The medical-psychiatric coordinating physician-led model: team-based treatment for complex patients.
OBJECTIVE
We propose a patient care model involving psychiatrist-led multispecialty teams for treatment of the most treatment-refractory segment of "complex" outpatients. We call the psychiatrist taking this leadership role the Medical-Psychiatric Coordinating Physician.


METHODS
The authors conducted a pilot study for this treatment model with 52 office-based outpatient cases each involving complex patients, and each with at least 2 major treatment failures. They followed these patients empirically for at least 18 months. Outcomes examined included Hamilton Anxiety Rating Scale; Hamilton Depression Rating Scale; and Health Related Quality of Life-14 scores (HRQOL-14, modified), in association with a comprehensive treatment review.


RESULTS
Comprehensive treatment review indicated sustained improvement in at least 2 of 4 clinical dimensions (utilization, treatment adherence, symptomatology, and quality of life) in 44 of 52 patients. Included were Hamilton Anxiety Rating Scale scores that improved significantly from 26.27 ± 7.5 to 18.13 ± 5.74 (p < 0.0001) and Hamilton Depression Rating Scale scores that improved from 22.02 ± 7.10 to 14.58 ± 6.46 (p < 0.0001). The Health-Related Quality of Life-14 improved significantly for general health from 2.54 ± 1.03 to 2.12 ± 1.06 (p < 0.0001), and sick days per month from 11.22 ± 7.76 to 6.60 ± 7.51 (p < 0.0001).


CONCLUSIONS
The Medical-Psychiatric Coordinating Physician-led multispecialty team method may be advantageous for the ongoing outpatient treatment of management-intensive, complex patients. We offer this model as having a place among the available integrated care models for the treatment of comorbid psychiatric-systemic medical illness.
Department of Psychiatry, University of California, San Francisco, Medical Center, San Francisco, CA. Electronic address: saf@stevenfrankelmd.com.
Steven A
SA
Frankel
Department of Psychiatry, University of California, San Francisco, Medical Center, San Francisco, CA.
James A
JA
Bourgeois
Department of Psychiatry & Behavioral Sciences, University of California, Davis, Medical Center, Sacramento, CA; Department of Internal Medicine, University of California, Davis, Medical Center, Sacramento, CA.
Glen
G
Xiong
Department of Psychiatry & Behavioral Sciences, University of California, Davis, Medical Center, Sacramento, CA; Department of Internal Medicine, University of California, Davis, Medical Center, Sacramento, CA; Department of Pain Medicine, University of California, Davis, Medical Center, Sacramento, CA.
Robert
R
McCarron
Department of Psychiatry & Behavioral Sciences, University of California, Davis, Medical Center, Sacramento, CA.
Jaesu
J
Han
Department of Psychiatry, University of California, San Francisco, Medical Center, San Francisco, CA.
Philip
P
Erdberg
D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000458:organization & administration; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications* / Q000628:therapy; D008875:Middle Aged; D017146:Models, Organizational; D010348:Patient Care Team / Q000458:organization & administration*; D010865:Pilot Projects; D011569:Psychiatric Status Rating Scales; D011570:Psychiatry / Q000458:organization & administration; D055815:Young Adult