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Rugkåsa J, Tveit OG, Berteig J, Hussain A, Ruud T. Collaborative care for mental health: a qualitative study of the experiences of patients and health professionals. BMC Health Serv Res 2020; 20:844. [PMID: 32907559 PMCID: PMC7487713 DOI: 10.1186/s12913-020-05691-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 08/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health policy in many countries directs treatment to the lowest effective care level and encourages collaboration between primary and specialist mental health care. A number of models for collaborative care have been developed, and patient benefits are being reported. Less is known about what enables and prevents implementation and sustainability of such models regarding the actions and attitudes of stakeholders on the ground. This article reports from a qualitative sub-study of a cluster-RCT testing a model for collaborative care in Oslo, Norway. The model involved the placement of psychologists and psychiatrists from a community mental health centre in each intervention GP practice. GPs could seek their input or advice when needed and refer patients to them for assessment (including assessment of the need for external services) or treatment. METHODS We conducted in-depth qualitative interviews with GPs (n = 7), CMHC specialists (n = 6) and patients (n = 11) in the intervention arm. Sample specific topic guides were used to investigate the experience of enablers and barriers to the collaborative care model. Data were subject to stepwise deductive-inductive thematic analysis. RESULTS Participants reported positive experiences of how the model improved accessibility. First, co-location made GPs and CMHC specialists accessible to each other and facilitated detailed, patient-centred case collaboration and learning through complementary skills. The threshold for patients' access to specialist care was lowered, treatment could commence early, and throughput increased. Treatment episodes were brief (usually 5-10 sessions) and this was too brief according to some patients. Second, having experienced mental health specialists in the team and on the front line enabled early assessment of symptoms and of the type of treatment and service that patients required and were entitled to, and who could be treated at the GP practice. This improved both care pathways and referral practices. Barriers revolved around the organisation of care. Logistical issues could be tricky but were worked out. The biggest obstacle was the funding of health care at a structural level, which led to economic losses for both the GP practices and the CMHC, making the model unsustainable. CONCLUSIONS Participants identified a range of benefits of collaborative care for both patients and services. However, the funding system in effect penalises collaborative work. It is difficult to see how policy aiming for successful, sustainable collaboration can be achieved without governments changing funding structures. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03624829.
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Affiliation(s)
- Jorun Rugkåsa
- Health Services Research Unit, Akershus University Hospital, 1478 Lørenskog, Norway
- Centre for Care Research, University of South-Eastern Norway, Porsgrunn, Norway
| | - Ole Gunnar Tveit
- R&D Department of Mental Health, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Julie Berteig
- Department of Acute Psychiatry Oslo University Hospital, Oslo, Norway
| | - Ajmal Hussain
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - Torleif Ruud
- R&D Department of Mental Health, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Abstract
The worldwide burden of mental disorders is considerable, and on the rise, putting pressure on health care systems. Current reforms aim to improve the efficiency of mental health care systems by increasing service integration in communities and strengthening primary mental health care. In this context, mental health care professionals (MHPs) are increasingly required to work on interdisciplinary teams in a variety of settings. Little is known, however, about the profiles of MHPs in relation to their perceived work role performance. MHPs in Quebec (N = 315) from four local service networks completed a self-administered questionnaire eliciting information on individual and team characteristics, as well as team processes and states. Profiles of MHPs were created using a two-step cluster analysis. Five profiles were generated. MHPs belonging to profiles labelled senior medical outpatient specialized care MHPs and senior psychosocial outpatient specialized care MHPs perceived themselves as more performing than MHPs in other profiles. The profile labelled low-collaborators was significantly less performing than all other groups. Two other profiles were identified, positioned between the aforementioned groups in terms of the perceived performance of MHPs: the junior primary care MHPs and the diversified specialized care MHPs. Seniority within the team, delivering specialized type of care, and positive team processes were all features associated with profiles where perceived work performance was high. Overall, this study supports the case for initiatives aimed at improving stability and interdisciplinary collaboration in health teams, especially in primary care.
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Graham K, Cheng J, Bernards S, Wells S, Rehm J, Kurdyak P. How Much Do Mental Health and Substance Use/Addiction Affect Use of General Medical Services? Extent of Use, Reason for Use, and Associated Costs. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:48-56. [PMID: 27543084 PMCID: PMC5302109 DOI: 10.1177/0706743716664884] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To measure service use and costs associated with health care for patients with mental health (MH) and substance use/addiction (SA) problems. METHODS A 5-year cross-sectional study (2007-2012) of administrative health care data was conducted (average annual sample size = 123,235 adults aged >18 years who had a valid Ontario health care number and used at least 1 service during the year; 55% female). We assessed average annual use of primary care, emergency departments and hospitals, and overall health care costs for patients identified as having MH only, SA only, co-occurring MH and SA problems (MH+SA), and no MH and/or SA (MH/SA) problems. Total visits/admissions and total non-MH/SA visits (i.e., excluding MH/SA visits) were regressed separately on MH, SA, and MH+SA cases compared to non-MH/SA cases using the 2011-2012 sample ( N = 123,331), controlling for age and sex. RESULTS Compared to non-MH/SA patients, MH/SA patients were significantly ( P < 0.001) more likely to visit primary care physicians (1.82 times as many visits for MH-only patients, 4.24 for SA, and 5.59 for MH+SA), use emergency departments (odds, 1.53 [MH], 3.79 [SA], 5.94 [MH+SA]), and be hospitalized (odds, 1.59 [MH], 4.10 [SA], 7.82 [MH+SA]). MH/SA patients were also significantly more likely than non-MH/SA patients to have non-MH/SA-related visits and accounted for 20% of the sample but over 30% of health care costs. CONCLUSIONS MH and SA are core issues for all health care settings. MH/SA patients use more services overall and for non-MH/SA issues, with especially high use and costs for MH+SA patients.
