TY - JOUR
KW - Humans
KW - Internship and Residency
KW - Medically Underserved Area
KW - Mental Disorders/therapy
KW - Primary Health Care
KW - Psychiatry
KW - Referral and Consultation
KW - Collaboration
KW - consultation
KW - primary care
KW - Psychiatric disorders
AU - Dennis J. Butler
AU - Dominique Fons
AU - Travis Fisher
AU - James Sanders
AU - Sara Bodenhamer
AU - Julie R. Owen
AU - Marc Gunderson
A1 - 
AB - 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.
AD - 1 Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.; 2 Columbia St. Mary's Family Medicine Program, Medical College of Wisconsin, Milwaukee, WI, USA.; 3 Department of Family and Community Medicine, University of Illinois Medical School, Urbana, IL, USA.; 4 Family Medicine Residency Program, University of Illinois College of Medicine at Peoria, Peoria, IL, USA.; 5 Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.; 6 Community Division Psychiatry, Froedtert Hospital, Milwaukee, WI, USA.; 1 Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.; 2 Columbia St. Mary's Family Medicine Program, Medical College of Wisconsin, Milwaukee, WI, USA.; 7 Ascension Health, Milwaukee, WI, USA.; 8 Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin Affiliated Hospitals, Milwaukee, WI, USA.; 9 Saint Louis Behavioral Medicine Institute, Saint Louis, MO, USA.
BT - International journal of psychiatry in medicine
C5 - Education & Workforce; Healthcare Disparities
CP - 5-6
CY - United States
DO - 10.1177/0091217418791456
IS - 5-6
JF - International journal of psychiatry in medicine
LA - eng
M1 - Journal Article
N2 - 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.
PP - United States
PY - 2018
SN - 1541-3527; 0091-2174
SP - 415
EP - 426
EP - 
T1 - A review of the benefits and limitations of a primary care-embedded psychiatric consultation service in a medically underserved setting
T2 - International journal of psychiatry in medicine
TI - A review of the benefits and limitations of a primary care-embedded psychiatric consultation service in a medically underserved setting
U1 - Education & Workforce; Healthcare Disparities
U2 - 30132357
U3 - 10.1177/0091217418791456
VL - 53
VO - 1541-3527; 0091-2174
Y1 - 2018
Y2 - Nov
ER -