Integrating psychiatric services into primary care settings: A systems approach

In this article, we described several reasons for the separation of psychiatry and medicine as well as recent changes, such as capitation, that will foster future integration. Psychiatric disorders are prevalent in primary care, and we reviewed the barriers to diagnosing and treating depressive disorders in primary care settings. To promote integration of psychiatry into medical settings, Goldberg5 and others have advocated working in the same area, sharing the same medical record, and developing critical pathways for the diagnosis and treatment of psychiatric patients by primary care physicians. Although some early studies have not demonstrated the cost offset of integrated psychiatric-medical care, these studies have had methodologic problems and more prospective studies are needed.