title: Canadian Rural/Remote Primary Care Physicians Perspectives on Child/Adolescent Mental Health Care Service Delivery.
abstract: BACKGROUND
  Primary Care Physicians (PCP) play a key role in the recognition and management of child/adolescent mental health struggles. In rural and under-serviced areas of Canada, there is a gap between child/adolescent mental health needs and service provision.
  
  
  METHODS
  From a Canadian national needs assessment survey, PCPs' narrative comments were examined using quantitative and qualitative approaches. Using the phenomenological method, individual comments were drawn upon to illustrate the themes that emerged. These themes were further analyzed using chi-square to identify significant differences in the frequency in which they were reported.
  
  
  RESULTS
  Out of 909 PCPs completing the survey, 39.38% (n = 358) wrote comments. Major themes that emerged were: 1) psychiatrist access, including issues such as long waiting lists, no child/adolescent psychiatrists available, no direct access to child/adolescent psychiatrists; 2) poor communication/continuity, need for more systemized/transparent referral processes, and need to rely on adult psychiatrists; and, 3) referral of patients to other mental health professionals such as paediatricians, psychologists, and social workers.
  
  
  CONCLUSIONS
  Concerns that emerged across sites primarily revolved around lack of access to care and systems issues that interfere with effective service delivery. These concerns suggest potential opportunities for future improvement of service delivery.
  
  
  CONCLUSIONS
  Although the survey only had one comment box located at the end, PCPs wrote their comments throughout the survey. Further research focusing on PCPs' expressed written concerns may give further insight into child/adolescent mental health care service delivery systems. A comparative study targeting urban versus rural regions in Canada may provide further valuable insights.
authors.affiliation: The University of Western Ontario, Department of Psychiatry, London, Ontario.
authors.forename: Richard
authors.initials: R
authors.lastname: Zayed
authors.affiliation: The University of Western Ontario, Department of Psychiatry, London, Ontario.
authors.forename: Brenda
authors.initials: B
authors.lastname: Davidson
authors.affiliation: McGill University, Montreal, Quebec.
authors.forename: Lucie
authors.initials: L
authors.lastname: Nadeau
authors.affiliation: Memorial University of Newfoundland, St. John's, Newfoundland.
authors.forename: Terrence S
authors.initials: TS
authors.lastname: Callanan
authors.affiliation: University of Manitoba, Winnipeg, Manitoba.
authors.forename: William
authors.initials: W
authors.lastname: Fleisher
authors.affiliation: Alberta Health Services, Healthy Minds/Healthy Children Outreach Services, Calgary, Alberta.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Hope-Ross
authors.affiliation: The University of Western Ontario, Department of Psychiatry, London, Ontario.
authors.forename: Stacey
authors.initials: S
authors.lastname: Espinet
authors.affiliation: Childrens Hospital of Eastern Ontario, Ottawa, Ontario.
authors.forename: Helen R
authors.initials: HR
authors.lastname: Spenser
authors.affiliation: Formerly Alberta Health Services, Calgary, Alberta.
authors.forename: Harold
authors.initials: H
authors.lastname: Lipton
authors.affiliation: The University of Western Ontario, Department of Psychiatry, London, Ontario.
authors.forename: Amresh
authors.initials: A
authors.lastname: Srivastava
authors.affiliation: Dalhousie University, Windsor, Nova Scotia.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Lazier
authors.affiliation: Hotel Dieu Grace Hospital, Windsor, Ontario.
authors.forename: Tamison
authors.initials: T
authors.lastname: Doey
authors.affiliation: Queen's University, Kingston, Ontario.
authors.forename: Sarosh
authors.initials: S
authors.lastname: Khalid-Khan
authors.affiliation: Hamilton-Wentworth District School Board, Hamilton, Ontario.
authors.forename: Ann
authors.initials: A
authors.lastname: McKerlie
authors.affiliation: University of Ottawa, Hanover, Ontario.
authors.forename: Neal
authors.initials: N
authors.lastname: Stretch
authors.affiliation: Health PEI, Charlottetown, Prince Edward Island.
authors.forename: Roberta
authors.initials: R
authors.lastname: Flynn
authors.affiliation: Dalhousie University, Windsor, Nova Scotia.
authors.forename: Sabina
authors.initials: S
authors.lastname: Abidi
authors.affiliation: Memorial University of Newfoundland, St. John's, Newfoundland.
authors.forename: Kimberly
authors.initials: K
authors.lastname: St John
authors.affiliation: McGill University, Montreal, Quebec.
authors.forename: Genevieve
authors.initials: G
authors.lastname: Auclair
authors.affiliation: Dalhousie University, Windsor, Nova Scotia.
authors.forename: Vitaly
authors.initials: V
authors.lastname: Liashko
authors.affiliation: University of Manitoba, Winnipeg, Manitoba.
authors.forename: Sarah
authors.initials: S
authors.lastname: Fotti
authors.affiliation: University of Saskatchewan, Division of Child and Adolescent Psychiatry, Saskatoon, Saskatchewan.
authors.forename: Declan
authors.initials: D
authors.lastname: Quinn
authors.affiliation: The University of Western Ontario - London Health Sciences Centre, London, Ontario.
authors.forename: Margaret
authors.initials: M
authors.lastname: Steele
keywords: access to care; primary care; rural and remote; service delivery; systems issues