Sharing care: the psychiatrist in the family physician's office.
OBJECTIVE
One way of strengthening ties between primary care providers and psychiatrists is for a psychiatrist to visit a primary care practice on a regular basis to see and discuss patients and to provide educational input and advice for family physicians. This paper reviews the experiences of a program in Hamilton, Ontario that brings psychiatrists and counsellors into the offices of 88 local family physicians in 36 practices.


METHODS
Data are presented based on the activities of psychiatrists working in 13 practices over a 2-year period. Data were gathered from forms routinely completed by family physicians when making a referral and by psychiatrists whenever they saw a new case. An annual satisfaction questionnaire for all providers participating in the program was also used to gather information.


RESULTS
Over a 2-year period, 1021 patients were seen in consultation by one full-time equivalent psychiatrist. The average duration of a consultation was 51 minutes, and a family member was present for 12% of the visits. Twenty-one percent of the patients were seen for at least one follow-up visit, 75% of which were prearranged. In addition, 1515 cases were discussed during these visits without the patient being seen. All participants had a high satisfaction rating for their involvement with the project.


CONCLUSIONS
Benefits of this approach include increased accessibility to psychiatric consultation, enhanced continuity of care, support for family physicians, and improved communication between psychiatrists and family physicians. This model, which has great potential for innovative approaches to continuing education and resident placements, demands new skills of participating psychiatrists.
Kates
N
N
Department of Psychiatry, McMaster University, Hamilton, Ontario.
Craven
M A
MA
Crustolo
A M
AM
Nikolaou
L
L
Allen
C
C
Farrar
S
S
D003258:Consumer Behavior; D003299:Cooperative Behavior; D005194:Family Practice / Q000379:methods* / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006801:Humans; D007588:Job Satisfaction; D008137:Longitudinal Studies; D008605:Mental Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D011570:Psychiatry / Q000379:methods* / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000458:organization & administration* / Q000706:statistics & numerical data; D012189:Retrospective Studies