Daniels M L, Linn L S
Gen Hosp Psychiatry. 1984 Jul;6(3):196-202. doi: 10.1016/0163-8343(84)90040-9.
A participant observation needs assessment of the use of a psychiatrist in a primary care medical setting was undertaken to quantify details of the interaction between a psychiatrist and primary care providers. Two hundred seventeen encounters involving 63 providers were recorded over a five and one-half month period. Utilization of the psychiatrist was widespread but skewed, with only 17% of the sample using 50% of the services. The mean number of encounters for all providers was 3.44. Consultation occurred mainly in a private area of the clinic, usually in an unplanned fashion. Only 21% of encounters involved seeing a patient. The range and content of these interactions was broad. Initial reasons for consultation were often redefined as the consultation ensued. The kinds of help most frequently requested involved discussing nonpsychopharmacologic treatments (35%), assisting providers with evaluations (31%), and exploring unresolved feelings about patients or patient care issues (29%). Slightly more than 50% of encounters required some type of follow-up. The findings suggest that psychiatrists who wish to work in primary care settings must have expertise in a multitude of areas and must be flexible in adapting themselves to the setting in which the primary care providers work.
为了量化精神科医生与初级保健提供者之间互动的细节，对在初级保健医疗环境中使用精神科医生的情况进行了参与式观察需求评估。在五个半月的时间里，记录了涉及63名提供者的217次会诊。精神科医生的使用很普遍，但存在偏差，只有17%的样本使用了50%的服务。所有提供者的平均会诊次数为3.44次。会诊主要发生在诊所的一个私密区域，通常是无计划的。只有21%的会诊涉及看患者。这些互动的范围和内容很广泛。随着会诊的进行，最初的会诊原因常常会被重新定义。最常请求的帮助类型包括讨论非药物治疗（35%）、协助提供者进行评估（31%）以及探讨对患者或患者护理问题未解决的感受（29%）。略多于50%的会诊需要某种类型的随访。研究结果表明，希望在初级保健环境中工作的精神科医生必须在多个领域具备专业知识，并且必须灵活适应初级保健提供者的工作环境。
