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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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Telepsychiatry in South Australia

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JOURNAL OF TELEMEDICINE AND TELECARE 1998年第4期4卷 187-194页

作者： Hawker, F Kavanagh, S Yellowlees, P Kalucy, RS Glenside Hosp Rural & Remote Mental Hlth Serv S Australia Eastwood SA 5063 Australia Royal Brisbane Hosp Dept Psychiat Brisbane Qld Australia Flinders Univ S Australia Dept Psychiat Adelaide SA 5001 Australia

Telemedicine has evolved to become an integral part of the South Australian Rural and Remote Mental Health Service. The resulting telemedicine service is one of only a few telepsychiatry services around the world that is firmly embedded in normal clinical practice and can be regarded as sustainable. The telepsychiatry service has been operational in Adelaide since January 1994 and more than 2000 clinical consultations have been performed since that time. In contrast to other telepsychiatry systems internationally, more than 80% of the usage of the South Australian system has been for clinical purposes. The benefits and limitations of telepsychiatry are reviewed, as are factors that have affected the success of the project.

关键词：精神病学/方法精神病学/组织和管理远程会诊/方法远程会诊/组织和管理远程会诊/利用农村人口南澳大利亚人类

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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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Focus on psychiatry in Hungary

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BRITISH JOURNAL OF PSYCHIATRY 1999年第1期174卷 81-85页

作者： Tringer, L Semmelweis Univ Med Dept Psychiat & Psychotherapy H-1083 Budapest Hungary

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A view of prescriptive practice collaboration: Perspectives of psychiatric-mental health clinical nurse specialists and psychiatrists

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ARCHIVES OF PSYCHIATRIC NURSING 2000年第5期14卷 222-234页

作者： Kaas, MJ Dehn, D Dahl, D Frank, K Markley, J Hebert, P Univ Minnesota Sch Nursing Minneapolis MN 55455 USA Minneapolis Vet Adm Hosp Minneapolis MN USA Chippewa Valley Profess Counseling Eau Claire WI USA Woodland Ctr Mental Hlth Ctr Wilmar MN USA

A majority of states require collaborative prescribing agreements between advanced practice nurses and physicians, Unfortunately, there is limited research describing the collaboration that occurs between the clinicians who have such prescribing agreements. This exploratory study identifies the characteristics, activities, and outcomes of collaboration between psychiatricmental health clinical nurse specialists (CNSs) with prescribing agreements and their collaborating psychiatrists. Surveys were sent to all the 73 prescribing psychiatric-mental health CNSs identified by the Minnesota Board of Nursing in I998 and their primary collaborating psychiatrists, Forty-nine CNSs and 32 psychiatrists returned the surveys with 31 matched collaborating dyads identified. Overall satisfaction with the collaborative relationship was high, CNSs ((x) over bar = 4.34/5) and psychiatrists ((x) over bar = 4.46/5), Good communication, trust, shared goals for patient outcomes, shared professional values, and respect for clinical competency were identified as important characteristics for effective collaboration, CNSs identified increased professional growth and job satisfaction as professional benefits, while psychiatrists reported shared workload responsibilities. Fewer than half of the CNSs and psychiatrists perceived professional liability as a professional constraint. Psychiatricmental health CNSs and psychiatrists agreed that the continuity of patient care and efficient access to mental health care were patient benefits. The statistically significant differences between the CNSs' and psychiatrists' responses were related to the number of years they had been in practice, the number of years the CNS had been a prescriber, and the length of time the CNS and psychiatrist had worked together within a collaborative prescribing agreement. Copyright (C) 2000 by W.B. Saunders Company.

关键词：合作行为效率组织精神障碍/药物疗法精神障碍/护理明尼苏达临床护理医生医生护士关系处方药物专业业务/组织和管理精神病护理学/组织和管理精神病学/组织和管理成年人女(雌)性人类男(雄)性中年人

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Telepsychiatry: Addressing mental health needs in Georgia

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COMMUNITY MENTAL HEALTH JOURNAL 2000年第5期36卷 525-536页

作者： Vought, RG Grigsby, RK Adams, LN Shevitz, SA Med Coll Georgia Telemed Ctr Augusta GA 30912 USA Med Coll Georgia Dept Psychiat & Hlth Behav Augusta GA 30912 USA

Creation of a comprehensive mental health telecommunications system to serve isolated persons in Georgia, resulting in a more equitable distribution of mental health resources, is the goal of the telepsychiatry program at the Medical College of Georgia. Although telepsychiatric consultation is not a new idea, the "distribution" of telepsychiatry through additional integrated telecommunications channels such as the World Wide Web is a distinctive approach. This report describes the history of the development of the MCG Telepsychiatry Program. Through the use of a multichanneled telecommunications system, a more equitable distribution of mental health resources is underway in Georgia.

