Psychiatry in general practice. A pilot scheme using the liaison-attachment model.
OBJECTIVE: To improve the quality and accessibility of psychiatric service in the primary care setting. DESIGN: Under the liaison-attachment model, a senior psychiatry trainee provided psychiatric consultations part-time in general practice over an 18-month period. Patients regarded by the participating doctors as having significant psychiatric problems were referred to the trainee for consultation. SETTING: Four group general practices, involving 18 doctors, took part in the scheme. PARTICIPANTS: During the study 172 patients with a wide spectrum of diagnoses were assessed. Near the end of the 18-month period the participating general practitioners provided their evaluations of the scheme. INTERVENTION: In almost all cases standard treatment was provided in the primary care setting and administered by either a general practitioner, the trainee or both working collaboratively together. OUTCOME MEASURES: The general practitioners evaluated the results of the consultations and the effect of the service on their referral patterns. They also rated the overall impact of the scheme on their own knowledge and skills, the quality of care, and its accessibility. RESULTS: The quality of outcome, if known, was regarded as satisfactory in 88% of cases. The reported frequency of referrals to psychiatrists in private practice dropped significantly. The participating doctors perceived improvements in their own abilities to deal with psychiatric problems and regarded the quality and accessibility of psychiatric care to be enhanced by the scheme. CONCLUSIONS: The psychiatric liaison-attachment model, developed in Britain, is applicable and effective in the Australian primary care setting.