Magazine article Clinical Psychiatry News

Psychiatrists Call for Coordination with Primary Care

Magazine article Clinical Psychiatry News

Psychiatrists Call for Coordination with Primary Care

Article excerpt

EXPERT ANALYSIS FROM A BRIEFING SPONSORED BY THE APA

WASHINGTON -- The American Psychiatric Association is putting out a call for much tighter integration of primary care and mental health care, saying that it will lead to better services for patients and a reduction in costs to the health system.

"Studies have shown that concurrently treating behavioral and physical conditions leads to better control of the illness itself, but also better patient satisfaction, quality of life, and reduced costs," Dr. Jeffrey Lieberman, former president of the APA, said at a briefing, sponsored by the American Psychiatric Association.

The APA released a report that shows that effective integration could save $26 billion to $48 billion a year in general medical care. The report was written by the consulting firm Milliman, which the APA commissioned to take a look at integrated care models and the potential to improve care.

Dr. Lieberman, who is also chairman of the psychiatry department at Columbia University Medical Center, New York, said the Milliman report was only the latest in a series of studies that have shown that addressing medical conditions and behavioral issues simultaneously is more effective and more cost effective than creating silos to address each. A recent review by the Cochrane Collaboration of 79 randomized controlled trials, including more than 24,000 patients worldwide, compared collaborative care with routine care for depression and anxiety (Cochrane Database Syst. Rev. 2012;10:CD006525). The review found that collaborative care is more effective, increasing patient satisfaction and quality of life.

"The jury is now in, that integrated care is effective," said Michael F. Hogan, Ph.D., the former commissioner of the New York State Office of Mental Health, at the briefing. He said the specialty mental health system is not the solution to helping people with mental illness and comorbid conditions improve.

Almost half of people with a mental disorder first consult with a primary care physician. On average, it takes 9 years after the first symptoms for a patient to receive a diagnosis, Dr. Hogan said. Given that the average age at which those symptoms appear is 14, that means a lot of individuals are struggling without a diagnosis during adolescence, he said, calling that a "bad approach."

And, about 50% of the 38,000 people who commit suicide each year have seen a primary care physician within a month of the completed attempt, he added. Dr. Hogan said that not only do primary care physicians need the tools and education to help them do a better job in diagnosing and treating patients with mental disorders, but that they also need a team that includes a psychiatrist or behavioral health specialist. …

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