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Psychiatrists' views of managed care and the future of psychiatry

GENERAL HOSPITAL PSYCHIATRY 2000年第2期22卷 97-106页

作者： Regestein, QR Brigham & Womens Hosp Dept Med Div Psychiat Boston MA 02115 USA

Managed care aims to insure the health of a population rather than that of an individual. This paper compiles opinions of psychiatrists and others on managed care and lists ways managed cave potentially affects psychiatry. Managed cave reverses the economic incentives indemnity insurance gave doctors to prolong treatment. It encourages psychiatrists to spend less rime on empathic discussion and to tl:je move standardized, less costly treatments. Many psychiatrists feel distressed about how managed care has changed their practices. Capitation care will change it further. Current trends suggest the U.S. will use and train fewer psychiatrists. Psychiatrists will spend less time with individual patients and more tin-re planning and guiding the treatment of severely impaired patients. Many more psychiatrists will likely have unprecedented changes imposed on their careers. (C) 2000 Elsevier Science Inc.

关键词：伦理学医学管理医疗规划/经济学管理医疗规划/组织和管理管理医疗规划/发展趋势精神卫生服务/经济学精神卫生服务/立法和法学精神卫生服务/组织和管理精神病学/经济学精神病学/教育精神病学/组织和管理精神病学/标准精神病学/发展趋势舆论美国人类

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Developmental psychiatry - insights from learning disability

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BRITISH JOURNAL OF PSYCHIATRY 2000年第3期177卷 201-206页

作者： Hollins, S St George Hosp Sch Med Dept Psychiat Disabil London SW17 0RE England

Background The Blake Marsh lecture, an annual lecture on learning disability was endowed in 1963 in memory of Dr Blake Marsh, the former medical superintendent of Bromham House Colony in Bedford. The first lecture was given in 1967. Aims To review the speciality of the psychiatry of learning disability and how it is currently practised in the UK. Method Clinical,service, research and educational issues in learning disability psychiatry are reviewed and illustrated. Results Key issues which emerge in all four areas include the importance of communication skills, consultation with users and carers, professional education and partnership. Conclusions The psychiatry of learning disability is a complex, varied and stimulating branch of psychiatry with a strong developmental focus. Declaration of interest None.

关键词：教育医学/组织和管理教育医学/发展趋势学习障碍/心理学学习障碍/治疗精神卫生服务/组织和管理精神卫生服务/发展趋势病人辩护精神病学/教育精神病学/发展趋势人类

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Integration of mental health care into primary care - Demonstration cost-outcome study in India and Pakistan

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BRITISH JOURNAL OF PSYCHIATRY 2000年第6期176卷 581-588页

作者： Chisholm, D Sekar, K Kumar, KK Saeed, K James, S Mubbashar, M Murthy, RS Kings Coll London Ctr Econ Mental Hlth Inst Psychiat London SE5 8BB England Inst Hlth Sector Dev London England Natl Inst Mental Hlth & Neurosci Bangalore 560029 Karnataka India Inst Psychiat Rawalpindi Pakistan

Background Targeting resources on cost-effective care strategies is important For the global mental health burden. Aims To demonstrate cost-outcome methods in the evaluation of mental health care programmes in low-income countries. Method Four rural populations were screened fbr psychiatric morbidity. Individuals with a diagnosed common mental disorder were invited to seek treatment, and assessed prospectively on symptoms, disability, quality of life and resource use. Results Between 12% and 39% of the four screened populations had a diagnosable common mental disorder. In three of the four localities there were improvements over time in symptoms. disability and quality of life, while total economic costs were reduced. Conclusion Economic analysis of mental health care in low-income countries is feasible and practicable. Our assessment of the cost-effectiveness of integrating mental health into primary care was confounded by the naturalistic study design and the low proportion of subjects using government primary health care services. Declaration of interest The study was funded by the Department for International Development, UK (HP-ACORD Small Project Grant RD 463).

关键词：印度精神障碍/经济学精神卫生服务/经济学精神卫生服务/组织和管理巴基斯坦初级卫生保健/经济学初级卫生保健/组织和管理前瞻性研究社会经济因素成年人女(雌)性人类男(雄)性

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Models of collaboration

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PRIMARY CARE 1999年第2期26卷 401-+页

作者： Lorenz, AD Mauksch, LB Gawinski, BA Univ Rochester Sch Nursing Dept Family Med Rochester NY USA

In order for primary care clinicians to address the complex needs of their patient population they must be able to collaborate with mental health professionals. The peculiar need for this collaboration arises from the mind-body split embedded in our cultural heritage and the resulting professional separatism. A brief review of that history is followed by sections on the spirit of collaboration, the spectrum of collaboration, key ingredients for effective collaboration, and some thoughts about the future of collaboration.

