Consulting Psychiatry within an Integrated Primary Care Model

Schreiter, Elizabeth A. Zeidler; Pandhi, Nancy; Fondow, Meghan D. M.; Thomas, Chantelle; Vonk, Jantina; Reardon, Claudia L.; Serrano, Neftali

doi:10.1353/hpu.2013.0178

Cited by 22 publications

(16 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Both Macaulay and Montgomery-Taylor find that a model with joint consultations with GPs and paediatricians provides learning for the participating GPs [ 16 , 17 ]. Mouland states that patients often receive sufficient help from one joint consultation with the GP and the psychiatrist [ 20 ] and Saillant’s study suggests that joint consultation is an effective way of transferring skills and building confidence in primary care physicians regarding care of patients with mental health problems [ 21 ]. Saillant discusses the limitation that they, as we, were unable to explore the experiences of the patients.…”

Section: Discussionmentioning

confidence: 99%

“…It is therefore important to gain more knowledge as to how GPs’ competence and skills can be further developed. Generally, collaborative programmes seem to be more effective than more theoretical educational programmes [ 14 – 20 ], in line with theories of experiential learning [ 21 ]. A Cochrane review examining interventions to change outpatient referral rates or improve outpatient referral appropriateness found that active local educational interventions involving secondary care specialists and structured referral sheets are the only interventions that lower referral rates, based on current evidence [ 22 ].…”

Section: Introductionmentioning

confidence: 92%

“…There are various types of on-site mental health interventions, and in the literature, it is not always clear exactly what is included [ 23 ]. Different types of collaboration have been described, ranging from a consultative role only for a psychiatrist, [ 24 , 25 ] to consultation-liaison psychiatry [ 26 – 29 ], specialist clinics in a primary care setting [ 30 ], telepsychiatry [ 29 , 31 ] or collaborative care with various mental health care providers [ 20 , 32 , 33 ]. We have found joint consultations with GPs described in adult psychiatry [ 34 – 36 ] and in paediatrics [ 16 , 17 ], but we have found no studies that specifically describe joint consultation in a general practice with child and adolescent psychiatry specialists.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

GPs’ and child and adolescent psychiatry specialists’ experiences of joint consultations in the GP’s office: a qualitative study

et al. 2017

View full text Add to dashboard Cite

BackgroundThe study is an exploration of a joint consultation model, a collaboration between general practitioners (GPs) and specialists from child and adolescent mental health services (CAMHS) in Lillehammer, Norway.MethodsA qualitative study based on two focus group interviews, one with participating GPs and one with participating specialists from the local CAMHS. Participants were five GPs, with work experience varying from 6 months to 20 years (four of them specialists in general medicine) and two CAMHS specialists—a psychiatrist and a psychologist—both with more than 20 years of experience.ResultsThe focus group discussions revealed that both GPs and CAMHS specialists saw the joint consultations as a good teaching method for improving GPs’ skills in child and adolescent psychiatry. Both groups believed that this low-threshold service benefits the patients and that the joint consultation is especially suited to sort problems and determine the level of help required.ConclusionsThe GPs and CAMHS specialists shared the impression that the collaboration model is beneficial for both patients and health care providers. Close collaboration with primary health care is recommended in the guidelines for child and adolescent psychiatry outpatient clinics. We suggest that the joint consultation model could be a good way for GPs and CAMHS specialists to collaborate.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

GPs’ and child and adolescent psychiatry specialists’ experiences of joint consultations in the GP’s office: a qualitative study

et al. 2017

View full text Add to dashboard Cite

show abstract

“…This close collaboration sets our intervention apart from community psychiatric services such as Mobile Crisis or Assertive Community Treatment (ACT), where treatment of chronic or emergent mental illness in community-dwelling patients may not partner with the primary medical team (Phillips et al, 2001). In clinic-based settings, this sort of collaboration is increasingly identified as a way to create lasting impact from psychiatric interventions and bring behavioral health services to primary care (Sederer, 2014; Zeidler Schreiter et al, 2013). Our pilot describes an important way to bring this sort of collaborative psychiatric care to the homebound.…”

Section: Discussionmentioning

confidence: 99%

Meeting the Mental Health Needs of the Homebound: A Psychiatric Consult Service Within a Home-Based Primary Care Program

Reckrey

DeCherrie²,

Dugue³

et al. 2015

Care Management Journals

View full text Add to dashboard Cite

The growing population of homebound adults is increasingly receiving home-based primary care (HPBC) services. These patients are predominantly frail elderly who are homebound due to multiple medical comorbidities, yet they often also have psychiatric diagnoses requiring mental health care. Unfortunately, in-home psychiatric services are rarely available to homebound patients. In order to address unmet psychiatric need among the homebound patients enrolled in our large academic HBPC program, we piloted a psychiatric in-home consultation service. During our 16 month pilot, ten percent of all enrolled HBPC patients were referred for and received psychiatric consultation. Depression and anxiety were among the most common reasons for referral. In order to better meet patients’ medical and psychiatric needs, HBPC programs need to consider strategies to incorporate psychiatric services into their routine care plans.

show abstract

“…The model at Access has high fidelity to the original description,[10] and has been nationally recognized. [19,20,21] Continuing model fidelity is demonstrated by maintaining the focus on population based care with an average 18-20% penetration into the medical population, and 85-90% adherence to 4 or fewer visits per patient per year. [10] The sole variation has been the addition of a consulting psychiatry service.…”

Section: Methodsmentioning

confidence: 99%

Visit Patterns for Severe Mental Illness with Implementation of Integrated Care: A Pilot Retrospective Cohort Study

et al. 2015

Self Cite

View full text Add to dashboard Cite

There is increasing interest in models that integrate behavioral health services into primary care. For patients with severe mental illness (SMI), a population with disproportionate morbidity and mortality, little is known about the impact of such models on primary care clinic utilization, and provider panels. We performed a retrospective cohort pilot study examining visit patterns for 1,105 patients with SMI overall, by provider, before, and after the implementation of a primary care behavioral health model which had a ramp up period from May 2006-August 2007. We used 2003–2012 electronic health record data from two clinics of a Federally Qualified Health Center and conducted interrupted time series and chi-square analyses. During the intervention period there was a significant increase in the proportion of visits per month to the clinic for patient with SMI relative to overall visits (0.27; 95% CI 0.22-0.32). After the intervention period, this rate declined (-0.23; -0.19-0.28) but remained above the pre-intervention period. After integration of behavioral health into our primary care clinics, there was a sharp increase in the number of patients with SMI, suggesting patient willingness to explore receiving care under this model. Clinics looking to adopt the model should be mindful of potential changes in patient subpopulations and proactively manage this transition.

show abstract

Consulting Psychiatry within an Integrated Primary Care Model

Cited by 22 publications

References 27 publications

GPs’ and child and adolescent psychiatry specialists’ experiences of joint consultations in the GP’s office: a qualitative study

GPs’ and child and adolescent psychiatry specialists’ experiences of joint consultations in the GP’s office: a qualitative study

Meeting the Mental Health Needs of the Homebound: A Psychiatric Consult Service Within a Home-Based Primary Care Program

Visit Patterns for Severe Mental Illness with Implementation of Integrated Care: A Pilot Retrospective Cohort Study

Contact Info

Product

Resources

About