Psychiatrists for Medically Complex Patients: Bringing Value at the Physical Health and Mental Health/Substance-Use Disorder Interface

Dept. of Internal Medicine and Psychiatry, Univ. of Minnesota, USA.
Psychosomatics (Impact Factor: 1.86). 03/2009; 50(2):93-107. DOI: 10.1176/appi.psy.50.2.93
Source: PubMed


In their current configuration, traditional reactive consultation-liaison services see a small percentage of the general-hospital patients who could benefit from their care. These services are poorly reimbursed and bring limited value in terms of clinical improvement and reduction in health-service use.
The authors examine models of cross-disciplinary, integrated health services that have been shown to promote health and lower cost in medically-complex patients, those with complicated admixtures of physical, mental, social, and health-system difficulties.
Psychiatrists who specialize in the treatment of medically-complex patients must now consider a transition from traditional consultation to proactive, value-added programs and bill for services from medical, rather than behavioral, insurance dollars, since the majority of health-enhancement and cost-savings from these programs occur in the medical sector. The authors provide the clinical and financial arguments for such program-creation and the steps that can be taken as psychiatrists for medically-complex patients move to the next generation of interdisciplinary service.

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Available from: Roger G Kathol, Jul 27, 2014
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    • "c o m Please cite this article as: Chan L.G., Carvalhal A, Journeying with HIV patients across the health care spectrum — an examination of a seamless model of HIV Psychiatry of a large urb..., Gen Hosp Psychiatry (2015), physical and health-systems problems. Kathol et al. [19] went further and described this concept as " case complexity, " where multiple interacting diseases complicate each other. Their definition includes " complexity of care " as a function of the " involvement of multiple systems and specialties that require interdisciplinary communication to be effective " [18]. "
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    ABSTRACT: To describe a model of HIV psychiatry used in an urban hospital in Toronto and examine it against current literature. Using a narrative method, we elaborate on how this model delivers care across many different settings and the integral roles that the HIV psychiatrist plays in each of these settings. This is articulated against a backdrop of existing literature regarding models of HIV care. This model is an example of an integrated model as opposed to a traditional consultation-liaison model and is able to deliver seamless care while remaining focused on patient-centric care. An HIV psychiatrist delivers seamless and patient-centric care by journeying with patients across the healthcare spectrum and playing different roles in different care settings. Copyright © 2015. Published by Elsevier Inc.
    Full-text · Article · Jul 2015 · General hospital psychiatry
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