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Affiliation(s)
- Kathryn Graham
- 1 Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto/London, Ontario.,2 Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario.,3 School of Psychology, Deakin University, Geelong, Australia.,4 National Drug Research Institute, Curtin University, Perth, Australia
| | - Joyce Cheng
- 1 Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto/London, Ontario
| | - Sharon Bernards
- 1 Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto/London, Ontario
| | - Samantha Wells
- 1 Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto/London, Ontario.,2 Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario.,3 School of Psychology, Deakin University, Geelong, Australia.,5 Department of Epidemiology, Western University, London, Ontario
| | - Jürgen Rehm
- 1 Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto/London, Ontario.,2 Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario.,3 School of Psychology, Deakin University, Geelong, Australia.,6 Klinische Psychologie & Psychotherapie, Technische Universität Dresden, Dresden, Germany.,7 Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Paul Kurdyak
- 1 Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto/London, Ontario.,7 Department of Psychiatry, University of Toronto, Toronto, Ontario.,8 Institute for Clinical Evaluative Sciences, Toronto, Ontario
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Sowers W, Arbuckle M, Shoyinka S. Recommendations for Primary Care Provided by Psychiatrists. Community Ment Health J 2016; 52:379-86. [PMID: 26803759 DOI: 10.1007/s10597-015-9983-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 12/22/2015] [Indexed: 10/22/2022]
Abstract
Recent studies have shown that people with severe mental illness have a dramatically lower life expectancy than the general population. Psychiatrists have not traditionally been very attentive to or involved with physical health issues and there has been growing emphasis on integrated care for physical and mental health and access to primary care for all members of the population. This paper examines the role of psychiatrists in the provision of primary care to the patients they treat. Some recommendations are offered for their involvement in the provision of primary care at three levels of complexity: Level 1--Universal Basic Psychiatric Primary Care; Level 2--Enhanced Psychiatric Primary Care; and Level 3--Fully Integrated Primary Care and Psychiatric Management. Some of the obstacles to the provision of primary care by psychiatrists are considered along with some suggestions for overcoming them.
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Affiliation(s)
- Wesley Sowers
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, 3811 O'Hara St, Webster Hall, Pittsburgh, PA, 15213, USA.
| | - Melissa Arbuckle
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Drive, Box 103, New York, NY, 10032, USA
| | - Sosunmolu Shoyinka
- Sunflower State Health Plan Columbia, University of Missouri Medical Center, 4507 Maxwell Lane, Columbia, MO, 65203-6565, USA
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Haskell R, Graham K, Bernards S, Flynn A, Wells S. Service user and family member perspectives on services for mental health, substance use/addiction, and violence: a qualitative study of their goals, experiences and recommendations. Int J Ment Health Syst 2016; 10:9. [PMID: 26900398 PMCID: PMC4761172 DOI: 10.1186/s13033-016-0040-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 02/05/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mental health and substance use disorders (MSD) are significant public health concerns that often co-occur with violence. To improve services that address MSD and violence [MSD(V)], it is critical to understand the perspectives of those most affected, people who have sought help for MSD(V) (i.e., "service users"), especially those with co-occurring issues, as well as their family members. METHODS We conducted structured interviews with 73 service users and 41 family members of service users in two Ontario communities (one urban, one rural) regarding their goals related to help-seeking, positive and negative experiences, and recommendations for improving systems of care. RESULTS Overall, participants expressed a need for services that: (1) are respectful, nonjudgmental, and supportive, help service users to feel more 'normal' and include education to reduce stigma; (2) are accessible, varied and publicly funded, thereby meeting individual needs and addressing equity concerns at a systems level; and (3) are coordinated, holistic and inclusive of family members who often support service users. CONCLUSIONS The findings provide a rich understanding of how service users and their families perceive services for MSD(V) issues and identify key ways to better meet their needs.
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Affiliation(s)
- Rebecca Haskell
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, 200-100 Collip Circle, London, ON N6G 4X8 Canada
| | - Kathryn Graham
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, 200-100 Collip Circle, London, ON N6G 4X8 Canada ; Department of Psychology, Western University, London, ON Canada ; Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada ; School of Psychology, Faculty of Health, Deakin University, Geelong, VIC Australia ; National Drug Research Institute, Curtin University, Perth, WA Australia
| | - Sharon Bernards
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, 200-100 Collip Circle, London, ON N6G 4X8 Canada
| | - Andrea Flynn
- Provincial System Support Program, Centre for Addiction and Mental Health, London, ON Canada
| | - Samantha Wells
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, 200-100 Collip Circle, London, ON N6G 4X8 Canada ; Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada ; School of Psychology, Faculty of Health, Deakin University, Geelong, VIC Australia ; Department of Epidemiology and Biostatistics, Western University, London, ON Canada
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Tobon JI, Reid GJ, Brown JB. Continuity of Care in Children's Mental Health: Parent, Youth and Provider Perspectives. Community Ment Health J 2015; 51:921-30. [PMID: 25827303 DOI: 10.1007/s10597-015-9873-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 03/25/2015] [Indexed: 11/24/2022]
Abstract
Continuity of care, how individuals experience care over time as coherent and linked, is considered an ethical principle of care. While continuity has been examined extensively in the adult health literature, there is a paucity of studies examining continuity in children's mental health care. Using qualitative semi-structured interviews with parents, youth, and service providers, the current study found themes and issues unique to this healthcare context, such as coordination across sectors; risks to discontinuity, such as transitions; and consequences of discontinuity, such as parents acting as liaisons. Implications of these findings are discussed.
