A model for psychiatric services in primary care settings.

The integration of mental health care and primary medical care enhances the quality of patient care and may improve the overall cost-effectiveness of a health care system. The authors describe implementation of a program that provides mental health care at 12 locations in a network of primary care sites associated with a university-affiliated community hospital in Rochester, New York. A project of the hospital's department of psychiatry, the program has as its goals improved recognition, diagnosis, and treatment of mental health problems and education of primary care providers in these areas. Each of the program's three primary therapists provide short-term, symptom-focused individual, marital, family, and group therapies and case consultation at several primary care sites. The program director, a psychiatrist, makes diagnostic assessments and provides medication consultation to both the primary therapists and the primary care physicians. The authors discuss the advantages and disadvantages of the program model and plans for its future development.

A psychosocial evaluation process for living liver donors: the University of Rochester model.

OBJECTIVE: The donation of livers by living donors entails complex processes, both surgically and psychosocially, potentially involving risks in both domains. Thorough psychosocial evaluation is necessary to minimize those risks, yet little has been written about the donor assessment process. This article describes one such process, utilized by a transplant program in upstate New York. METHOD: Donor candidates undergo multiple psychosocial interviews early in the overall transplant evaluation process. Evaluators subsequently meet as a group, along with an independent ethicist, to determine psychosocial candidacy prior to final medical/surgical clearance. RESULTS: Between 2003 and 2007, 416 donor candidates initiated and/or underwent full evaluation, resulting in a 17.5% surgery and 55.5% exclusion rate among those individuals. Of those ruled out, 20.8% were for (medical or psychosocial) reasons associated with the recipient, and 8.7% were for donor-related psychosocial issues. CONCLUSION: Given the primacy ofpsychosocial and ethical issues in living liver donor candidate evaluation, the multiple interview process, followed by team discussion and overseen by an ethicist removed from other transplant program functions, has advantages as a donor assessment model.