A health services perspective on delivery of psychiatric services in primary care including internal medicine.
Serious problems persist in the recognition and treatment of psychiatric problems in primary care despite multiple interventions directed at correcting these problems. Improved outcomes depend on improved recognition, and screening instruments need to be streamlined tremendously to be accepted by primary care providers. Publication of guidelines and physician education, although essential for improved care, are probably insufficient to implement guidelines-based care. Improvements in psychiatric outcome appear to depend on the level of intensity of the intervention employed. Continued research is needed to determine the most effective type of educational intervention and more widely applicable quality improvement processes. Broad-based changes in health service delivery focusing on the true integration of mental health services with general medical care are required to bring about meaningful, effective change. Ongoing changes in physician training programs (combined primary care/psychiatry programs) may facilitate implementation of guideline-based psychiatric care in medical settings, but the full impact of these changes is not likely to be felt for several years.
Anfinson
T J
TJ
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA.
Bona
J R
JR
D000553:Ambulatory Care / Q000458:organization & administration; D003159:Community-Institutional Relations; D003299:Cooperative Behavior; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D019317:Evidence-Based Medicine; D006801:Humans; D007388:Internal Medicine / Q000592:standards*; D008403:Mass Screening / Q000379:methods; D008605:Mental Health Services / Q000458:organization & administration* / Q000592:standards; D017146:Models, Organizational; D020380:Needs Assessment; D009936:Organizational Innovation; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000592:standards*; D011569:Psychiatric Status Rating Scales; D011570:Psychiatry / Q000458:organization & administration*; D017749:Total Quality Management / Q000458:organization & administration; D014481:United States