Elsevier

Psychosomatics

Volume 55, Issue 4, July–August 2014, Pages 333-342
Psychosomatics

Original Research Reports
The Medical-Psychiatric Coordinating Physician–Led Model: Team-Based Treatment for Complex Patients

https://doi.org/10.1016/j.psym.2013.12.014Get rights and content

Objective

We propose a patient care model involving psychiatrist-led multispecialty teams for treatment of the most treatment-refractory segment of “complex” outpatients. We call the psychiatrist taking this leadership role the Medical-Psychiatric Coordinating Physician.

Method

The authors conducted a pilot study for this treatment model with 52 office-based outpatient cases each involving complex patients, and each with at least 2 major treatment failures. They followed these patients empirically for at least 18 months. Outcomes examined included Hamilton Anxiety Rating Scale; Hamilton Depression Rating Scale; and Health Related Quality of Life-14 scores (HRQOL-14, modified), in association with a comprehensive treatment review.

Results

Comprehensive treatment review indicated sustained improvement in at least 2 of 4 clinical dimensions (utilization, treatment adherence, symptomatology, and quality of life) in 44 of 52 patients. Included were Hamilton Anxiety Rating Scale scores that improved significantly from 26.27 ± 7.5 to 18.13 ± 5.74 (p < 0.0001) and Hamilton Depression Rating Scale scores that improved from 22.02 ± 7.10 to 14.58 ± 6.46 (p < 0.0001). The Health-Related Quality of Life-14 improved significantly for general health from 2.54 ± 1.03 to 2.12 ± 1.06 (p < 0.0001), and sick days per month from 11.22 ± 7.76 to 6.60 ± 7.51 (p < 0.0001).

Conclusions

The Medical-Psychiatric Coordinating Physician–led multispecialty team method may be advantageous for the ongoing outpatient treatment of management-intensive, complex patients. We offer this model as having a place among the available integrated care models for the treatment of comorbid psychiatric-systemic medical illness.

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