Family doctors and psychologists working together: doctors' and patients' perspectives

BACKGROUND: Strategies to improve primary care in the Canadian Primary Care Reform include integrating different professionals to the medical team. OBJECTIVE: This demonstration project explores the perceived impact on doctors and patients, of having family doctors and psychologists work together. SETTING: Two family practices of Eastern Ontario, Canada METHODS: Two board certified psychologists (one per practice) were integrated in the practices for 12 months. Psychologists conducted assessments, consultations and short-term treatments, as well as knowledge-transfer sessions for doctors. Outcome measures included referral patterns, patient outcomes, patient and provider satisfaction as well as doctors' billing. RESULTS: Three hundred and seventy-six participants received psychological care; most were women (68%) and between the ages of 25-64 (67%). Anxiety and depression were the most prevalent diagnoses. Reasons for referral included: psychological treatment (70%); emotional support and counselling (35%); clarification of diagnosis and case conceptualization (25%). Referrals could be for more than one reason. After intervention, 60% of patients had improvement on the outcome questionnaire-45 (OQ-45). Quality of life as measured by the EuroQol-5D also improved (P < 0.001). Over 77% of patients reported increased confidence in handling their problems after treatment. Compared with their family doctor, patients felt the psychologist had more time and was better trained (75%) Doctors felt mental health problems were diagnosed more rapidly, patient care improved as well as their own knowledge of psychological management and treatment. Doctors felt it freed up their time and improved working conditions. Audit of the doctors' billing showed reduction in doctors' mental health billing. CONCLUSIONS: Having an on-site psychologist was highly satisfactory for patients and providers, resulting in improved patient care and outcomes.