The registered dietitian in primary care: the Hamilton experience.

The Hamilton Health Service Organization Nutrition Program integrates nine registered dietitians (RDs) into the offices of 80 family physicians (FPs) at 50 sites in Hamilton, Ontario. The program is based on a shared care model, in which FPs and RDs work collaboratively to provide nutrition services aimed at prevention, treatment, and management of nutrition-related problems. In addition to their clinical role, dietitians in the program are involved in health promotion, disease prevention and early intervention strategies, interdisciplinary collaboration, building links with community services, and research. The RDs' specialized knowledge, skills, and experience allow them to provide a wide range of services that complement and augment those of the FP. This model is consistent with Canadian health care reform recommendations and offers significant benefits for both health care providers and consumers.

Integrating nutrition services into primary care: Experience in Hamilton, Ont.

PROBLEM BEING ADDRESSED: Nutrition services can have an important role in prevention and management of many conditions seen by family physicians, but access to these services in primary care is limited. OBJECTIVE OF PROGRAM: To integrate specialized nutrition services into the offices of family physicians in Hamilton, Ont, in order to improve patient access to those services, to expand the range of problems seen in primary care, and to increase collaboration between family physicians and registered dietitians. PROGRAM DESCRIPTION: Registered dietitians were integrated into the offices of 80 family physicians. In collaboration with physicians, they assessed, treated, and consulted on a variety of nutrition-related problems. A central management team coordinated the dietitians' activities. CONCLUSION: Registered dietitians can augment and complement family physicians' activities in preventing, assessing, and treating nutrition-related problems. This model of shared care can be applied to integrating other specialized services into primary care practices.

Counsellors in primary care: benefits and lessons learned.

OBJECTIVE: To describe a program that integrates mental health counsellors within primary care settings, to present data on the program's impact, and to discuss lessons learned that may apply in other communities. METHODS: This paper describes a Canadian program that brings counsellors and psychiatrists into the offices of 87 family physicians in 36 practices in a community of 460,000 in Southern Ontario. It describes the goals and organization of the program and the activities of counsellors when working in primary care. In addition, it summarizes data from the program's evaluation, including demographic data and the individual problems seen and services delivered (all from the program's database) as well as data on patient outcomes using the General Health Questionnaire (GHQ), the Centre for Epidemiological Studies Depression (CESD) Rating Scale, and consumer-satisfaction questionnaires. RESULTS: Each counsellor sees an average of 161 new cases yearly. The major problems are depression, anxiety, and family problems. In fact, over 70% of individuals who are seen show significant improvements in outcomes. The program has led to a significant increase in access to mental health services, a reduction in the use of traditional mental health services, high levels of satisfaction with counsellors and family physicians, and significant improvements in symptoms and functioning of individuals seen. CONCLUSION: This program has effectively integrated counsellors within primary care settings, increasing the capacity of primary care to handle mental health problems, strengthening links between providers from different sectors, and making mental health care more accessible.

Mental health care and nutrition. Integrating specialist services into primary care.

PROBLEM BEING ADDRESSED: Primary care reform is an important component of health services restructuring. One of the goals of primary care reform is to integrate specialized services into primary care settings. To date, few programs have successfully achieved this. OBJECTIVE OF PROGRAM: To integrate specialized mental health services into the offices of family physicians through the Hamilton Health Services Organization (HSO) Mental Health and Nutrition Program. MAIN COMPONENTS OF PROGRAM: Since 1994, the Hamilton HSO Mental Health and Nutrition Program has integrated mental health counselors, psychiatrists, and dietitians into the offices of 87 family physicians. Activities of specialists are coordinated by a central administrative body. CONCLUSION: Lessons learned from this program can indicate how to succeed in integrating specialist services into primary care offices.