Depression in general medical settings. Implications of three health policy studies for consultation-liaison psychiatry.
Prepaid or prospective reimbursement has implications for the consultation-liaison (C-L) psychiatrist. The author reviews results from three health policy studies that indicated 1) degree of reliance on general medical providers for mental health care is not affected by generosity of fee-for-service (FFS) coverage, but is greater in some prepaid health care systems; 2) psychological sickness of depressed outpatients visiting general medical providers is similar across prepaid and FFS systems of care; 3) prepaid care is associated with lower rates of detection of depression and counseling in the general medical sector; 4) depression outcomes in the general medical sector are similar under prepaid or FFS care; 5) quality of care for depressed patients is moderate to low in the general medical sector; and 6) depressed elderly inpatients receive higher quality of psychological care in psychiatric units, but they receive higher quality of physical care in general medical wards. The discussion emphasizes the C-L psychiatrist's role in educating general medical providers, improving outcomes for the sickest patients, and improving psychosocial care in prepaid practices.
Wells
K B
KB
UCLA Neuropsychiatric Institute and Hospital 90024.
D003866:Depressive Disorder / Q000523:psychology* / Q000534:rehabilitation; D005194:Family Practice / Q000458:organization & administration*; D006291:Health Policy; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007348:Insurance, Health / Q000191:economics; D007902:Length of Stay / Q000191:economics; D008603:Mental Health; D017061:Prepaid Health Plans / Q000191:economics; D011570:Psychiatry / Q000458:organization & administration*; D011787:Quality of Health Care; D012017:Referral and Consultation