Faculty Collaboration Database

A review of the benefits and limitations of a primary care-embedded psychiatric consultation service in a medically underserved setting. Int J Psychiatry Med 2018 Nov;53(5-6):415-426

Date

08/23/2018

Pubmed ID

30132357

DOI

10.1177/0091217418791456

Scopus ID

2-s2.0-85052553649 (requires institutional sign-in at Scopus site)   13 Citations

Abstract

A significant percentage of patients with psychiatric disorders are exclusively seen for health-care services by primary care physicians. To address the mental health needs of such patients, collaborative models of care were developed including the embedded psychiatry consult model which places a consultant psychiatrist on-site to assist the primary care physician to recognize psychiatric disorders, prescribe psychiatric medication, and develop management strategies. Outcome studies have produced ambiguous and inconsistent findings regarding the impact of this model. This review examines a primary care-embedded psychiatric consultation service in place for nine years in a family medicine residency program. Psychiatric consultants, family physicians, and residents actively involved in the service participated in structured interviews designed to identify the clinical and educational value of the service. The benefits and limitations identified were then categorized into physician, consultant, patient, and systems factors. Among the challenges identified were inconsistent patient appointment-keeping, ambiguity about appropriate referrals, consultant scope-of-practice parameters, and delayed follow-up with consultation recommendations. Improved psychiatric education for primary care physicians also appeared to shift referrals toward more complex patients. The benefits identified included the availability of psychiatric services to underserved and disenfranchised patients, increased primary care physician comfort with medication management, and improved interprofessional communication and education. The integration of the service into the clinic fostered the development of a more psychologically minded practice. While highly valued by respondents, potential benefits of the service were limited by residency-specific factors including consultant availability and the high ratio of primary care physicians to consultants.

Author List

Butler DJ, Fons D, Fisher T, Sanders J, Bodenhamer S, Owen JR, Gunderson M

Authors

Travis J. Fisher MD Associate Professor in the Psychiatry and Behavioral Medicine department at Medical College of Wisconsin
Marc A. O. Gunderson MD Assistant Professor in the Psychiatry and Behavioral Medicine department at Medical College of Wisconsin
Julie R. Owen MD Assistant Professor in the Psychiatry and Behavioral Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Humans
Internship and Residency
Medically Underserved Area
Mental Disorders
Primary Health Care
Psychiatry
Referral and Consultation