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The psychiatrist in primary care: let's look before we leap

Published online by Cambridge University Press:  13 June 2014

Darra Phelan
Darra Phelan*
Affiliation:
Lakeview Unit, Naas General Hospital, Naas, Co. Kildare, Ireland
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Abstract

Objective: Irish psychiatrists may begin to spend, as their British have counterparts have, at least some of their time delivering a psychiatric service from primary care settings. It was therefore decided to review the origins and development of attitudes towards and outcome this practice in Britain.

Method: A literature search and review of relevant papers was undertaken.

Results: Collaboration between psychiatrists and general practitioners began to expand significantly in the 1970s and 1980s. Three main models are used, the shifted outpatient model, the selected consultation model and the liaison-attachment team model. The shifted out-patient model is liked by patients whose attendance rate is better at such clinics and in some areas this model has resulted in a fall in hospital admission rates. There is a paucity of papers examining outcome of the other models. Results of the one extensively studied team liaison approach reports higher treated prevalence rates and lower admission rates for those patients referred. There was no effect on detection of illness by GPs and the service was much more costly.

Conclusions: While some benefits may result from use of the shifted out-patient approach, they are not compelling enough to enable a firm recommendation for its widespread implementation to be made. The results to date suggest the team-liaison approach does not produce benefits sufficient to outweigh the increased cost. The selected consultation model may hold greater potential but needs to be more extensively researched. Finally the structure of general practice in Ireland, with so few GPs working in multiple partner practices makes it highly unlikely that the widespread introduction of collaboration will be feasible.

Keywords

Primary careCollaborationShifted outpatientSelected consultationLiaison-attachment team
Type
Review
Information
Irish Journal of Psychological Medicine , Volume 12 , Issue 1 , March 1995 , pp. 17 - 21
Copyright
Copyright © Cambridge University Press 1995

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