Public Health in the Rockies 2026

Background: Timely access to psychiatric support remains limited for primary care clinicians in rural and underserved communities, yet many available resources like provider-to-provider consultation programs remain underutilized. To address underutilization and integrate such programs with workforce training, we developed a data-guided educational model using psychiatry consultation patterns.

Methods: Requests were reviewed from two psychiatry consultation programs at the University of Colorado Anschutz School of Medicine: eConsults, an asynchronous, EHR-based service, and Effective Access and Support from Psychiatry (EASY), a phone-based service. Submissions (97 EASY; 2,136 eConsults) were reviewed to identify diagnoses, submission characteristics, and clinical questions, informing the development of an Extension for Community Healthcare Outcomes (ECHO) curriculum for primary care clinicians. ECHO sessions included case-based discussions and peer exchange, promoting application and reflection while aligning with practice-based instructional design theory. Post-series evaluations assessed learning, confidence, and intended use of consultation pathways.

Results: Thirty-three individuals participated; nine completed a post-series evaluation. Most participants were direct care providers (85%) and served Medicaid patients (73%); one-third worked in Colorado’s rural or frontier counties (32%). All respondents reported increased understanding of how and when to submit consultation requests. Seventy-eight percent intended to use eConsults and 89% intended to use EASY within six months. Self-reported high confidence using psychiatry access programs increased from 11% pre- to 44% post-series. In open-ended responses, most respondents planned to submit higher-quality consultations or use consultation pathways more frequently.

Implications: This consultation-training feedback loop offers a practical strategy for strengthening community psychiatric care. By converting consultation experience into training, the model improved clinicians’ understanding, confidence, and intended use of access supports. For communities with limited access to psychiatric specialists, this approach may reduce reliance on referrals which require travel, delay care, or impose high costs. The model is adaptable to other specialties seeking to align consultation and access-focused practice.