Clinical Study of Insomnia, a Common Disorder in Primary Care: From a Viewpoint of Consultation-Liaison Psychiatry

Objective: This article describes the evolution of a primary care geriatric psychiatry program which serves clinical, educational, and research functions. Methods: Program development proceeded through stages of liaison using research, focusing on primary care attendings, and developing the common interest of geriatrics. Results: Collaborative research with external funding has continued. A geriatric psychiatry primary care fellowship program was established. Clinical activity is based on consultation-liaison work in nursing homes, an outpatient dementia clinic, a general hospital medical service, and the outpatient clinic. Fellows are involved in training both psychiatry and primary care residents. Conclusions: Necessary components of a successful collaboration include: 1) primary care physicians with an interest in and aptitude for psychiatric issues; 2) delivery of service and training based on an assessment of the primary care site's needs; 3) a physical presence in the primary care site.

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Primary Care Psychiatry: Taking Consultation–Liaison Psychiatry to the Community

Australasian Psychiatry ◽

10.1080/j.1440-1665.2005.02206.x ◽

2005 ◽

Vol 13 (3) ◽

pp. 302-306

Author(s):

Grant Blashki ◽

Rob Selzer ◽

Fiona Judd ◽

Gene Hodgins ◽

Lisa Ciechomski

Keyword(s):

Mental Health ◽

Primary Care ◽

General Practice ◽

Secondary Care ◽

Support Needs ◽

Liaison Psychiatry ◽

Clinical Support ◽

Consultation Liaison Psychiatry ◽

Context Knowledge

Objective: To assist psychiatrists who work closely with general practitioners (GPs) at the primary/secondary care interface. Conclusion: The role of primary care psychiatrists can be enhanced by a sound appreciation of the general practice context, knowledge of the local mental health services and an understanding of the educational and clinical support needs of GPs.

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Consultation-Liaison Psychiatry Fellowship in Primary Care

The International Journal of Psychiatry in Medicine ◽

10.2190/38bv-9jpa-ve3d-00h7 ◽

1996 ◽

Vol 26 (2) ◽

pp. 135-143 ◽

Cited By ~ 2

Author(s):

Maurice D. Steinberg ◽

Steven A. Cole ◽

Stephen M. Saravay

Keyword(s):

Primary Care ◽

Primary Care Physicians ◽

Care Setting ◽

Primary Care Setting ◽

Liaison Psychiatry ◽

Service Staff ◽

Consultation Liaison Psychiatry ◽

Primary Care Practitioners ◽

Primary Care Medicine ◽

Selection Of

Objective: This article describes the need for and development of an outpatient primary care psychiatry fellowship program. Method: The Department of Psychiatry at Hillside Hospital established a primary care fellowship for psychiatrists in 1994, through its consultation-liaison (C-L) service. Staff alliances established by the C-L service with primary care physicians provided the basis for identifying appropriate outpatient practices in the community. Knowledge and skills objectives were adapted from a traditional C-L fellowship to outpatient primary care medicine. Results: The selection of a psychologically minded primary care practitioners was crucial. Practitioners used an inclusive model in which fellows would see all patients with them, not just those with mental disorders. Fellows have felt comfortable working in the primary care setting and have been well received by practitioners, staff, and patients. The practitioners were clearly more interested in psychosocial aspects of their patient than were primary care residents. Conclusions: The gap in preparing U.S. psychiatrists to function in integrated primary care programs requires establishing a presence in the primary care setting. Skills and relationships from traditional C-L settings can be productively used to accomplish this goal.

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Determining the Effect That Consultation-Liaison Psychiatry in Primary Care Has on Family Physicians’ Psychiatric Knowledge and Practice

Psychosomatics ◽

10.1016/s0033-3182(97)71458-0 ◽

1997 ◽

Vol 38 (3) ◽

pp. 217-229 ◽

Cited By ~ 19

Author(s):

Vaughan J. Carr ◽

Catherine Faehrmann ◽

Terry J. Lewin ◽

Jane M. Walton ◽

Alexander A. Reid

Keyword(s):

Primary Care ◽

Family Physicians ◽

Liaison Psychiatry ◽

Consultation Liaison Psychiatry ◽

Knowledge And Practice

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Clinician perceptions of common mental disorders before and after implementation of a consultation-liaison psychiatry service: a longitudinal qualitative study in government-operated primary care settings in Penang, Malaysia

BMJ Open ◽

10.1136/bmjopen-2020-043923 ◽

2021 ◽

Vol 11 (6) ◽

pp. e043923

Author(s):

Vincent Russell ◽

Ching Ee Loo ◽

Aisling Walsh ◽

Arokiamary Bharathy ◽

Umadevi Vasudevan ◽

...

Keyword(s):

Primary Care ◽

Mental Disorders ◽

Common Mental Disorders ◽

Mental Healthcare ◽

Front Line ◽

Liaison Psychiatry ◽

Primary Care Clinics ◽

Primary Care Settings ◽

Before And After ◽

Consultation Liaison Psychiatry

ObjectivesTo explore primary care clinician perceptions of barriers and facilitators in delivering care for common mental disorders (CMD) before and after implementation of a consultation-liaison psychiatry service (Psychiatry in Primary Care (PIPC)) in government-operated primary care clinics and to explore the clinicians’ experience of the PIPC service itself.DesignThis longitudinal qualitative study was informed by the Normalisation Process Model and involved audiotaped semi-structured individual interviews with front-line clinicians before (Time 1) and after (Time 2) the PIPC intervention. The Framework Method was used in the thematic analysis of pre/post interview transcripts.SettingTwo government-operated primary care clinics in Penang, Malaysia.Participants17 primary care medical, nursing and allied health staff recruited purposely to achieve a range of disciplines and a balanced representation from both clinics.InterventionPsychiatrists, accompanied by medical students in small numbers, provided one half-day consultation visit per week, to front-line clinicians in each clinic over an 8-month period. The service involved psychiatric assessment of patients with suspected CMDs, with face-to-face discussion with the referring clinician before and after the patient assessment.ResultsAt Time 1 interviewees tended to equate CMDs with stress and embraced a holistic model of care while also reporting considerable autonomy in mental healthcare and positively appraising their current practices. At Time 2, post-intervention, participants demonstrated a shift towards greater understanding of CMDs as treatable conditions. They reported time pressures and the demands of key performance indicators in other areas as barriers to participation in PIPC. Yet they showed increased awareness of current service deficits and of their potential in delivering improved mental healthcare.ConclusionsDespite resource-related and structural barriers to implementation of national mental health policy in Malaysian primary care settings, our findings suggest that front-line clinicians are receptive to future interventions designed to improve the mental healthcare capacity.

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