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Affiliation(s)
- Juliana I Tobon
- St. Joseph's Healthcare Hamilton, 38 James Street South, 2nd Floor, Hamilton, ON, L8P 4W6, Canada. .,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada. .,Department of Psychology, The University of Western Ontario, London, ON, Canada.
| | - Graham J Reid
- Department of Psychology, The University of Western Ontario, London, ON, Canada.,Department of Family Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada.,Department of Paediatrics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada.,Children's Health Research Institute, London, ON, Canada.,Lawson Health Research Institute, London, ON, Canada
| | - Judith B Brown
- Department of Family Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada.,School of Social Work, King's University College, The University of Western Ontario, London, ON, Canada
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7
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Masotti P, Longstaffe S, Gammon H, Isbister J, Maxwell B, Hanlon-Dearman A. Integrating care for individuals with FASD: results from a multi-stakeholder symposium. BMC Health Serv Res 2015; 15:457. [PMID: 26438317 PMCID: PMC4594899 DOI: 10.1186/s12913-015-1113-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 09/23/2015] [Indexed: 11/18/2022] Open
Abstract
Background Fetal Alcohol Spectrum Disorder (FASD) has a significant impact on communities and systems such as health, education, justice and social services. FASD is a complex neurodevelopmental disorder that results in permanent disabilities and associated service needs that change across affected individuals’ lifespans. There is a degree of interdependency among medical and non-medical providers across these systems that do not frequently meet or plan a coordinated continuum of care. Improving overall care integration will increase provider-specific and system capacity, satisfaction, quality of life and outcomes. Methods We conducted a consensus generating symposium comprised of 60 experts from different stakeholder groups: Allied & Mental Health, Education, First Nations & Métis Health, Advocates, Primary Care, Government Health Policy, Regional FASD Coordinators, Social Services, and Youth Justice. Research questions addressed barriers and solutions to integration across systems and group-specific and system-wide research priorities. Solutions and consensus on prioritized lists were generated by combining the Electronic Meeting System approach with a modified ‘Nominal Group Technique’. Results FASD capacity (e.g., training, education, awareness) needs to be increased in both medical and non-medical providers. Outcomes and integration will be improved by implementing: multidisciplinary primary care group practice models, FASD system navigators/advocates, and patient centred medical homes. Electronic medical records that are accessible to multiple medical and non-medical providers are a key tool to enhancing integration and quality. Eligibility criteria for services are a main barrier to integration across systems. There is a need for culturally and community-specific approaches for First Nations communities. Conclusions There is a need to better integrate care for individuals and families living with FASD. Primary Care is well positioned to play a central and important role in facilitating and supporting increased integration. Research is needed to better address best practices (e.g., interventions, supports and programs) and long-term individual and family outcomes following a diagnosis of FASD.
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Affiliation(s)
- Paul Masotti
- Community Wellness Department, Native American Health Center, 3124 International Blvd. Ste 214, Oakland, CA, 94601, USA.
| | - Sally Longstaffe
- Children's Hospital of Winnipeg, University of Manitoba, CK253-840 Sherbrook Street, Winnipeg, Manitoba, R3A 1S1, Canada.
| | - Holly Gammon
- Healthy Child Manitoba Office, Government of Manitoba, 3rd Floor - 332 Bannatyne Avenue, Winnipeg, Manitoba, R3A 0E2, Canada.
| | - Jill Isbister
- Healthy Child Manitoba Office, Government of Manitoba, 3rd Floor - 332 Bannatyne Avenue, Winnipeg, Manitoba, R3A 0E2, Canada.
| | - Breann Maxwell
- Manitoba FASD Centre, 633 Wellington Crescent, Winnipeg, Manitoba, R3M 0A8, Canada.
| | - Ana Hanlon-Dearman
- Children's Hospital of Winnipeg, University of Manitoba, CK253-840 Sherbrook Street, Winnipeg, Manitoba, R3A 1S1, Canada.
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8
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Zeidler Schreiter EA, Pandhi N, Fondow MD, Thomas C, Vonk J, Reardon CL, Serrano N. Consulting psychiatry within an integrated primary care model. J Health Care Poor Underserved 2014; 24:1522-30. [PMID: 24185149 DOI: 10.1353/hpu.2013.0178] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
After implementation of an integrated consulting psychiatry model and psychology services within primary care at a federally qualified health center, patients have increased access to needed mental health services, and primary care clinicians receive the support and collaboration needed to meet the psychiatric needs of the population.
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9
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Abstract
OBJECTIVES This study aims to assess the rate of six monthly communications between specialised psychiatric services and primary care and to determine factors which predict such communication. METHODS A retrospective review of the clinical records of all patients attending the relevant local psychiatric outpatient clinic was carried out by all members of the multidisciplinary team to identify patient demographic and clinical variables as well as to determine if there has been documentation of communication with primary care in the preceding six months. Letters were sent to the relevant primary care teams regarding progress on their patients in cases where it was identified that no communication had occurred in the preceding six months. RESULTS A total of 145 patients' charts were reviewed. Of these, 53.3% of the patients were females and 46.7% were males. The mean age was 47.9 years (SD = 14). Patients' diagnoses included; depression (41%), bipolar affective disorder (6.7%), schizophrenia/schizoaffective disorder (27.6%), anxiety disorders (6.7%), alcohol dependency syndrome (11%) and other disorders (7%). Overall, only 36% of patients' charts had a record of communication with primary care in the last six months. Only one variable, 'changes made to the patents medication in the last six months' was significantly associated with the likelihood that there had been communication with primary care with an odds ratio of 15 and a p-value of 0.00. CONCLUSION A six monthly review has a potential to improve the level of communication between specialised psychiatric services and primary care.
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Abstract
Chronic disease (care) management (CDM) is a patient-centered model of care that involves longitudinal care delivery; integrated, and coordinated primary medical and specialty care; patient and clinician education; explicit evidence-based care plans; and expert care availability. The model, incorporating mental health and specialty addiction care, holds promise for improving care for patients with substance dependence who often receive no care or fragmented ineffective care. We describe a CDM model for substance dependence and discuss a conceptual framework, the extensive current evidence for component elements, and a promising strategy to reorganize primary and specialty health care to facilitate access for people with substance dependence. The CDM model goes beyond integrated case management by a professional, colocation of services, and integrated medical and addiction care-elements that individually can improve outcomes. Supporting evidence is presented that: 1) substance dependence is a chronic disease requiring longitudinal care, although most patients with addictions receive no treatment (eg, detoxification only) or short-term interventions, and 2) for other chronic diseases requiring longitudinal care (eg, diabetes, congestive heart failure), CDM has been proven effective.
