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Biomedical subjects

N Kates

Publications and source records attributed to N Kates.

At least 19 recordsLinked to original sources
PubMed2005

Patient education materials for mental health problems in family practice: does location matter?

INTRODUCTION: This study examines how frequently family physicians display printed educational materials about mental health problems in their practices and where these materials should be located for optimal effect. METHODS: A cross-sectional observational study of pamphlet display practices in 13 family physicians' offices in Hamilton, Ontario, Canada was followed by an intervention which placed selected mental health educational materials in waiting rooms and examining rooms, and monitored the pick up rate from each location by patients. MAIN RESULTS: The study found that few mental health pamphlets were displayed by the participating physicians, that when a range of these pamphlets was made available, pamphlets on mood disorders were the most popular, and that significantly more pamphlets were picked up from examining rooms than from waiting rooms. CONCLUSIONS: We conclude that patients are interested in having access to printed materials about mental health problems, and that the optimal location is in display racks in examining rooms.

Bias↗
PubMed2001

Integrated model for mental health care. Are health care providers satisfied with it?

OBJECTIVE: To determine whether health care providers are satisfied with an integrated program of mental health care. DESIGN: Surveys using a mailed questionnaire. Surveys were developed for each of the three disciplines; each survey had 30 questions. SETTING: Thirty-six primary care practices in Hamilton, Ont, participating in the Hamilton-Wentworth Health Service Organization's Mental Health Program. PARTICIPANTS: Family physicians, psychiatrists, and mental health counselors providing mental health care in primary care settings. MAIN OUTCOME MEASURE: Satisfaction as shown on 5-point Likert scales. RESULTS: High levels of satisfaction with the model were recorded. Family physicians increased their skills, felt more comfortable with handling mental health problems, and were satisfied with the benefit to their patients. Psychiatrists and counselors were gratified that they were accepted by other members of the primary care team. Areas for improvement included finding space in primary care settings and better scheduling to allow for optimal communication. CONCLUSION: Family physicians, counselors, and psychiatrists expressed great satisfaction with a shared mental health care program based in primary care.

Adult↗
PubMed1999

Confidentiality.

Collaboration is easily hampered by real or perceived differences in confidentiality that prevent two critical providers from communicating openly. However, increased communication can be a two-edged sword. Sensitive and confidential information can reach individuals who may not be directly involved in patient care.

Adult↗
PubMed1998

Mental health services in the family physician's office: a Canadian experiment.

This paper describes a program in Hamilton-Wentworth, Ontario, Canada, that brings mental health counselors and psychiatrists into the offices of 87 local family physicians, working in 35 practices serving 170,000 people. It outlines the organization of the mental health teams in the family physician's office and the way in which these teams are coordinated and discusses how this "shared care" approach can overcome many of the problems that traditionally bedevil the relationship between psychiatric services and family practices. It summarizes the benefits of this approach for patients providers and the health care system and looks at its implications for learners and for new approaches to continuing education. This model can be adapted to most communities.

Canada↗
PubMed1998

Teaching behavioral science to family medicine residents: integrating training into the family practice unit.

The teaching of behavioral science is an integral part of the education of family physicians. This paper presents a model of a program that integrates the teaching of behavioral science with residents' daily activities in their clinical placement. It outlines the format of the program, the curriculum, teaching methodologies, evaluation and funding. The authors stress the importance of collaboration between family physician and psychiatrist in planning and implementing the program.

Behavioral Sciences↗
PubMed1997

Integrating mental health services within primary care. A Canadian program.

The increasingly prominent role of the family physician in delivering mental health care can be enhanced if productive and collaborative relationships can be established with local mental health services. This paper describes a Canadian program that has achieved this by bringing mental health counselors and psychiatrists into the offices of 87 family physicians in 35 practices in a community in Southern Ontario. The paper describes the program, the activities of counselors and psychiatrists within the practices, and the administrative structures set up to coordinate these activities. Data is presented from the evaluation of the first year of the program's operation (13 practices and 45 family physicians) during which time 3085 referrals were received. The program made mental health care more available and accessible, increased continuity of care, provided additional support for the family physician, offered new opportunities for continuing education, and led to a reduced and more efficient use of other mental health services. The components of the program can be adapted to most communities.

