A Qualitative Study on the Barriers to Learning in a Primary Care-Behavioral Health Integration Program in an Academic Hospital: the Family Medicine Perspective.

OBJECTIVE: Integrating behavioral health services into the primary care setting is a recognized approach to improving timely access and building capacity for primary care providers. The aim of this study was to examine barriers to family medicine resident learning in a co-located primary care-behavioral health integration program with psychiatrists in an academic hospital. METHODS: The authors used a descriptive qualitative study design to collect data on participants' learning experiences from focus groups and semi-structured interviews with 5 family medicine residents, 3 psychiatry residents, 5 family physicians, 3 psychiatrists, 2 office coordinators, and 2 educational coordinators. Thematic analysis of transcripts was performed. RESULTS: Three themes were identified with respect to barriers to learning in the program from the family medicine perspective. Organizational barriers encompassed lack of clear vision, goals, roles, and responsibilities. Administrative barriers involved complex appointment bookings and scheduling. Communication and engagement barriers included insufficient communication between team members and lack of patient engagement in the program. CONCLUSIONS: The study findings highlight the importance of several factors for the successful implementation of a co-located academic primary care-behavioral health integrated model. This includes the formalization of program structure that encompasses shared vision, goals, roles, and responsibilities; coordinated processes for appointment bookings; team communication and patient engagement; and diverse educational and longitudinal care opportunities. With the growing number of integrated care programs, these results provide guidance for health care leaders involved in the design and management of primary care-behavioral health integration programs.

Evaluation of professional role competency during psychiatry residency.

OBJECTIVE: The authors sought to determine psychiatry residents' perceptions on the current method of evaluating professional role competency and the use of multi-source feedback (MSF) as an assessment tool. METHOD: Authors disseminated a structured, anonymous survey to 128 University of Toronto psychiatry residents, evaluating the current mode of assessment of the professional role and the use of MSF. RESULTS: The overall response rate was 86%. Fewer than half (44%) of residents felt that their professional role is adequately evaluated, and 84% were in favor of incorporating MSF for the evaluation of this competency. Respondents believed their primary supervisor should have the largest proportional impact on the evaluation (50%), followed by allied heath staff (19%), patients (16%), co-residents (12%), self (11%), and administrative staff (9%). CONCLUSION: On the basis of this needs assessment and the Royal College recommendations, MSF may be considered a potential assessment tool for evaluating psychiatry residents in their professional role.

Acute Neuropsychiatric Symptoms Associated With Antibiotic Treatment of Helicobacter Pylori Infections: A Review.

Helicobacter pylori infects half the global population. Because serious complications can result from this infection, a so-called "triple therapy" is recommended: treatment with a proton-pump inhibitor and clarithromycin, along with amoxicillin or metronidazole. Although these antibiotics have been associated with neuropsychiatric symptoms, it is difficult to disentangle the effects of antibiotics from the effects of acute infections that may precipitate acute neuropsychiatric symptoms. Study of patients with chronic H. pylori infections who undergo antibiotic treatment may provide a clearer view of the associations between acute neuropsychiatric symptoms and antibiotics. The literature concerning this association in patients with H. pylori has not been reviewed. We therefore undertook a review of MEDLINE and postmarket surveillance data concerning this issue and identified 25 cases. Postmarket data indicated that gastrointestinal symptoms were the most commonly reported adverse reactions, followed by neurological adverse reactions; neuropsychiatric symptoms were less commonly reported, with variable and nonspecific terminology used to describe them. More specific, yet still variable terminology was found in the literature. Anxiety, delirium, dissociation, mania, and psychosis were reported, with approximately half of these neuropsychiatric symptoms occurring without symptoms of delirium. The use of standardized neuropsychiatric symptom rating scales and the Confusion Assessment Method for monitoring adverse reactions may improve our knowledge of neuropsychiatric symptoms and their association with antibiotics and thus mitigate underreporting. Physicians should remain alert to the possibility that neuropsychiatric symptoms may occur during antibiotic treatment of H. pylori and recognize that rapid resolution typically occurs with discontinuation of the antibiotics.