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Durbin J, Barnsley J, Finlayson B, Jaakkimainen L, Lin E, Berta W, McMurray J. Quality of communication between primary health care and mental health care: an examination of referral and discharge letters. J Behav Health Serv Res 2013; 39:445-61. [PMID: 22855384 DOI: 10.1007/s11414-012-9288-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In managing treatment for persons with mental illness, the primary care physician (PCP) needs to communicate with mental health (MH) professionals in various settings over time to provide appropriate management and continuity of care. However, effective communication between PCPs and MH specialists is often poor. The present study reviewed evidence on the quality of information transfer between PCPs and specialist MH providers for referral requests and after inpatient discharge. Twenty-three audit studies were identified that assessed the quality of content and nine that assessed strategies to improve quality. Results indicated that rates of item reporting were variable. Within the limited evidence on interventions to improve quality, use of structured forms showed positive results. Follow-up work can identify a minimum set of items to include in information transfers, along with item definitions and structures for holding this information. Then, methodologies for measuring data quality, including electronically generated performance metrics, can be developed.
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Affiliation(s)
- Janet Durbin
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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Carta M, Petretto D, Adamo S, Bhat K, Lecca M, Mura G, Carta V, Angermeyer M, Moro M. Counseling in primary care improves depression and quality of life. Clin Pract Epidemiol Ment Health 2012; 8:152-7. [PMID: 23173011 PMCID: PMC3502887 DOI: 10.2174/1745017901208010152] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 05/14/2012] [Accepted: 03/14/2012] [Indexed: 11/24/2022]
Abstract
Introduction: To measure the effectiveness on Quality of Life of adjunctive cognitive behavioral counseling in the setting of General Practitioners (GPs) along with the treatment as usual (TAU;) for the treatment of depression. Methods: Six month-controlled trial of patients who were referred to randomly assigned GPs (four for experimental group of patients and ten for the control) was done. Experimental sample had 34 patients with DSM-IV diagnosis of Depression (Depressed Episode, Dysthymia, or Adjustment Disorder with Depressed Mood) receiving the TAU supplemented with counseling. Control group had 30 patients with diagnosis of Depression receiving only the TAU. Results: The Beck Depression Inventory (BDI) score improved in both groups. Patients in the experimental group showed greater improvement compared to the control group at T2. The World Health Organization Quality OF Life Questionnaire (WHOQOL) score also improved in the experimental group but not in the control group. The improvement in the experimental group was statistically significant in terms of both BDI and WHOQOL scores. Conclusions: Adding counseling to TAU in general medical practice settings is more effective in controlling the symptoms of depression and improving the quality of life as measured over a period of six months, than TAU alone. These results while encouraging, also calls for a larger study involving a largersample size and a longer period of time.
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Affiliation(s)
- Mg Carta
- Centro di Psichiatria di Consultazione e Psicosomatica, University of Cagliari and AOU Cagliari, Italy
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13
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Abstract
OBJECTIVES Primary care teams have the potential to deliver much of the care currently provided by specialist services. The aim of this review was to determine from patients' clinical records and multidisciplinary team discussions, those that may be suitable for discharge back into primary care. METHODS A retrospective review of the clinical notes of all patients attending a psychiatric outpatient clinic was carried out by all members of the multidisciplinary team to determine the appropriateness of continuing to provide psychiatric services in a specialised psychiatric clinic rather than in a primary care setting, taking into account the patients demographic and clinical variables. RESULTS It was recommended that 60% of all the patients needed to continue attending the local mental health service, 35.2% could be discharged back into primary care for continuing management whilst the remaining 4.8% could be managed jointly between primary care and the community mental health service. The bulk of the patients recommended for discharge into primary care had a diagnosis of anxiety disorder or depression and all of them had been stable on their treatment for more than six months. CONCLUSION Regular multidisciplinary team review has a potential to identify patients who could be discharged back into primary care.
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14
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Goldner EM, Jones W, Fang ML. Access to and waiting time for psychiatrist services in a Canadian urban area: a study in real time. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2011; 56:474-80. [PMID: 21878158 DOI: 10.1177/070674371105600805] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To obtain improved quality information regarding psychiatrist waiting times by use of a novel methodological approach in which accessibility and wait times are determined by a real-time patient referral procedure. METHOD An adult male patient with depression was referred for psychiatric assessment by a family physician. Consecutive calls were made to all registered psychiatrists (n = 297) in Vancouver. A semistructured call procedure was used to collect information about the psychiatrists' availability for receipt of this and similar referrals, identify factors that affect psychiatrist accessibility, and determine the availability of cognitive-behavioural therapy (CBT). RESULTS Efforts were made to contact 297 psychiatrists and 230 (77%) were reached successfully. Among the 230 psychiatrists contacted, 160 (70%) indicated that they were unable to accept the referral. Although 70 (30%) indicated that they might be able to consider accepting a referral, 64 (91% of those who would consider accepting the referral) indicated that they would need to review detailed, written referral information and could not provide estimates of the length of wait times if the patient was to be accepted. Only 6 (3% of the 230 psychiatrists contacted) offered immediate appointment times and their wait times ranged from 4 to 55 days. When asked whether they could provide CBT, most (56%) psychiatrists in clinical practice answered maybe. CONCLUSIONS Substantial barriers exist for family physicians attempting to refer patients for psychiatric referral. Consolidated efforts to improve access to psychiatric assessment are needed.
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Affiliation(s)
- Elliot M Goldner
- Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia.