Adolescent↗
PubMed1997

Mental health practices of Ontario family physicians: a study using qualitative methodology.

OBJECTIVE: To obtain descriptions of how family physicians detect and manage mental health problems commonly encountered in their practices and how they function in their role as mental health care providers. Also, to elicit their perceptions of barriers to the delivery of optimal mental health care. METHOD: Focus groups with standardized questions were used to elicit descriptive data, opinions, attitudes, and terminology. Convenience samples of 10 to 12 physicians were chosen in each of Ontario's 7 health care planning regions, with a mixture of rural, urban, and university settings. Discussions were audiotaped, transcribed, analyzed, and recurring themes were extracted. RESULTS: Family physicians' descriptions of the range of problems commonly encountered and their detection and management highlight the unique nature of mental health care in the primary care setting. The realities of family medicine, the undifferentiated nature of presenting problems, the long-term physician-patient relationship, and the frequent overlap of physical and mental health problems dictate an approach to diagnosis and treatment that differs from mental health care delivery in other settings. Difficulties in the relationship with local psychiatric services--accessing psychiatric care (especially for emergencies), poor communication with mental health care providers, and cumbersome intake procedures of many mental health services--were consistently identified as barriers to the delivery of optimal mental health care. CONCLUSIONS: This study confirms the importance of the family physician in the detection and management of mental health problems. It offers insights into how family physicians function in their role as mental health care providers and how they deal with diagnostic and management challenges that are specific to primary care. It also identifies barriers to the optimal delivery of mental health care in the primary care setting, including difficulties at the clinical interface between psychiatry and family medicine. Further studies are needed to explore these issues in greater depth.

Appointments and Schedules↗
PubMed1997

Providing psychiatric backup to family physicians by telephone.

OBJECTIVE: To examine whether links between psychiatric services and family physicians can be strengthened and additional support provided for family physicians if a psychiatrist is available by phone to respond to clinical calls from family physicians. METHOD: A psychiatrist, who visited 18 family physicians in 5 practices on a regular basis to provide clinical consultations, was available to provide telephone backup concerning mental health problems the family physicians encountered. All calls received by the psychiatrist were documented and analysed at the end of a 12-month period. RESULTS: Over the course of one year, 128 calls were received from the 5 practices. Fifty were considered urgent, while 78 involved more routine management or medication issues. Telephone advice enabled the family physicians to handle these cases more effectively, often reducing utilization of other mental health services and providing support that was not otherwise available. The average time spent per call was 8 minutes, which meant the psychiatrist was only spending 20 minutes per week on the phone responding to family physicians' requests. CONCLUSION: Providing telephone backup to family physicians is a time-efficient and effective method of supporting family physicians and reducing utilization of mental health services. It is applicable to psychiatrists working in any clinical setting.

Cooperative Behavior↗
PubMed1997

Sharing care: the psychiatrist in the family physician's office.

OBJECTIVE: One way of strengthening ties between primary care providers and psychiatrists is for a psychiatrist to visit a primary care practice on a regular basis to see and discuss patients and to provide educational input and advice for family physicians. This paper reviews the experiences of a program in Hamilton, Ontario that brings psychiatrists and counsellors into the offices of 88 local family physicians in 36 practices. METHOD: Data are presented based on the activities of psychiatrists working in 13 practices over a 2-year period. Data were gathered from forms routinely completed by family physicians when making a referral and by psychiatrists whenever they saw a new case. An annual satisfaction questionnaire for all providers participating in the program was also used to gather information. RESULTS: Over a 2-year period, 1021 patients were seen in consultation by one full-time equivalent psychiatrist. The average duration of a consultation was 51 minutes, and a family member was present for 12% of the visits. Twenty-one percent of the patients were seen for at least one follow-up visit, 75% of which were prearranged. In addition, 1515 cases were discussed during these visits without the patient being seen. All participants had a high satisfaction rating for their involvement with the project. CONCLUSIONS: Benefits of this approach include increased accessibility to psychiatric consultation, enhanced continuity of care, support for family physicians, and improved communication between psychiatrists and family physicians. This model, which has great potential for innovative approaches to continuing education and resident placements, demands new skills of participating psychiatrists.

