William F. Pirl1, B J Beck, Steven A. Safren, Helen Kim. 1. Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School and East Boston Neighborhood Health Center, Boston; and Hennepin County Medical Center/ University of Minnesota, Minneapolis.
Abstract
BACKGROUND: This retrospective chart review study describes on-site psychiatric consultations at a large, urban community primary care center. The referral population, diagnostic reliability of primary care providers (PCPs) and social workers, appropriateness of PCP-initiated treatment, impact of treatment recommendations, and outcomes are examined. METHOD: Charts of all patients who received psychiatric consultations (N = 78) during an 8-month period (August 1996 to April 1997) were reviewed. RESULTS: Prereferral diagnoses by PCPs matched the psychiatrist's diagnosis based on DSM-IV diagnostic criteria approximately half the time. PCPs initiated psychopharmacology in half the referrals (39/78) and used generally appropriate medications (30/39) based on diagnosis by a psychiatrist, but at subtherapeutic doses (21/39). PCPs tended to continue medications recommended by the psychiatrist. At 1 year, PCPs clearly documented improvement in nearly a third of the consults (24/78). CONCLUSION: Diagnostic disagreement of caregivers, inadequate PCP psychopharmacology practices, and patient nonadherence are 3 main problems that impede optimal care within the model of psychiatric consultation described in this study.
BACKGROUND: This retrospective chart review study describes on-site psychiatric consultations at a large, urban community primary care center. The referral population, diagnostic reliability of primary care providers (PCPs) and social workers, appropriateness of PCP-initiated treatment, impact of treatment recommendations, and outcomes are examined. METHOD: Charts of all patients who received psychiatric consultations (N = 78) during an 8-month period (August 1996 to April 1997) were reviewed. RESULTS: Prereferral diagnoses by PCPs matched the psychiatrist's diagnosis based on DSM-IV diagnostic criteria approximately half the time. PCPs initiated psychopharmacology in half the referrals (39/78) and used generally appropriate medications (30/39) based on diagnosis by a psychiatrist, but at subtherapeutic doses (21/39). PCPs tended to continue medications recommended by the psychiatrist. At 1 year, PCPs clearly documented improvement in nearly a third of the consults (24/78). CONCLUSION: Diagnostic disagreement of caregivers, inadequate PCP psychopharmacology practices, and patient nonadherence are 3 main problems that impede optimal care within the model of psychiatric consultation described in this study.
Authors: J Ormel; W Van Den Brink; M W Koeter; R Giel; K Van Der Meer; G Van De Willige; F W Wilmink Journal: Psychol Med Date: 1990-11 Impact factor: 7.723
Authors: M Von Korff; S Shapiro; J D Burke; M Teitlebaum; E A Skinner; P German; R W Turner; L Klein; B Burns Journal: Arch Gen Psychiatry Date: 1987-02
Authors: Elizabeth A Zeidler Schreiter; Nancy Pandhi; Meghan D Fondow; Chantelle Thomas; Jantina Vonk; Claudia L Reardon; Neftali Serrano Journal: J Health Care Poor Underserved Date: 2013-11