关键词：佐治亚卫生服务易得程度规划制订精神病学/组织和管理精神病学/发展趋势电信远程医学/组织和管理远程医学/发展趋势青少年成年人老年人儿童儿童学龄前女(雌)性人类男(雄)性中年人

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The impact of managed care on psychiatry

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ADMINISTRATION AND POLICY IN MENTAL HEALTH 1998年第2期26卷 149-157页

作者： Domino, ME Salkever, DS Zarin, DA Pincus, HA Johns Hopkins Univ Sch Hyg & Publ Hlth Baltimore MD 21205 USA Amer Psychiat Assoc Res Off Washington DC 20005 USA

It is estimated that 50% of all practicing psychiatrists have at least one contract with a managed care organization (AMA, 1994). As the field of psychiatry increasingly adopts the tools of managed care, it is important for researchers to clarify the extent to which managed care affects the practice of psychiatry, and how the changing practice climate in turn affects patients seeking mental health care. A diverse array of managed care techniques have been introduced into the profession of psychiatry in an effort to alter treatment patterns. One commonly used tool, utilization review, can alter treatment patterns by restricting access to treatment alternatives and providing incentives to practitioners to meet managed care goals. Other managed care tools are the determination of "medical necessity" and the use of triage and treatment guidelines among insured enrollees requesting services. These guidelines serve as selection criteria to help determine not only which members of the insured population receive treatment for mental health care, but also to determine the allocation of enrollees to staff members and to prescribe the starting point for the types of services received. Managed care psychiatrists may find changes not only in their client populations and treatment alternatives, but in many other aspects of their practice. Some psychiatrists working in managed care have become increasingly involved in treatment teams. Other psychiatrists contracting with MCOs are reserved for medication management, consultation, or administration in carved-out mental health departments or agencies. Little is known about the extent to which managed care restrictions affect psychiatrists' patient care roles, collaborative relationships with other mental health professionals, and the degree to which psychiatrists are involved in administration of managed mental health care benefits. The era of managed care has constrained the clinical decision making of psychiatrists whose magnitude

关键词：医务工作者的态度合同业务/组织和管理管理医疗规划/组织和管理组织改革病人遴选医师的作用精神病学/组织和管理美国利用情况审核/组织和管理人类

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Exploring a model to improve diversity among trainees in psychiatry

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HARVARD REVIEW OF PSYCHIATRY 2000年第2期8卷 91-93页

作者： Naidoo, U Sams, C Donlon, E Brigham & Womens Hosp Dept Psychiat 75 Francis St Boston MA 02115 USA

Examines a model to improve diversity among trainees in psychiatry in the U.S. Formation of the Harvard Longwood Psychiatry Residency Training Program (HLPRTP) in 1994; Efforts of the HLPRTP to improve minority recruitment efforts; Matching of one Afro-American resident who had done the Visiting Clerkship and one Asian who had met with several Diversity Committee members during the application process.

关键词：非洲裔美国人/统计学和数值数据亚裔美国人/统计学和数值数据波士顿教育医学研究生/组织和管理教育医学研究生/发展趋势欧洲大陆世系人群/统计学和数值数据西班牙裔美国人/统计学和数值数据医院教学/组织和管理实习医师和住院医师职务/统计学和数值数据少数民族/教育模型组织管理精神病学/教育精神病学/组织和管理精神病学/发展趋势人类

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The role of the psychiatrist as medical director: A survey of psychiatric administrators

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ADMINISTRATION AND POLICY IN MENTAL HEALTH 2000年第5期27卷 299-312页

作者： Ranz, JM Stueve, A Rosenheck, S Columbia Univ Coll Phys & Surg New York NY 10032 USA Columbia Univ Sch Publ Hlth Div Epidemiol New York NY USA

Previous surveys of public and community psychiatrists have demonstrated that medical directors perform a wider variety of tasks, and experience increased job satisfaction, compared to staff psychiatrists. Notwithstanding respondents' belief that clinical collaboration tasks contribute most to job satisfaction, the performance of administrative tasks is most highly correlated with overall job satisfaction. The current survey was undertaken to determine whether these findings could be replicated among hospital-based psychiatrists. Demographic and job characteristic profiles of hospital-based psychiatrists were clearly distinguished from those of community psychiatrists. Despite these differences, task profiles and job satisfaction parameters of hospital-based psychiatrists were comparable to those previously reported for community psychiatrists.

关键词：方差分析社区精神卫生中心/组织和管理人口统计学职业满意领导医生行政负责人/心理学医生行政负责人/统计学和数值数据精神病科医院/组织和管理精神病学/组织和管理精神病学/统计学和数值数据问卷调查作业完成和分析美国成年人人类男(雄)性中年人

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Advocating for persons who are mentally ill: A history of mutual empowerment of patients and profession

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ADMINISTRATION AND POLICY IN MENTAL HEALTH 2000年第5期27卷 353-367页

作者： Foulks, EF Tulane Univ Sch Med Dept Psychiat Neurol New Orleans LA 70112 USA

The author reviews the history of advocacy for mentally ill individuals. Through organizations such as the National Mental Health Association and the National Alliance for the Mentally ill, collaboration among professionals, consumers, and concerned citizens is enhanced. The common causes and differences among organizations are discussed within the context of how psychiatrists can realize leadership strategies to further advance advocacy for mentally ill persons and for the profession.

关键词：健康态度健康教育领导精神障碍/心理学病人辩护政策制订政治权力(心理学) 精神病学/组织和管理研究美国志愿卫生机构/组织和管理人类

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