Assuntos
Cromatografia de Afinidade/métodos , Fibronectinas/isolamento & purificação , Plasma/química , Adulto , Western Blotting , Adesão Celular/efeitos dos fármacos , Células Cultivadas , Fracionamento Químico , Cromatografia de Afinidade/economia , Citratos/química , Eletroforese , Endotélio Vascular/citologia , Fibronectinas/química , Fibronectinas/farmacologia , Gelatina/química , Humanos , Óleos de Plantas/química , Reprodutibilidade dos Testes , Cloreto de Sódio/química , Citrato de Sódio , Óleo de Girassol , Compostos de Tosil/química , Ureia/químicaRESUMO
While the evolving managed care revolution is dramatically changing the clinical, educational, and economic systems in which consultation-liaison (C-L) psychiatrists must operate, this revolution also present several important opportunities for those in C-L psychiatry. The authors, who are academic department chairs and formerly directed C-L divisions, discuss C-L psychiatry's potential involvement and suggest approaches to effectively address key aspects of these changes.
Assuntos
Programas de Assistência Gerenciada/tendências , Equipe de Assistência ao Paciente/tendências , Psiquiatria/tendências , Previsões , Humanos , Padrões de Prática Médica/tendências , Atenção Primária à Saúde/tendências , Estados UnidosRESUMO
Nonpsychiatrist physicians were surveyed regarding problems that they had experienced when seeking a psychiatric consultation or treatment referral. They gave three main reasons for not referring more patients to psychiatrists: a belief that other mental health professionals could do as well at less cost, that psychiatrists were less available to discuss patients, and that greater stigma was attached to seeing a psychiatrist than seeing other mental health professionals. Psychiatrists might improve their consultation and referral networks by addressing the misperceptions of their nonpsychiatrist physician colleagues.
Assuntos
Relações Interprofissionais , Psiquiatria , Encaminhamento e Consulta , Análise Custo-Benefício , Humanos , Psiquiatria/economiaRESUMO
Psychiatry needs to conduct more rigorously designed empirical research studies to demonstrate its cost-effectiveness, especially since the DRG era is becoming more firmly established. The effectiveness of psychiatric intervention can be evaluated on its abilities to improve physical functioning as well as its improvement of psychosocial symptoms and cost savings. Some of the problems in consultation-liaison research are discussed, including the potentially confounding influences of demographic variables, type and severity of somatic disease, time since diagnosis, level of psychosocial stress, and initial level of physical functioning. Several types of research measures used in assessing physical and psychosocial functioning are discussed, and some of the dilemmas for psychiatry in utilizing individual versus standardized research interventions are explored.