Psychiatrists' and internists' knowledge and attitudes about delivery of clinical preventive medical services.
ABSTRACT Changes in the health care environment have placed a greater responsibility on psychiatrists to deliver basic primary care services. The study assessed baseline knowledge and attitudes about clinical preventive medical services among psychiatric faculty and psychiatric residents at a tertiary care medical center.
Residents and faculty in psychiatry and general internal medicine completed a structured questionnaire, including 20 case scenarios, that assessed their baseline knowledge of clinical preventive medical services, their attitudes concerning delivery of those services, and their beliefs about the effectiveness of those services in changing patients' behavior. The case scenarios and knowledge questions were based on the clinical preventive medical services recommendations outlined by the U. S. Preventive Services Task Force.
Psychiatrists reported more frequent assessment of and counseling about the use of illicit drugs and weapons, and internists were more likely to query about measures related to physical health such as cancer screening and immunizations. The two groups reported similar attitudes toward the need for and the efficacy of preventive medical services. Commonly cited barriers to the delivery of preventive care included lack of time and education. Psychiatrists scored reasonably well on baseline knowledge about guidelines for preventive medical services, particularly given their recent lack of specific education in these matters.
Psychiatrists believe clinical preventive services are important and express interest in their delivery. Additional educational interventions are needed to train psychiatrists in clinical preventive services to avoid missed clinical opportunities for intervention in psychiatric populations that may have poor access to other medical care.
SourceAvailable from: Jeannine Goetz[Show abstract] [Hide abstract]
ABSTRACT: Individuals with serious mental illness (SMI) are likely highly vulnerable to food insecurity, yet this issue remains unexplored within this population. METHODS: A mixed method approach to assess the prevalence and underlying factors was conducted. Food security status was assessed within a convenience sample of 72 community-dwelling individuals with SMI. Semi-structured interviews (n=28) and focus groups (n=4) were subsequently conducted. RESULTS: Within the sample, 45.8% were classified as food insecure, with 29.2% identified as very low food secure. While classic food insecurity barriers (e.g. lack of transportation, fixed income, inadequate resources, etc) were identified, these factors were further compounded by symptoms associated with mental illness. CONCLUSIONS: In comparison to national data, this SMI sample was nearly 8 times more likely to report food insecurity. Information discovered during interviews and focus groups will enable researchers to tailor a food security intervention uniquely suited to address the challenges presented within this population.
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ABSTRACT: This study explored how mental health clinicians assess and respond to physical illness among patients presenting for mental health intake evaluations. A total of 129 adults were seen for a mental health intake visit. The intake visits were videotaped and involved 47 mental health clinicians from eight clinics who provided outpatient mental health and substance abuse treatment. A total of 120 videos of patient-provider interactions were coded using an information checklist containing 21 physical illness items. Twenty-eight intake visits exemplifying in-depth physical illness assessments were selected and transcribed for qualitative analysis. Physical health was discussed in most intake visits (87%). Clinicians elicited information on physical health in 79 visits (66%), and patients volunteered such information in 80 visits (67%). Frequency of assessment differed by clinician discipline (p<.05) and by patient ethnicity (p=.06). Qualitative analysis revealed characteristics of appropriate assessments, such as formulating the contribution of physical conditions in the psychiatric differential diagnosis, noting physical side effects of medications, adjusting treatment plans, encouraging patient contact with primary care providers, and promoting physical health care. Assessment of physical illness is relatively common among mental health clinicians but was lacking in one-third of the cases in this study, until raised by patients. Because frequency of assessment differed by clinician discipline and patient ethnicity, innovations in patient assessment and clinician education are needed to address disparities in management of physical illness among individuals with mental illness.Psychiatric services (Washington, D.C.) 01/2010; 61(1):32-7. DOI:10.1176/appi.ps.61.1.32 · 1.99 Impact Factor
Academic Psychiatry 09/2012; 36(5):353-5. DOI:10.1176/appi.ap.11020038 · 0.81 Impact Factor