Consumer Behavior↗
PubMed1996

An integrated regional emergency psychiatry service.

This paper presents a model of an integrated Psychiatric Emergency Service serving Hamilton, a community of 450,000 in Southern Ontario. It describes the evolution of the service and how it has integrated five separate, hospital-run Emergency Psychiatric Services into a single service. The principles of the service and ways in which it operates are outlined and the advantages and drawbacks of the model are discussed. The authors conclude that such a model leads to a more efficient use of resources and is adaptable to most urban communities with a similar, or even larger population.

Delivery of Health Care, Integrated↗
PubMed1995

Community resources for psychiatric and psychosocial problems. Family physicians' referral patterns in urban Ontario.

OBJECTIVE: To document the number and pattern of psychiatric and psychosocial referrals to community resources by family physicians (FPs) and to determine whether referral practices correlate with physician variables. DESIGN: Cross-sectional survey of referrals by FPs to 34 key psychiatric and psychosocial community resources identified by a panel of FPs, psychiatric social workers, psychiatric nurses, public health nurses, and the local community information service. SETTING: Regional municipality of 434,000 persons in Ontario. PARTICIPANTS: Twenty-seven of 34 (79%) community agencies identified 261 FPs who made 4487 referrals to participating agencies (range 0 to 65, median 15, mean 17.19 +/- 13.42). MAIN OUTCOME MEASURES: Number of referrals to all agencies; variables, such as physician sex, school of graduation, year of graduation, and certificate status in the College of Family Physicians of Canada, related to referral patterns. RESULTS: Referrals to outpatient psychiatric clinics, support services, and general counseling services accounted for 96% of all referrals. Physicians' average annual referral profile was as follows: 8.6 patients to a support service, 6.3 to an outpatient psychiatric service, 1.6 to a counseling service, and 0.46 to a substance abuse service. Referral profiles of individual physicians varied greatly. Female FPs made fewer referrals than male FPs to support services, but both made similar numbers of referrals to psychiatric, counseling, and substance abuse services. The more recent the year of graduation, the greater the number of referrals to psychiatric (r = 0.158, P = 0.0107) and counseling services (r = 0.137, P = 0.0272) and the higher the fraction of referrals to psychiatric services (r = 0.286, P = 0.0001). CONCLUSIONS: Family physicians in Hamilton-Wentworth made few referrals to psychiatric and psychosocial services. Only physician sex and year of graduation correlated significantly with numbers of referrals made. Recent graduates of both sexes made significantly more referrals to psychiatric clinics and counseling services than their older colleagues.

Community Mental Health Services↗
PubMed1994

Services and trends in Israel's mental health system.

Despite a rapidly growing population, continuing funding shortages, and threats to its national security, Israel has developed a comprehensive mental health care system, based on the psychiatric hospital. Services are provided through several networks, including government-financed and for-profit hospitals, government-financed mental health clinics in each of 23 service areas, and four health funds. Other networks provide care for specific groups such as soldiers, kibbutz members, orthodox Jews, and Israeli Arabs. The system's reliance on the hospital creates special problems, such as dependency and fragmentation of care, and a community mental health model adopted almost 20 years ago has yet to achieve the goal of shifting treatment to the community. However, Israel's mental health system is in a transition period. By drawing on its many strengths and learning from other countries' experience, Israel has the potential for developing a unique community-focused system.

Community Mental Health Services↗