Private Psychiatric Practice Research Articles

Notice biographique sur le Dr Achille Delmas (1879–1947). Première partie : débuts de carrière et principaux travaux

Dr Achille Delmas, a psychiatrist in private practice, achieved fame between the two world wars for his work, which was an extension of Professor Ernest Dupré’s insights. He defended a view of mental illness based on the theory of “constitutions,” i.e., hereditary dispositions that persist throughout life, the most common of which is the cyclothymic constitution. He thus represented a traditionalist point of view and was an adamant opponent of psychoanalysis as well as sociology. In his book Psychologie pathologique du suicide, he argued for the essential role of mood disorders in suicide and vigorously criticized the sociological theses derived from the works of Durkheim and Halbwachs. His work deserves a renewed interest in the face of a contemporary sociologizing discourse concerning suicide that overemphasizes the role of environmental conditions – particularly those of the workplace – and that tends to deny the importance of pathological factors.

Challenges of Private Practice: Working With Health Care Colleagues

Challenges of Private Practice: Working With Health Care Colleagues

Child Psychiatric Services in the Private Sector: Some Insights

This paper looks at child psychiatric services in the private sector and all that can be done with child psychiatric services in the private sector. The need for public-private partnerships, the role of child psychiatrists in private practice providing integrated services, and the need for school mental health services by private psychiatrists is emphasized. The paper ends by emphasizing the need to focus on adolescent mental health and eradicating the stigma that surrounds child and adolescent mental health.

Buprenorphine Program Evaluation in a Private Psychiatric Office-Based Practice.

The opioid crisis has contributed to the mortality, morbidity, and rising healthcare costs in the United States. Buprenorphine (BUP) is an effective medication for opioid use disorder. The aims of this quality assurance evaluation of a BUP program were to (a) evaluate the clinic's performance in illicit opioid abstinence and (b) identify patient risk and resilience characteristics to improve patient success in recovery with BUP. A retrospective chart review of open (n = 35) and closed (n = 21) cases and a cross-sectional survey in open cases were completed. Adults (aged ≥18 years) who completed 6 months of BUP treatment at a psychiatric clinic were included. Clinical performance was measured with percentages of opioid-negative urine and completed monthly urine drug tests (UDTs) for the first 6 months. Open cases were surveyed regarding risk and resilience characteristics (frequency of opioid cravings and triggers, therapy participation, and coping skills). Descriptive statistics, t test, and chi-square test were used to analyze data. Average opioid-negative urine was significantly higher in open cases than closed cases (88.57% vs. 74.82%; t = 2.885, p = .004). There was no significant association between open cases (61.4%) and closed cases (73.8%) in completed monthly UDT. Opening and closing of cases stabilized with mandatory monthly UDT. Most individuals reported therapy participation, minimal opioid cravings, and use of distraction to cope with chronic-pain-induced cravings. This clinic met benchmarks leading to improved substance recovery. Recommendations include regular evaluations of UDT, cravings, and chronic pain; therapy participation; and continuous quality assurance activities.

When Patients Become Colleagues

When Patients Become Colleagues

Antipsychotic prescribing practices in real-life (APPREAL study): Findings from the French National Healthcare System Database (2007-2017).

Antipsychotics are used in a large variety of psychiatric and neurological disorders; investigating their use in real life is important to understand national prescribing practices, as well as to determine the levels of patient adherence. Using a 1/97e random sample (General Sample of Beneficiaries, EGB) of the French health insurance reimbursement database, we conducted a historical cohort study on the 2007-2017 period. The aim was to describe the sociodemographic characteristics of patients, the types of antipsychotics dispensed, the types of prescribers, the mean doses and average durations of treatment, the co-dispensed medications, and the levels of adherence to treatment. To exclude punctual uses of antipsychotics, we selected only patients with a continuous dispensing of the same antipsychotic over at least 3 months. In total, 13,799 subjects (1.66% of the EGB sample) were included (56.0% females; mean age 55.8 ± 19.4 years). Risperidone (19.3%), cyamemazine (18.7%), olanzapine (11.9%), tiapride (8.8%), and haloperidol (7.5%) were the five most prescribed antipsychotics. 44.9% of prescriptions were written by general practitioners, 34.1% by hospital practitioners, and 18.4% by private-practice psychiatrists. On average, the mean dispensed doses were relatively low, but the variation range was large. Long-acting forms were used in 5.4% of the sample, and clozapine in 1.3%. 34.2% of patients received more than one antipsychotic, and almost 15% were prescribed at least three concomitant antipsychotics. Paliperidone and clozapine were associated with the highest levels of adherence, and risperidone and haloperidol with the lowest ones. An important heterogeneity of antipsychotic prescribing practices was observed in France. The rate of use of long-acting antipsychotics was low, whereas multiple antipsychotic prescriptions were frequent.