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15
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Ahn S, Tai-Seale M, Huber C, Smith ML, Ory MG. Psychotropic medication discussions in older adults' primary care office visits: So much to do, so little time. Aging Ment Health 2011; 15:618-29. [PMID: 21815854 DOI: 10.1080/13607863.2010.548055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To examine discussions of psychotropic medications during the older patient's visit to primary care physicians, identify how physician's competing demands influence these discussions, describe different scenarios physicians utilize to address mental health complaints of older adults, and recommend best practices for diagnosing and treating such patients. METHOD Convenience sample of 59 videotapes of primary care office visits involving mental health discussions in the United States complemented by patient and physician surveys. Videotaped visits were examined using logistic regression for grouped-level data to explore contributions of physician's competing demands to the likelihood of having psychotropic medication discussions. Tape transcripts were selected to provide examples of prescribing and referral behaviors. RESULTS One-third of these visits contained no psychotropic medication discussions despite its important role in treating mental illnesses. When prescribing psychotropic medicines, physicians presented information about the medication's purpose and brand name more often than adverse effects or usage. More competing demands (i.e., more topics discussed or more leading causes of disability addressed during the visit) were associated with less psychotropic medication discussions. Selected case scenarios illustrate the importance of acknowledging mental illness, prescribing psychotropic medications, explaining the medications, and/or referring patients to mental health providers to address their mental health complaints. CONCLUSION Competing demands may constrain discussions of psychotropic medications. Given the seriousness of mental illness in late life, system-level changes may be needed to correctly diagnose mental illness, take more proactive actions to improve mental health, and enhance information exchange concerning psychotropic medication in a manner that meets patients' needs.
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Affiliation(s)
- SangNam Ahn
- Department of Social and Behavioral Health, School of Rural Public Health, Texas A&M Health Science Center, College Station, TX, USA.
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Abstract
This study examines routine computerized mental health screening for adolescents scheduled for a routine physical examination in a group pediatric practice. Medical records of adolescents aged 13 to 17 who were offered screening (n = 483) were reviewed. Approximately 44.7% (95% confidence interval (CI) 40.3-49.2) were screened, and 13.9% (95% CI 9.3-18.5) were identified as being at risk. Screening was associated with significantly increased odds of receiving either pediatric mental health care or a referral for specialty mental health care (adjusted odds ratio (AOR): 2.6 95% CI 1.2-5.6). Among patients who received either mental health intervention, those who were screened were significantly more likely to be referred to specialty care (AOR: 15.9 95% CI 2.5-100.4), though they were less likely to receive pediatric mental health care (AOR: 0.10 95% CI 0.02-0.54). The findings support the feasibility of routine mental health screening in pediatric practice. Screening is acceptable to many parents and adolescents, and it is associated with referral for specialized mental health care rather than care from the pediatrician.
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Kates N, McPherson-Doe C, George L. Integrating Mental Health Services Within Primary Care Settings. J Ambul Care Manage 2011; 34:174-82. [DOI: 10.1097/jac.0b013e31820f6435] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
INTRODUCTION The paper highlights key trajectories and outcomes of the recent policy developments toward integrated health care delivery systems in Quebec and Ontario in the primary care sector and in the development of regional networks of health and social services. It particularly explores how policy legacies, interests and cultures may be mitigated to develop and sustain different models of integrated health care that are pertinent to the local contexts. POLICY DEVELOPMENTS In Quebec, three decades of iterative developments in health and social services evolved in 2005 into integrated centres for health and social services at the local levels (CSSSs). Four integrated university-based health care networks provide ultra-specialised services. Family Medicine Groups and network clinics are designed to enhance access and continuity of care. Ontario's Family Health Teams (2004) constitute an innovative public funding for private delivery model that is set up to enhance the capacity of primary care and to facilitate patient-based care. Ontario's Local Health Integration Networks (LHINs) with autonomous boards of provider organisations are intended to coordinate and integrate care. CONCLUSION Integration strategies in Quebec and Ontario yield clinical autonomy and power to physicians while simultaneously making them key partners in change. Contextual factors combined with increased and varied forms of physician remunerations and incentives mitigated some of the challenges from policy legacies, interests and cultures. Virtual partnerships and accountability agreements between providers promise positive but gradual movement toward integrated health service systems.
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Affiliation(s)
- Izzat Jiwani
- Health Policy Researcher and Management Consultant, IMJ Management Inc. Suite 2801-78 Harrison Garden Boulevard, North York, Ontario, M2N 7E2, Canada
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Siano AK, Ribeiro LC, Ribeiro MS. Análise comparativa do registro médico-pericial do diagnóstico de transtornos mentais de segurados do Instituto Nacional do Seguro Social requerentes de auxílio-doença. JORNAL BRASILEIRO DE PSIQUIATRIA 2010. [DOI: 10.1590/s0047-20852010000200009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVOS: Analisar comparativamente os registros médico-periciais dos diagnósticos de segurados do INSS requerentes de auxílio-doença apresentando transtorno mental. MÉTODO: Estudo retrospectivo de registros de perícias iniciais realizadas em agências da Previdência Social de Juiz de Fora, MG, entre julho/2004 e dezembro/2006. Foram realizadas análises bivariadas de acordo com o local de realização da perícia, categoria de perito médico examinador e período da avaliação RESULTADOS: Transtornos depressivos leves ou moderados e transtornos persistentes do humor (39,6%) e os transtornos de ansiedade (34,5%) - quadros mais leves que não comprometeriam tanto a capacidade laborativa - foram os diagnósticos mais frequentemente registrados. Dentre as comorbidades, transtornos mentais foram mais frequentes (33,6%) que quadros clínicos, especialmente na agência Riachuelo, entre peritos concursados após 2005 e no quarto período estudado. A concordância entre o diagnóstico do benefício atual e o do benefício anterior foi baixa, inferior a 50% na maioria dos casos, mesmo para transtornos mentais graves e com características clínicas mais bem definidas, como as psicoses. A maior taxa de concordância ocorreu com os transtornos por uso de substâncias psicoativas entre peritos credenciados (66,7%). CONCLUSÃO: Este estudo evidencia possíveis falhas no treinamento dos peritos médicos de Juiz de Fora no que se refere ao registro do diagnóstico dos transtornos mentais dos segurados avaliados.
