Deployment of the consultation-liaison model in adult and child-adolescent psychiatry and its impact on improving mental health treatment

Abstract

Background Little information exists on the perceptions of psychiatrists regarding the implementation and various impacts of the consultation-liaison model. This model has been used in Quebec (Canada) through the function of specialist respondent-psychiatrists (SRP) since 2009. This study assessed the main activities, barriers or facilitators, and impact of SRP in adult and child-adolescent psychiatry on the capacity of service providers in primary care and youth centers to treat patients with mental health disorders (MHD). Methods Data included 126 self-administered questionnaires from SRP and semi-structured interviews from 48 SRP managers. Mixed methods were used, with qualitative findings from managers complementing the SRP survey. Comparative analyses of SRP responses in adult versus child-adolescent psychiatry were also conducted. Results Psychiatrists dedicated a median 24.12 h/month to the SRP function, mainly involving case discussions with primary care teams or youth centers. They were confident about the level of support they provided and satisfied with their influence in clinical decision-making, but less satisfied with the support provided by their organizations. SRP evaluated their impacts on clinical practice as moderate, particularly among general practitioners (GP). SRP working in child-adolescent psychiatry were more comfortable, motivated, and positive about their overall performance and impact than in adult psychiatry. Organizational barriers (e.g. team instability) were most prevalent, followed by system-level factors (e.g. network size and complexity, lack of resources, model inflexibility) and individual factors (e.g. GP reluctance to treat patients with MHD). Organizational facilitators included support from family medicine group directors, collaboration with university family medicine groups and coordination by liaison nurses; at the system level, pre-existing relationships and working in the same institution; while individual-level facilitators included SRP personality and strong organizational support. Conclusion Quebec SRP were implemented sparingly in family medicine groups and youth centers, while SRP viewed their overall impact as moderate. Results were more positive in child-adolescent psychiatry than in adult psychiatry. Increased support for the SRP function, adapting the model to GP in need of more direct support, and resolving key system issues may improve SRP effectiveness in terms of team stability, coordination among providers, access to MH services and readiness to implement innovations.

Environmental factors determine the occurrence of pulmonary tuberculosis

“…Besides the house humidity which was regarded as a risk factor for pulmonary TB transmission (22), it was also revealed that house lighting also plays a part as a risk factor for this disease to occur (23). However, it was statistically not significant because the lower limit and upper limit include 1 ' (24).…”

Predictors of Death From Physical Illness or Accidental/Intentional Causes Among Patients With Substance-Related Disorders

“…According to the literature, GP greatly underdetect and undertreat patients with SRD and cooccurring SRD-MD, as they are often uncomfortable with these patients. 74,75 This might explain the finding that these two variables did not protect against death.…”

General practitioners’ everyday clinical decision-making on psychosocial problems of children and youth in the Netherlands

“…Since it is important that GPs address psychological problems in children and youth early, investments to improve their clinical practice regarding youth care are necessary, e.g., in medical education. Furthermore, more effective cross-disciplinary work should be encouraged, so that the expertise of multiple care providers can be utilized during GPs’ assessment and decision whether or not to refer [ 3 , 30 ]. GPs’ daily CDM may be interesting to policy makers, so that usage of community-based resources by care providers and families can be well thought out [ 5 ].…”

“…In the literature, psychosocial problems are broadly described as impairments, activity limitations and participation restrictions related to mood and living, financial and domestic conditions and interpersonal relationships [ 2 ]. While psychosocial problems among children and youth are of frequent occurrence in general practice, GPs experience several barriers to their identification and management [ 1 , 3 ]. Barriers relate to the consulting child and its family, to the GP and their methods and to referral to youth care providers [ 1 , 4 , 5 ].…”