关键词：信息交流病人医护连续性合作行为家庭医学/组织和管理整体保健职业间关系精神卫生服务/组织和管理模型组织管理病人医疗小组初级卫生保健/组织和管理专业场所心理生理学人类

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A preliminary study of staff perception of psychiatric services in general hospitals

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GENERAL HOSPITAL PSYCHIATRY 1999年第1期21卷 57-61页

作者： Ito, H Kishi, Y Kurosawa, H Minist Hlth & Welf Natl Inst Hlth Serv Management Dept Hlth Care Econ Shinjuku Ku Tokyo 1620052 Japan Nippon Med Sch Dept Neuropsychiat Tokyo Japan

There has been increasing recognition of the importance of integrating physical and psychiatric cave under growing economic pressure. We conducted a survey of staff perception on psychiatric services in four general hospitals. The purpose of this study was to see differences among the staff in their recognition and expectation of the role of the psychiatric department and the need for psychiatric and other staff to work more closely together. Although 81% of psychiatrists recognized their role in acute psychiatry, only 42.6% thought that acute psychiatry was the most important role of psychiatry. Mooed disorders were recognized as a psychiatric category in 95.2% of psychiatrists and 54.8% of nonpsychiatrist physicians. Overall satisfaction with psychiatric services in psychiatric and other staff were 54.0% and 68.2%, respectively. Although 85.7% of psychiatrists answered that they supported staff in other departments that have psychiatric or psychological problems, only 53.5% of those staff in other departments were satisfied with their support. Staff in other departments expected psychiatric staff to establish consultation hotlines and to visit other departments regularly. Our results suggest that there are discrepancies between psychiatric and other staff in their perception of psychiatric services, and it is our belief that those gaps must be bridged for better collaboration in general hospitals. (C) 1999 Elsevier Science Inc.

关键词：医务工作者的态度卡方分布卫生保健提供联合/标准卫生保健调查医院综合/组织和管理职业间关系日本精神障碍/分类精神障碍/诊断精神障碍/心理学精神障碍/治疗精神卫生服务/组织和管理精神卫生服务/标准人员医院/心理学精神病科医院/组织和管理精神病科医院/标准精神病学/方法精神病学/标准人类

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Violence in the workplace: new perspectives in forensic mental health services in the USA

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BRITISH JOURNAL OF PSYCHIATRY 2000年第4期176卷 339-344页

作者： Fletcher, TA Brakel, SA Cavanaugh, JL Rush Presbyterian St Lukes Med Ctr Sect Psychiat & Law Isaac Ray Ctr Inc Chicago IL 60612 USA

Background This paper reviews current research on workplace violence in the USA and offers suggestions concerning the roles that mental health professionals with forensic expertise can play in this expanding field. Aims To clarify the role of the mental health professional in evaluating issues related to workplace violence. Method Manual and computer literature searches were performed. Results The incidence of reported workplace violence is on the rise and can be devastating beyond the immediate injury. Forensically oriented mental health professionals can assist companies by providing pre-employment screenings, fitness-for-duty evaluations and threat assessment by using the results of current research on potentially violent individuals. Conclusions With the growing interest in workplace violence come many opportunities for mental health professionals to assist companies in assessment, intervention and prevention. Declaration of interest This paper was financially supported by the Isaac Ray Center, Inc. (Section of Psychiatry and the Law, Rush-Presbyterian-St. Luke's Medical Center), Chicago, Illinois, USA.

关键词：司法精神病学精神卫生服务/组织和管理人员选用专业业务研究设计美国暴力/预防和控制暴力/统计学和数值数据工作场所人类

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Collaborative care in the United Kingdom

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PRIMARY CARE 1999年第2期26卷 411-+页

作者： Jenkins, GC Counselling Primary Care Staines TW18 4DG England

It is estimated that in 1999, psychological counselors will work in over half of all general practices (primary care physician partnerships) in the United Kingdom. The history of the growth of counseling in general practice is, in many ways, typical of the British way of doing things. Ad hoc arrangements at a personal level, in which individual general practices let a counselor, of ten a social worker, colleague, or personal friend, see those patients who had a variety of problems the primary care physician felt unskilled to handle, characterized many of the early reports of General Practice Counseling.(2,3,26) From provisional data available from the first ever National Survey of general practice counselors,(29) it seems that most counselors are women (87%), with an average age of 48 years;all but a tiny handful have recognizable counselling or psychotherapy qualifications. Fifty percent usually possess a British Association for Counseling Recognized Certificate and Diploma, 25% possess additional counselling and psychotherapy qualifications, and 13% possess qualifications at a Masters level. The counselors surveyed come from many backgrounds, including social work, teaching, and nursing, and they work between 5 to 30 hours a week in general practice. As more research studies are published in the United Kingdom, their work, along with other members of the primary care teams (doctors, nurse practitioners, health visitors, psychotherapists, social workers, and others), is becoming increasingly valued by their fellow primary care team members, and by the patients they see who are referred to them by their primary care colleagues.(4,21,24)

