Psychiatric outpatient consultation for seniors. Perspectives of family physicians, consultants, and patients / family: A descriptive study

Mark J Yaffe,Francois Primeau,Nandini Dendukuri,Jane Mccusker,Johanne Laplante,Eric Belzile,Michel Elie,Martin G Cole

doi:10.1186/1471-2296-6-15

Abstract

BackgroundFamily 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.MethodsAn 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.Results101 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.ConclusionGaps 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.

Highlights

Practitioners take care of large numbers of seniors with increasingly complex mental health problems
The interface between physician groups has been examined from the perspective of family doctors gatekeeping access to specialized services in Canada [1], the United States [2], Britain [3], and Australia [4]
Patient participant characteristics Over 18 months 207 people were referred by family practitioners for psychogeriatric consultation

Summary

Introduction

Practitioners take care of large numbers of seniors with increasingly complex mental health problems. This study examines patients'/family, family practitioners', and psychiatrists' perceptions of the bi-directional pathway between such primary care doctors and consultants. Within the domain of mental health services a shared care model between psychiatrist and family physician has been described [9,10] and advocated for the care of elderly.[11] For example, while the prevalence of major depression in an older primary care population is 6%, [12] less than 20% of these depressed elderly are diagnosed and adequately treated.[13] Interventions may be designed to improve the process of out-patient psychogeriatric care.[14] The PROSPECT [15,16] and IMPACT [1720] studies have recently demonstrated, for example, the particular benefit of psychiatric care managers in managed health care settings

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