Background This paper examines the feasibility of evaluating innovative models of working at the interface between primary care and secondary mental health services.
Method Methodological problems relevant to evaluation of innovative models of working at the interface are discussed.
Results Although there is some evidence that neurotic disorders can be more cost-effectively treated in primary care, many general practitioners (GPs), and possibly some patients, prefer referral to community mental health teams and community psychiatric nurses, which are provided by the secondary health care services.
Since the latter are provided with the intention of improving serious mental illness their involvement in the care of neurotic illness can lead to tensions between GPs, local health authorities and service providers.
There is little evidence to suggest that psychiatrists working in health centres using the shifted out-patient model have eased this problem.
By contrast the'consultation liaison' (C-L) model has a number oftheoretical advantages ; referrals to secondary care should be limited to those most in need ofthis level ofexpertise and GP management skills should improve, so leading to better quality of care for patients who are not referred.
Conclusion Studies comparing the different models of service delivery are required to address the tensions that have arisen following changes in government policy Further work is also needed to develop the necessary research tools.
Mots-clés Pascal : Soin santé primaire, Santé mentale, Organisation santé, Soin, Trouble psychiatrique, Royaume Uni, Europe, Homme, Article synthèse
Mots-clés Pascal anglais : Primary health care, Mental health, Public health organization, Care, Mental disorder, United Kingdom, Europe, Human, Review
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0165173
Code Inist : 002B18H05B. Création : 21/05/1997.