Panelists Outline How to Address Patients’ Social Determinants of Health, Why It’s Important

Panelists Outline How to Address Patients’ Social Determinants of Health, Why It’s Important

Pandemic Revealed Unique Aspects of Sexual Addictions

Pandemic Revealed Unique Aspects of Sexual Addictions

Members Report Uptick in Plans’ Claims Denials, Scrutiny, and Hassles

Members Report Uptick in Plans’ Claims Denials, Scrutiny, and Hassles

Outpatient Psychiatric Care Not for the Poor—What Is Our Obligation?

Outpatient Psychiatric Care Not for the Poor—What Is Our Obligation?

Changes in private psychiatric practice in Australia: An analysis of trends in claims for outpatient Medicare item numbers over 14 years.

The Better Health Access Initiative added 32 Medicare Benefits Schedule (MBS) item numbers in 2006 to increase the number of people with access to mental health care. We investigated trends in the provision of outpatient Medicare-subsidised psychiatric services since the introduction of these item numbers in 2006 through 2019. Medicare Benefits Schedule aggregated item-number claims data were obtained from the Services Australia Medicare website, between January 2006 and December 2019 inclusive, for face-to-face psychiatrist consultations. Item number rates were collated and graphed per 100,000 population according to year and item number. There has been an increase in the number of claims for new patient assessments (291-296) and a reduction in most ongoing care Medicare item numbers, especially longer appointments that are often associated with psychotherapy provision (306-308). There have been changes in private psychiatric practice in Australia over the past 14years. There are several possible causes for these changes and further research is required to determine the impact on patient care.

Addressing Access to Care in Geriatric Psychiatry through Outpatient Consultation

<h3>Introduction</h3> Article 31 clinics, under the regulation of the Office of Mental Health, have limitations in the patients that are able to be seen. In particular, patients with a primary diagnosis of neurocognitive disorder are considered ineligible for admission to such a clinic. Furthermore, many of the patients that would seek treatment at Montefiore Medical Center's Outpatient Psychiatry clinic, an Article 31 clinic, would not be able to afford private practice psychiatrists. Nevertheless, older adults with neurocognitive disorder experience symptoms that are typically managed by psychiatrists. In response to this gap in care, the Outpatient Geriatric Psychiatry team at Montefiore Medical Center developed an outpatient psychiatric consultation service to increase access to care and meet the mental health care needs of older adults living in the community. This service is provided under an Article 28 clinic, which is regulated by the Department of Health like any other medical specialty clinic. In this study, we aimed to identify which patients benefited from this service, what types of interventions were made and the impact on referring providers. This was done by collecting demographic data on patients referred for consultation and the format, frequency, and outcomes of these consultations. We also plan to collect feedback from referring providers. <h3>Methods</h3> The Geriatric Psychiatry outpatient consultation service started in December 2019 and conducted visits in person for 3 months, stopped during the 3 months of lockdown due to the COVID-19 pandemic (March to June 2020), restarted with virtual visits in July 2020 and then resumed with in person visits. Patients are referred by other providers in the Montefiore Health System or through self-referral. Patients are then screened for appropriateness for outpatient consultation. Patients who are ≥65 years old or have an underlying medical condition that contributes to their frailty, and who have a psychiatric concern are scheduled for an appointment. Efforts are made to direct those who are not appropriate for the service to more appropriate resources. In a retrospective chart review, data was gathered on patient age, referral source and reason for referral, diagnosis, format and number of visits, and outcomes of interest including medication changes, supportive services, and higher level of care. <h3>Results</h3> From December 2019 through September 2021, 38 patients were scheduled, 32 of whom presented to clinic for psychiatric evaluation. Patients ranged from 61 to 93 years old with a mean age of 79 years. A majority of patients were from ethnically diverse backgrounds with 59% Hispanic, 12.5% Black, 3% Asian and 3% American Indian. 50% of patients were Spanish speaking. About half the visits were conducted in person, with the remaining visits about evenly split between phone and video. Patients on average were seen for about 2 visits with a range from 1 to 11 visits. Most of the referrals came from primary care providers and among the reasons for referral were decline in function or cognition, behavioral concerns, depressed or anxious mood and psychosis. About 87.5% of patients had a diagnosis of major or minor neurocognitive disorder diagnosis. The most common interventions included medication changes, referral to support services, behavioral interventions, transfer to the outpatient department or sending for evaluation in the emergency department. <h3>Conclusions</h3> The Geriatric Psychiatry consultation service provided through an Article 28 clinic was primarily used by patients with neurocognitive disorders who would otherwise not be seen in Article 31 outpatient psychiatry clinics and would not be able to afford private practice. Through this service we were able to address a gap in care for a diverse and underserved patient population. In order to further assess the impact of this service, we plan to ask referring providers for feedback about the process of referral, the evaluations conducted and the recommendations received for their patients. Future studies would be helpful to collect prospective data on patients being followed by consultation service and additionally obtain patient and caregiver feedback. <h3>This research was funded by</h3> N/A Chart: https://apps.aagponline.org/abstracts/uploads/2022/gpn8zt4h8w464zu.pdf

