Continuing Medical Education
Psychiatry in primary care using the three-stage assessment
- Mental illness imposes a massive burden on all levels of service, including primary care.
- Challenges particular to primary care include the overwhelming service loads and time/resource constraints.
- A further challenge revolves around the frequent mismatch between undergraduate teaching and the clinical nature of psychiatric care in primary level clinics.
- Clinical presentations at primary level are often nonspecific and undifferentiated, and complicated by comorbid medical illness and psychosocial stressors.
- The three-stage assessment that embraces the core principles of family practice can be adapted to incorporate the psychiatric needs of patients in primary care and deliver a truly holistic and integrated assessment of their individual needs.
- These adaptations need not involve additional training or the need for additional clinical tasks.
- Psychiatric management requires continuity of care within an enduring therapeutic relationship, which provides the ideal framework within which a comprehensive assessment and management plan can be formulated.
- Successful adaptations to the three-stage assessment could provide an effective (and efficient) model for the integration of psychiatry at the primary care level.
C A Draper, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
P Smith, Lentegeur Hospital and Department of Psychiatry, University of Cape Town, South Africa
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Date published: 2013-11-19
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