关键词：合作行为咨询/组织和管理效率组织家庭医学/组织和管理大不列颠卫生保健费用/统计学和数值数据精神卫生服务/组织和管理初级卫生保健/组织和管理心理学临床/组织和管理人类

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Management of suicide attempts in Italy and Sweden - A comparison of services offered to consecutive samples of suicide attempters

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GENERAL HOSPITAL PSYCHIATRY 2000年第6期22卷 432-436页

作者： Runeson, B Scocco, P DeLeo, D Meneghel, G Wasserman, D Karolinska Inst St Gorans Hosp Dept Clin Neurosci Sect Psychiat S-11281 Stockholm Sweden Univ Padua Dept Neurol & Psychiat Sci WHO Collaborating Ctr Res & Training Suicide Prev Padua Italy Griffith Univ Brisbane Qld 4111 Australia Karolinska Inst Natl Inst Psychosocial Med Natl Swedish Ctr Suicide Res & Prevent Mental Ill Stockholm Sweden Karolinska Inst WHO Collaborating Ctr Stockholm Sweden

The aim of the study was to compare the management of suicide attempts by patients in Sweden and Italy with a view to providing a perspective on differences in treatment. Two consecutive samples of suicide attempters from Huddinge (n=97) and Padua (n=100) were studied in trans of sociodemographic characteristics previous care, referral, medical and psychiatric care, hospitalization, aftercare and short-term compliance. In Italian somatic management of acute suicidal crises, there are more physicians specializing in anesthesia or internal medicine working in ambulances and emergency wards, and there is a heavier emphasis on somatic care. Swedish management procedures seem to entail more medical examinations and biohumoral tests. Moreover, the procedures at the Swedish hospital give priority to early psychiatric intervention, and admission to psychiatric inpatient care is more frequent. However, it is not normal practice in emergency psychiatric care at either of the centers for specialists to serve in the immediate liaison consultation. There are differences in assessment and treatment between the two countries that may provide a perspective on their procedures, implying that current procedures for managing patients belonging to groups identified as "high-risk" in terms of suicide may be modified. (C) 2000 Elsevier Science Inc.

关键词：出院后医疗/组织和管理急诊室精神病/组织和管理住院/统计学和数值数据意大利精神卫生服务/组织和管理病人依从/心理学病人依从/统计学和数值数据精神病学/组织和管理卫生保健质量转诊和会诊/组织和管理社会经济因素自杀未遂/预防和控制自杀未遂/心理学自杀未遂/统计学和数值数据瑞典青少年成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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An evaluation of a network for professional development in child and adolescent mental health in rural and remote communities

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JOURNAL OF TELEMEDICINE AND TELECARE 2000年第3期6卷 158-162页

作者： Mitchell, J Robinson, P Seiboth, C Koszegi, B Womens & Childrens Hosp N Adelaide SA 5006 Australia John Mitchell & Associates Sydney NSW Australia

In 1998 a telemedicine network was established in South Australia and the Northern Territory to deliver educational material to professionals working in child and adolescent mental health in remote areas. The network involved a wide range of health professions, from psychiatrists to psychologists and social workers. The first 12 months of network activity were evaluated by quantitative and qualitative techniques. Four sources of data were used: an activity log, questionnaires, interviews and action research. A total of 36 telemedicine sessions were held, ranging in duration from 45 to 90 min (average 56 min) and involving a total of 45 different professionals, who participated an average of four times each (range 1-15). The most common types of session were case discussions (47%), followed by specialist seminars (36%) and administrative and introductory sessions (17%). The benefits of the network included: networking and peer support;improved efficiency and reduced travel costs;and improved efficiency of health services. The problems included: costs;lack of access to technical support;and the need for staff induction and training.

关键词：青少年保健服务/组织和管理精神卫生服务/组织和管理专业能力方案评价问卷调查乡村卫生服务/组织和管理南澳大利亚人员开发/组织和管理远程医学/组织和管理青少年儿童儿童学龄前人类

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The carved-out system's view.

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New directions for mental health services 1999年第81期1999卷 53-61页

作者： Alter, C.L. Neurosciences Division of Bristol-Meyers-Squibb and chair of the Managed Care Committee of the Academy of Psychosomatic Medicine

Rarely do issues of mental health care in medical settings and the medical care of severely and persistently mentally ill patients treated in public mental health get addressed. The best approach to ensure that care is integrated is to reduce obstacles to reimbursement. In particular, carved-out systems should ask questions that highlight areas for change.

关键词：精神卫生服务/经济学精神卫生服务/组织和管理精神病学美国人类男(雄)性

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