Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
Gen Hosp Psychiatry. 2013 Sep-Oct;35(5):461-7. doi: 10.1016/j.genhosppsych.2013.06.011. Epub 2013 Jul 30.
This evaluation assessed the opinions and experiences of primary care providers and their support staff before and after implementation of expanded on-site mental health services and related system changes in a primary care clinic.
Individual semistructured interviews, which contained a combination of open-ended questions and rating scales, were used to elicit opinions about mental health services before on-site system and resource changes occurred and repeated following changes that were intended to improve access to on-site mental health care.
In the first set of interviews, prior to expanding mental health services, primary care providers and support staff were generally dissatisfied with the availability and scheduling of on-site mental health care. Patients were often referred outside the primary care clinic for mental health treatment, to the detriment of communication and coordinated care. Follow-up interviews conducted after expansion of mental health services, scheduling refinements and other system changes revealed improved provider satisfaction in treatment access and coordination of care. Providers appreciated immediate and on-site social worker availability to triage mental health needs and help access care, and on-site treatment was viewed as important for remaining informed about patient care the primary care providers are not delivering directly.
Expanding integrated mental health services resulted in increased staff and provider satisfaction. Our evaluation identified key components of satisfaction, including on-site collaboration and assistance triaging patient needs. The sustainability of integrated models of care requires additional study.
本评估在初级保健诊所实施扩大现场精神卫生服务和相关系统变更之前和之后,评估了初级保健提供者及其支持人员的意见和经验。
采用半结构化访谈的方法,包括开放式问题和评分量表,以了解现场系统和资源变更之前对精神卫生服务的意见,并在旨在改善现场精神卫生保健服务可及性的变更之后重复进行。
在第一组访谈中,在扩大精神卫生服务之前,初级保健提供者和支持人员普遍对现场精神卫生保健的可用性和预约安排不满意。患者经常被转诊到初级保健诊所外进行精神卫生治疗,从而损害了沟通和协调护理。在扩大精神卫生服务、调整预约和其他系统变更后的后续访谈中,提供者对治疗可及性和护理协调的满意度提高。提供者赞赏即时和现场社会工作者的可用性,以对精神卫生需求进行分诊并帮助获得护理,现场治疗对于了解初级保健提供者未直接提供的患者护理也很重要。
扩大综合精神卫生服务导致员工和提供者的满意度提高。我们的评估确定了满意度的关键组成部分,包括现场合作和协助分诊患者需求。综合护理模式的可持续性需要进一步研究。