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Pandurangi AK, Desai NG. Report of the Indo-US health care summit 2009 - Mental health section. Indian J Psychiatry 2009; 51:292-301. [PMID: 20048457 PMCID: PMC2802379 DOI: 10.4103/0019-5545.58298] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The 2nd Indo-US Health Care Summit held in January 2009 was a forum to discuss collaboration between physicians in the US and India on medical education, health care services and research. Six specialties were represented including Mental Health (MH). Using Depression as the paradigmatic disorder, the following objectives were developed. Objective I - Leadership and Public Education: Linkage with like-minded agencies and organizations. The core message should be simple. Major Depression is a brain disorder. Depression is treatable. Timely treatment prevents disability and suicide. Objective II - Medical Education: To improve psychiatric education, it was proposed that (1) relations between US/UK and Indian mid-level institutions be established, (2) teaching methods such as tele-psychiatry and online courses be pursued, (3) use models of teaching excellence to arouse student interest, and (4) develop core curricula for other branches of medicine, and CME. Objective III - Reduce Complications of Depression (Suicide, Alcoholism): Goals include (1) decriminalizing attempted suicide, (2) improving reporting systems, and including depression, psychosis, alcoholism, and suicide in the national registry, (3) pilot studies in vulnerable groups on risk and interventions, and (4) education of colleagues on alcoholism as a link between psychiatric and medical disorders. Objective IV - Integrating MH Treatment& Primary Health Care: The focus should be on training of general practitioners in psychiatry. Available training modules including long distance learning modules to be suitably modified for India. Collaborations and specific project designs are to be developed, implemented and monitored by each specialty group and reviewed in future summits.
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Hacker KA, Myagmarjav E, Harris V, Suglia SF, Weidner D, Link D. Mental health screening in pediatric practice: factors related to positive screens and the contribution of parental/personal concern. Pediatrics 2006; 118:1896-906. [PMID: 17079560 DOI: 10.1542/peds.2006-0026] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The goals were to examine factors related to positive Pediatric Symptom Checklist scores in an urban practice and to examine the relative contribution of parental/personal concern about emotional and behavioral problems to mental health problem identification. METHODS Annual screening using the Pediatric Symptom Checklist was implemented in Cambridge Pediatrics (Cambridge, MA). A social worker was colocated in the clinic to provide therapeutic interventions for patients. A sample of 1668 screened patients between 4 years 11 months and 19 years of age was used for analysis. Bivariate and multivariate analyses were conducted to determine factors predictive of positive Pediatric Symptom Checklist scores, including demographics, socioeconomic indicators, enrollment in counseling, and parental/personal concern. Parental/personal concern, counseling, and positive Pediatric Symptom Checklist scores were examined to determine their efficacy as screening methods. RESULTS Six percent of the population had positive Pediatric Symptom Checklist scores. There were statistically significant relationships between a positive score and being in counseling, parental/personal concern, having public insurance, and living in an area with median household incomes of less than 50,000 dollars. Parental/personal concern was 40% sensitive for a positive score. A positive Pediatric Symptom Checklist score with or without parental/personal concern identified 3.8% of the population; parental/personal concern with or without a positive Pediatric Symptom Checklist score identified 4.5%. CONCLUSIONS Mental health screening can be effectively implemented in a pediatric practice. Colocated mental health professionals provide additional support. The combination of a screening tool and questions about parental/personal concern and present counseling can provide critical information about a child's mental health.
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Affiliation(s)
- Karen A Hacker
- Institute for Community Health, Cambridge Health Alliance, 163 Gore St, Cambridge, MA 02141, USA.
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Menchetti M, Tarricone I, Bortolotti B, Berardi D. Integration between general practice and mental health services in Italy: guidelines for consultation-liaison services implementation. Int J Integr Care 2006; 6:e05. [PMID: 16896385 PMCID: PMC1480371 DOI: 10.5334/ijic.152] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2005] [Revised: 03/09/2006] [Accepted: 03/16/2006] [Indexed: 11/20/2022] Open
Abstract
PURPOSE This paper illustrates some guidelines for the implementation of Consultation-liaison services in contexts where GPs work alone. We present some activity data of our experience in the period 1999-2004 and a critical evaluation of what works and what does not work. CONTEXT In Italy single-sited spontaneous initiatives of co-operation and integration between general practice and psychiatry have been implemented in many regions. Recently, the Italian Health Care Government has begun to encourage integration between primary and secondary care for the management of mental health. The Bologna Consultation-liaison Service opened in 1999 in one area. The service was first located in the Community Mental Health Centre and subsequently in a medical non-psychiatric outpatient service. In 2002, the services were implemented in the overall city area, and the Bologna Consultation-liaison Service had its own office in the centre of the town. DATA SOURCE Data have been collected by reviewing clinical charts. They include clinical (mental status examination, progress notes) and socio-demographic data, assessment scales that measure psychological distress and disability, reports for GPs, and consultation outcome. CONCLUSION A consultation-liaison service like the one proposed in this paper could contribute to an efficient and fully-integrated collaborative management of common psychiatric disorders, reducing the use of mental health services.
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Affiliation(s)
- M Menchetti
- Institute of Psychiatry, Bologna University, Italy.
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Abstract
OBJECTIVE The aim of this study was to evaluate the effectiveness of a primary care mental health service. DESIGN The study used a naturalistic longitudinal design to follow groups of participants who received intervention from a rural mental health worker, or 'usual' mental health service, or no treatment, over a period of 12 months. SETTING The service was evaluated in a rural primary care setting. PARTICIPANTS One hundred and forty-five primary care patients. OUTCOME MEASURES Changes in symptomatology were assessed using the SCL-90R summary scales, and changes in quality of life were assessed using the EuroQOL. RESULTS Those participants treated by the primary mental health worker showed significant improvements in symptoms and quality of life compared to both the usual and no-treatment groups. CONCLUSION There are few studies evaluating mental health services in rural settings. This study demonstrated that a particular model of primary mental health care was more effective than usual mental health care and no treatment at resolving symptoms and improving quality of life.
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Affiliation(s)
- Alistair Campbell
- Department of Rural Health, University of Tasmania, Launceston, Tasmania, Australia.
