A descriptive study of psychiatric consultations in a Community Primary Care Center

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Abstract

Background: This retrospective chart review study describes on-site psychiatric consultations at a large, urban community primary care center. The referral population, diagnostic reliability of primary care providers (PCPs) and social workers, appropriateness of PCP-initiated treatment, impact of treatment recommendations, and outcomes are examined. Method: Charts of all patients who received psychiatric consultations (N = 78) during an 8-month period (August 1996 to April 1997) were reviewed. Results: Prereferral diagnoses by PCPs matched the psychiatrist's diagnosis based on DSM-IV diagnostic criteria approximately half the time. PCPs initiated psychopharmacology in half the referrals (39/78) and used generally appropriate medications (30/39) based on diagnosis by a psychiatrist, but at subtherapeutic doses (21/39). PCPs tended to continue medications recommended by the psychiatrist. At 1 year, PCPs clearly documented improvement in nearly a third of the consults (24/78). Conclusion: Diagnostic disagreement of caregivers, inadequate PCP psychopharmacology practices, and patient nonadherence are 3 main problems that impede optimal care within the model of psychiatric consultation described in this study.

Original languageEnglish (US)
Pages (from-to)190-194
Number of pages5
JournalPrimary Care Companion to the Journal of Clinical Psychiatry
Volume3
Issue number5
StatePublished - 2001
Externally publishedYes

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ASJC Scopus subject areas

  • Psychiatry and Mental health

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