A Descriptive Study of Psychiatric Consultations in a Community Primary Care Center
Primary Care Companion J Clin Psychiatry 2001;3(5):190-194
© Copyright 2016 Physicians Postgraduate Press, Inc.
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.