De l'innovation au changement - Gouvernement du Québec

Projet 15
Quality of Outpatient Geriatric Psychiatric Consultation :
do referring consultant physicians and patients agree , région de Montréal
Évaluation du processus de consultation externe en psychiatrie gériatrique pour les patients âgés déprimés: perspective du
patient, de sa famille, du médecin référent et du médecin
essential that both groups of physicians have a clear idea of the type of consultation and reason of referral.
Standardized referral form well accepted and distributed;
Typed consultation report.
Increase availability of psychiatrist (phone) to the referring physician Simplified logistics for referrals (dealing with one secretary, one phone
number, one fax number).
Generally, increased teaching and support to referring physicians who tend to manage their cases for some months before referring (this
was specifically true for dementia cases).Improve the communication between referring physician and the patient so that patient
understands better the purpose of the referral to Psychiatry.
Improved methods of information transfer, e.g. computerized.
Use of nurse or other non-MD staff to assist in communicating with referring and patient/family parties.
Potential implications for policy are that a shared-health care approach for mental health problems in the elderly can work only if patients
cooperate with their physicians in understanding the need for referral in Psychiatry; are motivated to come to consultation; if referring and
consulting physicians communicate better with a clear, shared understanding of the type of consultation and reason for referral; if
consulting physicians are ready to be available in a reasonable time frame to the referring physician, and if both physician agree to
upgrade their knowledge by sustained CME program. Organizational structural changes in care delivery can only work if the doctors who
work within these structures (referring and consulting physicians) work together with community resources for the patient’s benefit with the
support of patients and family.
Such limitations highlight the need to improve mechanisms of integration of service delivery for elderly patients with psychiatric
disturbances. We suggest that using a standardized referral form developed jointly by family physicians and psychiatrists could alleviate
many of the problems in understanding the type of consultation and the reason for referral and would help the consultant get a better idea
of the question he/she has to answer. Such a form was developed at St. Mary’s Hospital in 1996 by a multi-disciplinary committee.
However, due to a less than adequate support from the institution, knowledge about the form, availability and acceptance for use have
impeded its widespread use.
6.3 Avantages généralisation These obstacles that the study highlighted can certainly be transferable to other communities, especially those who have less (or no)
geriatric psychiatrists for primary care physicians to refer their elderly patients to lack of communication, difficulty in availability, increased
waiting time for consultation appointment would than be increased compared to the findings of this study.
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