Implementation of the Consultation-liaison Model in Quebec and its Impact on Primary Care Providers

Integrated primary care models aim to improve MHD screening, diagnosis and treatment [16]; they include steppedcare [17], patient-centred medical homes [18], chronic care [19], collaborative or shared-care [20,21], and the consultationliaison model [22]. Treatment intensity in stepped-care is based on patient outcomes [17]. Patient-centered medical homes, used primarily in pediatric care, include patient rostering and collaborative scheduling among GPs, psychosocial and specialized MH services [18]. The more holistic chronic care model encompasses six domains: (1) service delivery; (2) patient self-management; (3) clinical decision support; (4) clinical information systems; (5) community resources; and (6) healthcare integration [23]. Collaborative care and shared-care emanate from Wagner’s chronic care model [19]. While shared-care recognizes collaboration between GPs and psychiatrists [24], collaborative care, developed subsequently, extends to collaboration between primary care and specialized MH services [3,8,21]. Both models comprise three core components: 1) systematic psychiatric assessment; 2) longitudinal monitoring, intervention and care coordination; and 3) specialist recommended stepped-care [25]. Their modalities Introduction Mental health disorders (MHD) account for significant health-related disability worldwide, and engender greater healthcare burden than diabetes, tuberculosis, HIV and motor vehicle injuries [1]. MHD often co-occur with chronic physical or substance use disorders [2], and with social problems including poverty and homelessness, producing substantial challenges for service delivery, including costs [3,4]. Primary healthcare services and GPs especially, provide the first point of contact, treatment and referral for individuals with MHD [5,6]. GPs also treat about 80% of general populations in industrialized nations annually [7]. In the US, primary care GPs treat nearly 70% of MHD cases [8], mainly depression and anxiety, and prescribe 79% of antidepressant medications [9]. More accessible, costeffective, and less stigmatizing than mental health (MH) services, primary care improves management of both mental and physical conditions [10,11]. Yet studies report limited ability among GPs to identify and treat MHD [7,12]; they diagnose 50% of MHD cases [13]. Moreover, half of patients diagnosed in primary care receive the recommended doses of medications, and only 10% adequate psychotherapy [9,14]. Patients referred by GPs to specialized MH services face lengthy waiting periods [8,11,15]. Implementation of the Consultation-liaison Model in Quebec and its Impact on Primary Care Providers Marie-Josée Fleury Associate Professor, Department of Psychiatry, McGill University, Researcher, Douglas Mental Health University Institute Research Centre, Canada