The primary care physician/psychiatrist joint consultation: A paradigm shift in caring for patients with mental health problems?
OBJECTIVE
Thirty to forty percent of patients seen in primary care medicine suffer from mental health problems, but primary care physicians (PCPs) often feel unprepared to deal with their patients' mental health problems. Joint consultations conducted with a liaison psychiatrist can help. The purpose of this study was to evaluate the experience of joint consultations in a primary care service in Geneva, Switzerland.


METHODS
We retrospectively analyzed reports of psychiatric evaluations conducted between October 2010 and August 2012 (n=182), in the Primary Care Service of the Geneva University Hospitals. We also carried out 4 focus groups with 23 physicians-in-training to explore their experiences and perceptions of the joint consultations.


RESULTS
Seventy two percent of the evaluations resulted in a psychiatric diagnosis. Psychiatric follow-up was not considered necessary in 61% of cases. Focus groups revealed that prior to experiencing joint consultations, PCPs considered mental health problems to be the domain of psychiatrists and outside their own area of competence. Joint consultations helped to demystify the role of psychiatrists, reduce their anxiety and increase PCPs' confidence in dealing with patients' mental health problems.


CONCLUSIONS
Joint consultations enabled PCPs to shift away from a dichotomous view of somatic versus mental health problems and their management, and towards a more integrated view.


CONCLUSIONS
Joint consultations provide a useful strategy for training primary care physicians in the management of mental health problems. Integrated management of somatic and mental health problems can lead to a better understanding of the patient and improve the therapeutic relationship.
Centre for Psychiatric Emergencies and Liaison Psychiatry, Neuchâtel Psychiatry Center (CNP), Maladière 45, CH-2000 Neuchâtel, Switzerland. Electronic address: Stephane.Saillant@cnp.ch.
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Saillant
Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, 4, rue Gabrielle Perret-Gentil, CH-1211 Geneva 14, Switzerland. Electronic address: Patricia.Hudelson@hcuge.ch.
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Hudelson
Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, 4, rue Gabrielle Perret-Gentil, CH-1211 Geneva 14, Switzerland. Electronic address: Melissa.Dominice@hcuge.ch.
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Dominicé Dao
Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, 4, rue Gabrielle Perret-Gentil, CH-1211 Geneva 14, Switzerland. Electronic address: Noelle.Junod@hcuge.ch.
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Junod Perron
D000328:Adult; D003299:Cooperative Behavior; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008605:Mental Health Services / Q000458:organization & administration; D008875:Middle Aged; D058007:Physicians, Primary Care; D011320:Primary Health Care / Q000458:organization & administration*; D011570:Psychiatry; D012017:Referral and Consultation; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013557:Switzerland
joint consultation; liaison psychiatry; primary care; training primary care physicians