Steinberg M D, Cole S A, Saravay S M
Albert Einstein College of Medicine, USA.
Int J Psychiatry Med. 1996;26(2):135-43. doi: 10.2190/38BV-9JPA-VE3D-00H7.
This article describes the need for and development of an outpatient primary care psychiatry fellowship program.
The Department of Psychiatry at Hillside Hospital established a primary care fellowship for psychiatrists in 1994, through its consultation-liaison (C-L) service. Staff alliances established by the C-L service with primary care physicians provided the basis for identifying appropriate outpatient practices in the community. Knowledge and skills objectives were adapted from a traditional C-L fellowship to outpatient primary care medicine.
The selection of a psychologically minded primary care practitioners was crucial. Practitioners used an inclusive model in which fellows would see all patients with them, not just those with mental disorders. Fellows have felt comfortable working in the primary care setting and have been well received by practitioners, staff, and patients. The practitioners were clearly more interested in psychosocial aspects of their patient than were primary care residents.
The gap in preparing U.S. psychiatrists to function in integrated primary care programs requires establishing a presence in the primary care setting. Skills and relationships from traditional C-L settings can be productively used to accomplish this goal.
本文描述了门诊初级保健精神病学 fellowship 项目的需求及发展情况。
希尔赛德医院精神科于1994年通过其会诊 - 联络（C - L）服务为精神科医生设立了一个初级保健 fellowship 项目。C - L服务与初级保健医生建立的员工联盟为确定社区中合适的门诊业务提供了基础。知识和技能目标是从传统的C - L fellowship 项目改编而来，以适应门诊初级保健医学。
选择有心理意识的初级保健从业者至关重要。从业者采用一种包容模式，即 fellows 将与他们一同诊治所有患者，而不仅仅是患有精神障碍的患者。 fellows 在初级保健环境中工作感觉很自在，并受到了从业者、工作人员和患者的欢迎。与初级保健住院医师相比，从业者显然对其患者的社会心理方面更感兴趣。
在美国，精神科医生在综合初级保健项目中发挥作用的准备方面存在差距，这需要在初级保健环境中占有一席之地。传统C - L环境中的技能和关系可有效地用于实现这一目标。
