easy. A patient s decision to follow through with a referral for medication evaluation may be a gradual process rather than a single event. 

The patient s insurance plan will often dictate the referral options. Even if the patient pays out of pocket for the therapist s services, he or she is unlikely to pay privately for medication evaluation and management. Physician charges are usually more expensive than psychotherapy charges, and appointments with physicians— regardless of whether they are psychiatrists or primary care doctors—are usually paid for by the patient s insurance. Thus, a therapist can usually start the referral process by asking whether the patient has previously seen a primary care physician or psychiatrist whose fees are paid by the patient s insurance. If the patient is comfortable with Dr. X, and the therapist is comfortable with Dr. X, the initial referral decision is made. 

Fourth, you should consider a collaborative referral for an adjunct therapist if you meet the needs of the client in most areas, but find that the client would benefit from specialized treatment in another area. An example of a reason for this type of referral would be the discovery that your client may need a psychiatric evaluation and perhaps medication management after you have been working with her or him for a period of time. You are not relinquishing your relationship with the client, but it may be necessary to bring in an outside expert in another area of care to help the client reach her or his goals for treatment. 

The referral for mental health care is often not made until an extensive medical evaluation has been completed. This medical assessment is often warranted, but a delay in recognizing the presence of panic disorder can result in an unending battery of expensive, unnecessary, and sometimes unpleasant medical tests. 

Therefore, a careful medical evaluation is critical and appropriate referral for consultation mandatory if an underlying organic process is suspected. 

Dr. P begins to offer many possible options for each problem they are looking to address and asks them what problems they would like to address first. As part of this discussion. Dr. P mentions the possibility of a referral for a medication evaluation even though she is not convinced medication is essential. In addition to other treatment choices, Mrs. B immediately accepts the medication referral. 

TABLE 9.1. Indications for Referral for Psychotropic Medication Evaluation... 

Evaluation and referral for any mental health-related complaint, even if not appropriate for followup care in medical setting... 

Provide case management which includes a complete medical evaluation, iron status, neurobehavioral assessment, and referral to local health program for environmental investigation. 

Managers and supervisors have often ignored the needs of the physically or psychologically abused or assaulted staff, requiring them to continue working, obtain medical care from private medical doctors, or blame the individual for irresponsible behavior. Injured staff must have immediate physical evaluations, be removed from the unit, and treated for acute injuries. Referral should be made for appropriate evaluation, treatment, counseling, and assistance at the time of the incident and for any required follow-up treatment. Medical services include... 

After an initial diagnostic evaluation and review of the inclusion criteria, the dog s medical history was taken and pre-treatment physical and ophthalmic examinations performed (Day 0). A cortisol stimulation test was performed at that time as well. Blood was drawn and submitted to a referral laboratory for plasma cortisol level determination by radio-immunoassay prior to IM injection of 2 u ACTH/kg and 1-2 hr later on Days 0 and 42. 

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