Strategies of collaboration between general practitioners and psychiatrists: An exploratory research project in Montreal

An exploratory research project was carried out with the overall objective of identifying strategies which may improve collaboration between general practitioners (GPs) and psychiatrists at the primary care level. This research project is described within two contexts: (a) the historical quantitative-qualitative research debate, and (b) the disease model along with other models of health care delivery. Two consecutive studies were conducted: one qualitative (first), the other quantitative (second).; The qualitative study was conducted in eastern Montreal between 1998 and 1999. The general study objective was to identify the key strategies which may increase collaboration between GPs and psychiatrists in the delivery of mental health services in primary care settings. In order to achieve this objective, information was collected on working patterns involving GPs and psychiatrists, their perceived roles and respective expectations, the barriers to collaboration, and suggestions for improvement of collaborative service delivery. All information was gathered from a purposefully selected sample of five GPs and five psychiatrists. Ten individual in-depth interviews and one focus group session were conducted.; Three groups of strategies were identified: (1) communication, (2) Continuing Medical Education (CME) for GPs in psychiatry, and (3) access to consulting psychiatrists in primary care settings. These groups of strategies set the basis for the quantitative study.; This study consisted of a survey conducted in the fall of 2000 in the metropolitan area of Montreal. The survey had two objectives. The first was to collect the opinions of both GPs and psychiatrists practicing in Montreal with respect to strategies for improving collaboration between them at three levels—communication, CME for GPs in psychiatry, and on-site collaboration in primary care settings. The second was to identify demographic and practice characteristics of physicians associated with the acceptance of such strategies.; A questionnaire was specifically designed to elicit physicians' agreement or disagreement with the strategies of collaboration and was mailed to 203 GPs and 203 psychiatrists randomly selected. The survey response rate was 86% for GPs and 87% for psychiatrists. The physicians expressed favorable opinions about most strategies involving (1) the improvement of communication and (2) the organization of CME activities concerning GPs' practices in the field of psychiatry. However, they did not indicate agreement with the strategies involving on-site collaboration in primary care settings. Physician gender, age, place of practice, type of practice (such as seeing patients with or without appointments), and responsibility for administrative duties were significantly associated with the degree of agreement with the proposed strategies.; The improvement of collaboration between GPs and psychiatrists is linked to specific strategies and physician characteristics. Most physicians may accept strategies involving communication and organization of CME for GPs in psychiatry. However, strategies of on-site collaboration may be only accepted by specific groups of GPs and psychiatrists who might share characteristics associated with propensity for closer collaboration.