Psychotherapy Caucus Creates Program to Increase Use of Psychotherapy

Psychotherapy Caucus Creates Program to Increase Use of Psychotherapy

Collaborative Care Model Promotes Justice and Equity

Collaborative Care Model Promotes Justice and Equity

Improving services for those who serve: A private practice initiative to improve psychiatric care for first responder and military patients.

Professional isolation and limited opportunities for multidisciplinary collaborations are well-recognised challenges for psychiatrists in private practice. This narrative paper describes the development of a private practice group to assist first responders (FRs) and military patients located in Adelaide, South Australia. The aims included both peer review, and interdisciplinary communication and collaboration. Relevant personnel in the ambulance, police and fire services, military and veterans' groups, and the compensation system, participated in monthly meetings. Lack of timely access to psychiatric care for FR and military patients was identified as a problem and an expedited referral service was established. The Closing the Gap Group was established in 2017. The terminology refers to the gap between treating psychiatrists and the complex organisations that manage the workplace context for FR/military patients. This initiative provides a template for private practice innovations to improve psychiatrists' skills and knowledge, along with better engagement and understanding between private psychiatrists and relevant community organisations.

Sustainable operation of private psychiatric practice for pandemics.

Sustainable operation of private psychiatric practice for pandemics.

Clinical update on public and private psychiatric practice shared-care partnerships - Can the twain work together?

We explore the previous research and current context regarding opportunities for shared-care partnerships between public and private psychiatric practice. Since the early 2000s, when there was impetus for the development of public-private psychiatric shared-care models as part of a previous National Mental Health Strategy, there has been surprisingly little research and policy development. Given an apparent exodus of psychiatrists to private practice due to current challenges facing the public health sector, it is timely to reconsider models of private and public sector shared-care that may improve the quality of public mental healthcare.

The Ministry for the Future: Climate Change and the Human Psyche

The Ministry for the Future: Climate Change and the Human Psyche

Covid-19-Pandemie: Angsterleben von niedergelassenen und Krankenhaus-Psychiatern

To date, no studies have examined the pandemic-related stress experience of inpatient versus outpatient psychiatrists. Therefore, the aim is to investigate the extent of Covid-19 exposure, anxiety, stress experience, and coping abilities among psychiatrists in private practice compared to physicians in psychiatric and psychosomatic hospitals. E-mail-based questionnaires with 13 items were used to assess anxiety and stress experience. A total of 105 practicing psychiatrists, and 73 physicians and psychologists from four clinics (including the Clinic for Psychosomatic Medicine and Psychotherapy) were surveyed between early April and mid-May 2020. Compared to hospital psychiatrists, psychiatrists in private practice more often felt severely restricted (52.4 vs. 32.9% p=0.010), at risk of infection (35.2 vs. 13.7%, p<0.001) and financially threatened (24.7 vs. 6.9%, p=0.002). The proportion of well-informed practicing psychiatrists was lower (47.6 vs. 63.0%, p=0.043) and the proportion with lack of protective equipment was higher (27.6 vs. 4.1%, p<0.001). At the same COVID-19 exposure level (8.6 vs. 8.2%), office-based psychiatrists were more likely to report high anxiety, although not significantly, compared to hospital psychiatrists (18.1 vs. 9.6%, p=0.114). Risk factors for experiencing anxiety in both groups were feeling restricted (OR=5.52, p=0.025) and experienced risk of infection (OR=5.74, p=0.005). Exposure level, clinic or practice affiliation, age, gender, and other dimensions of threat experience and coping behavior had no influence. Psychiatrists in private practice felt more stressed and threatened by the COVID-19 pandemic compared with hospital-based colleagues. The experience of anxiety was dependent on feeling constrained and at risk of exposure, but not on exposure, protective equipment. Objective indicators seem to play less of an important role in the expression of anxiety than subjective experience.

Honesty Fosters Trust

Honesty Fosters Trust