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Wright MJ, Harmon KD, Bowman JA, Lewin TJ, Carr VJ. Caring for depressed patients in rural communities: general practitioners' attitudes, needs and relationships with mental health services. Aust J Rural Health 2005; 13:21-7. [PMID: 15720311 DOI: 10.1111/j.1440-1854.2004.00641.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To examine the needs and practices of rural GPs and their relationships with local acute mental health services, particularly in the provision of care to depressed patients. DESIGN Postal survey. SETTING Rural general practices. SUBJECTS Ninety-nine GPs (63 males, 36 females) from the Hunter Valley region of NSW, Australia. MAIN OUTCOME MEASURES GPs' self-reported contact rates, confidence, needs and beliefs. RESULTS Depression was the most commonly seen mental disorder, with an average of 1.44 patients per GP per month referred to local acute mental health services, most commonly for suicidality. The preferred form of feedback after the referral of a depressed patient was a follow-up letter, while the most requested type of patient management support was cognitive behavioural therapy (CBT) groups. GPs were most confident in recognising depression, compared to other mental disorders except anxiety, and they were most confident in treating depression, compared to all other mental disorders. The most common barrier to providing care for depressed patients was reported to be 'time constraints' on GPs. CONCLUSIONS The challenge for mental health services is to develop ways to collaborate more effectively with GPs in the provision of psychological services for depressed patients in rural communities.
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Affiliation(s)
- Megan J Wright
- Hunter New England Mental Health and the Centre for Mental Health Studies, University of Newcastle, New South Wales, Australia.
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Krautscheid L, Moos P, Zeller J. Patient & Staff Satisfaction with Integrated Services at Old Town Clinic: A Descriptive Analysis. J Psychosoc Nurs Ment Health Serv 2004. [DOI: 10.3928/02793695-20041101-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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McElheran W, Eaton P, Rupcich C, Basinger M, Johnston D. Shared mental health care: The Calgary model. ACTA ACUST UNITED AC 2004. [DOI: 10.1037/1091-7527.22.4.424] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bourgeois JA, Hilty DM, Klein SC, Koike AK, Servis ME, Hales RE. Expansion of the consultation-liaison psychiatry paradigm at a university medical center: integration of diversified clinical and funding models. Gen Hosp Psychiatry 2003; 25:262-8. [PMID: 12850658 DOI: 10.1016/s0163-8343(03)00040-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The perspective of the contemporary Consultation-Liason Service (CLS) psychiatrist is increasingly one of consultant to medical and surgical colleagues in models other than inpatient medical and surgical units. Simultaneously, the need for a clinically and educationally robust inpatient CLS persists despite funding pressures. The University of California, Davis Medical Center Department of Psychiatry has made use of creative organizational and financial models to accomplish the inpatient CLS clinical and educational missions in a fiscally responsible manner. In addition, the department has in recent years expanded the delivery of psychiatry consultation-liaison clinical and educational services to other models of care delivery, broadening the role and influence of the CLS. Several of the initiatives described in this paper parallel an overall evolution of the practice of consultation-liaison psychiatry in response to managed care influences and other systems pressures. This consultation-liaison paradigm expansion with diversified sources of funding support facilitates the development of consultation-liaison psychiatry along additional clinical, administrative, research, and educational dimensions. Other university medical centers may consider adaptation of some of the initiatives described here to their institutions.
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Affiliation(s)
- James A Bourgeois
- University of California, Davis Medical Center, Department of Psychiatry, Sacramento, CA 95817, USA.
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Kirmayer LJ, Groleau D, Guzder J, Blake C, Jarvis E. Cultural consultation: a model of mental health service for multicultural societies. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2003; 48:145-53. [PMID: 12728738 DOI: 10.1177/070674370304800302] [Citation(s) in RCA: 134] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This paper reports results from the evaluation of a cultural consultation service (CCS) for mental health practitioners and primary care clinicians. The service was designed to improve the delivery of mental health services in mainstream settings for a culturally diverse urban population including immigrants, refugees, and ethnocultural minority groups. Cultural consultations were based on an expanded version of the DSM-IV cultural formulation and made use of cultural consultants and culture brokers. METHODS We documented the service development process through participant observation. We systematically evaluated the first 100 cases referred to the service to establish the reasons for consultation, the types of cultural formulations and recommendations, and the consultation outcome in terms of the referring clinician's satisfaction and recommendation concordance. RESULTS Cases seen by the CCS clearly demonstrated the impact of cultural misunderstandings: incomplete assessments, incorrect diagnoses, inadequate or inappropriate treatment, and failed treatment alliances. Clinicians referring patients to the service reported high rates of satisfaction with the consultations, but many indicated a need for long-term follow-up. CONCLUSION The cultural consultation model effectively supplements existing services to improve diagnostic assessment and treatment for a culturally diverse urban population. Clinicians need training in working with interpreters and culture brokers.
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Affiliation(s)
- Laurence J Kirmayer
- Division of Social and Transcultural Psychiatry, McGill University, Culture and Mental Health Research Unit, Sir Mortimer B Davis-Jewish General Hospital, Montreal, Quebec.
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Berardi D, Menchetti M, Dragani A, Fava C, Leggieri G, Ferrari G. The Bologna Primary Care Liaison Service: first year evaluation. Community Ment Health J 2002; 38:439-45. [PMID: 12474932 DOI: 10.1023/a:1020824016790] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Primary care and mental health were recently integrated by the Italian health authorities. The Bologna Primary Care Liaison Service (PCLS) is ideally suited to the Italian National Health Care System, because most primary care physicians practice individually and mental health services provide first level care. The distinctive features of the program are: 1) location within a mental health center; 2) comprehensive mental health assessment and intervention; 3) collaboration between primary care physicians and mental health services which is facilitated through committees and communication. First year results met expectations. Integrating a PCLS program within a mental health center can be a viable means of implementing national policy.
