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Original Research

A Descriptive Study of Psychiatric Consultations in a Community Primary Care Center

William F. Pirl, MD; B. J. Beck, MD; Steven A. Safren, PhD; and Helen Kim, MD

Published: October 1, 2001

Article 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.

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