Psychiatric outpatient consultation for seniors. Perspectives of family physicians, consultants, and patients/family: a descriptive study.
BACKGROUND
Family practitioners take care of large numbers of seniors with increasingly complex mental health problems. Varying levels of input may be necessary from psychiatric consultants. This study examines patients'/family, family practitioners', and psychiatrists' perceptions of the bi-directional pathway between such primary care doctors and consultants.


METHODS
An 18 month survey was conducted in an out-patient psychogeriatric clinic of a Montreal university-affiliated community hospital. Cognitively intact seniors referred by family practitioners for assessment completed a satisfaction and expectation survey following their visits with the psychiatric consultants. The latter completed a self-administered process of care questionnaire at the end of the visit, while family doctors responded to a similar survey by telephone after the consultants' reports had been received. Responses of the 3 groups were compared.


RESULTS
101 seniors, referred from 63 family practitioners, met the study entry criteria for assessment by 1 of 3 psychogeriatricians. Both psychiatrists and family doctors agreed that help with management was the most common reason for referral. Family physicians were accepting of care of elderly with mental health problems, but preferred that the psychiatrists assume the initial treatment; the consultants preferred direct return of the patient; and almost 1/2 of patients did not know what to expect from the consultation visit. The rates of discordance in expectations were high when each unique patient-family doctor-psychiatrist triad was examined.


CONCLUSIONS
Gaps in expectations exist amongst family doctors, psychiatrists, and patients/family in the shared mental health care of seniors. Goals and anticipated outcomes of psychogeriatric consultation require better definition.
Yaffe
Mark J
MJ
Department of Family Medicine, McGill University and St. Mary's Hospital Centre, 3830 Lacombe Avenue, Montreal, Qc, H3T 1M5, Canada. mark.yaffe@mcgill.ca
Primeau
Francois
F
McCusker
Jane
J
Cole
Martin G
MG
Belzile
Eric
E
Dendukuri
Nandini
N
Elie
Michel
M
Laplante
Johanne
J
D000368:Aged; D001291:Attitude of Health Personnel; D005852:Geriatric Psychiatry / Q000458:organization & administration / Q000592:standards*; D006764:Hospitals, Community / Q000458:organization & administration; D006801:Humans; D007400:Interprofessional Relations; D028642:Persons with Psychiatric Disorders / Q000523:psychology*; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration* / Q000592:standards; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000523:psychology; D017064:Process Assessment, Health Care; D011792:Quebec; D012017:Referral and Consultation; D011795:Surveys and Questionnaires