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Kates N, Crustolo AM, Farrar S, Nikolaou L. Counsellors in primary care: benefits and lessons learned. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2002; 47:857-62. [PMID: 12500756 DOI: 10.1177/070674370204700907] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe a program that integrates mental health counsellors within primary care settings, to present data on the program's impact, and to discuss lessons learned that may apply in other communities. METHODS This paper describes a Canadian program that brings counsellors and psychiatrists into the offices of 87 family physicians in 36 practices in a community of 460,000 in Southern Ontario. It describes the goals and organization of the program and the activities of counsellors when working in primary care. In addition, it summarizes data from the program's evaluation, including demographic data and the individual problems seen and services delivered (all from the program's database) as well as data on patient outcomes using the General Health Questionnaire (GHQ), the Centre for Epidemiological Studies Depression (CESD) Rating Scale, and consumer-satisfaction questionnaires. RESULTS Each counsellor sees an average of 161 new cases yearly. The major problems are depression, anxiety, and family problems. In fact, over 70% of individuals who are seen show significant improvements in outcomes. The program has led to a significant increase in access to mental health services, a reduction in the use of traditional mental health services, high levels of satisfaction with counsellors and family physicians, and significant improvements in symptoms and functioning of individuals seen. CONCLUSION This program has effectively integrated counsellors within primary care settings, increasing the capacity of primary care to handle mental health problems, strengthening links between providers from different sectors, and making mental health care more accessible.
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Affiliation(s)
- Nick Kates
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario.
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Brody DS. How Can Psychiatry and Primary Care Work Together More Effectively to Manage Patients With Mental Disorders? Psychiatr Ann 2002. [DOI: 10.3928/0048-5713-20020901-09] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Dewa CS, Hoch JS, Goering P. Using financial incentives to promote shared mental health care. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2001; 46:488-95. [PMID: 11526804 DOI: 10.1177/070674370104600602] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To consider the most common primary care reimbursement structures, to identify incentives inherent in each, and to discuss how each could be used to encourage a shared-care approach to treating mental disorders at the primary care level. METHOD Three major financial reimbursement models--fee-for-service, capitation, and blended payment mechanisms--are examined. Each is considered in terms of its risk-sharing elements and the consequent incentives. We offer several scenarios to illustrate how the shared-care practice model might be encouraged under each financing mechanism. RESULTS The current fee-for-service system does not encourage shared care. For wide adoption of the shared-care practice model, there must be a change in the reimbursement system's incentives. While none of the financing mechanisms offers a perfect solution, each has potential. Each, however, must be carefully tailored to its environment. CONCLUSIONS Financial considerations are just one aspect to achieving shared care. Nevertheless, in designing a system to encourage collaborative, coordinated care for those suffering from mental illness, decision makers should be wary of creating or maintaining obstacles (financial or otherwise) to provision of accessible, high-quality care.
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Affiliation(s)
- C S Dewa
- Centre for Addiction and Mental Health, Health Systems Research and Consulting Unit, Department of Psychiatry, University of Toronto, Toronto, Ontario.
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Harmon K, Carr VJ, Lewin TJ. Comparison of integrated and consultation-liaison models for providing mental health care in general practice in New South Wales, Australia. J Adv Nurs 2000; 32:1459-66. [PMID: 11136414 DOI: 10.1046/j.1365-2648.2000.01616.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Comparison of integrated and consultation-liaison models for providing mental health care in general practice in New South Wales, Australia The characteristics of a new service providing integrated mental health care in general practice are described and comparisons made with an earlier consultation-liaison (C-L) psychiatry service in general practice, including the range and severity of psychiatric problems, levels of general practitioner (GP) and psychiatrist involvement, and patterns of care. Clinical audit checklists were completed by two experienced mental health nurses for the first 100 patients referred to the service, which was conducted in conjunction with 8 general practices in the Port Stephens region of New South Wales, Australia. The mean age of the first 100 referrals was 38.05 years, 63.0% were female, and 55.0% were referred from GPs. Outcome measures included: referral information, patients' demographic and diagnostic characteristics, psychosocial functioning, psychotropic medication, management, and number of contacts with the mental health nurses. Relative to the earlier C-L psychiatry service in general practice, the integrated service treated a broader range of diagnostic groups with higher levels of disability. There were higher rates of mood (48.0%) and psychotic (20.0%) disorders and lower rates of adjustment (2.0%) disorders. One-third of patients were seen by an additional agency, other than the mental health nurses or GPs. Patients averaged 4.95 contacts with the mental health nurses, with marked variations according to diagnostic group. To date, the new service has been well received. It is highly accessible, acceptable to GPs and patients, caters for a broad range of psychopathology, including severe mental illness, and appears to be sufficiently versatile to be adaptable to a variety of treatment settings.
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Affiliation(s)
- K Harmon
- Clinical Nurse Consultant, Centre for Mental Health Studies, Hunter Mental Health Service, Newcastle, New South Wales, Australia.
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Berardi D, Leggieri G, Menchetti M, Ferrari G. Collaboration Between Mental Health Services and Primary Care: The Bologna Project. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 1999; 1:180-183. [PMID: 15014669 PMCID: PMC181090 DOI: 10.4088/pcc.v01n0602] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/1999] [Accepted: 10/27/1999] [Indexed: 10/20/2022]
Abstract
OVERVIEW: Management of anxiety and depressive disorders within the community necessitates collaboration between mental health services and primary care. While cooperative projects do exist in many countries, Italy's National Health System does not have a program designed to address this issue. In Bologna, a cooperative project arose as a spontaneous undertaking between mental health professionals and primary care physicians. A model of collaboration was designed specifically for the Italian National Health System, consisting of a network of primary care liaison services (PCLSs) instituted within the community mental health services. PCLSs are managed by a staff of specially trained mental health care professionals and are designed to facilitate communication between physicians, and they provide continual and multifaceted support consisting of diagnostic assessment and focused clinical intervention. PCLSs also provide formal consultation-liaison meetings and a telephone consultation service designed to promote communication and enrich diagnostic assessment and treatment. DISCUSSION: PCLSs are innovative, not only because they represent one of the first collaborative efforts in Italy to date, but also because of their innovative design, which is specific for the Italian National Health System. Overall, the project yielded a good result. Primary care physicians utilized the service extensively, and together with psychiatric personnel were satisfied with the outcome. These results, when compared with the traditional separation between the 2 services, are encouraging. Our model could be adapted for most communities in Italy, but must be preceded by shared recognition of local need.
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Affiliation(s)
- Domenico Berardi
- Institute of Psychiatry, Bologna University, Bologna,; and the Italian Society of General Practice, Bologna, Italy
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