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Geriatric Psychiatry Outreach Practices in the Province of Ontario: The Role of the Psychiatrist

Objective: To determine the mode of practice of multidiscliplinary and interdisciplinary teams in the field of geriatric psychiatry in the province of Ontario with specific reference to the role of the psychiatrist on the teams. Method: Teams were identified, and a simple questionnaire was developed and submitted to every team at an annual conference. Results: Responses were obtained from 38 out of 47 teams. The composition of the teams is variable as regards size and represented discliplines. Nine teams do not have psychiatrists directly affiliated with them. Eighteen teams, 4 of which are based in teaching hospitals, have fewer than 1 full-time equivalent (FTE) psychiatrist. Among these teams, 4 have fewer than 0.1 FTE psychiatrist and 10 have fewer than 0.5 FTE psychiatrist. Eleven teams include between 1 and 1.5 FTE psychiatrists on their staff. Four teams (10.5%) require that the initial assessment of all patients be undertaken by a psychiatrist. In 18 (47%) of the teams, assessment by a psychiatrist can be infrequent or nonexistent. Discussion of the referral with a psychiatrist occurs in the majority of teams, but in a significant minority (10 [27%]), this occurs quite infrequently or not at all. Conclusion: Geriatric psychiatry outreach practices in Ontario involve many different disciplines in the assessment and follow-up of geriatric psychiatry patients, often without the ready availability of psychiatric input. We applaud the expanding roles of different disciplines in this practice. We are concerned, however, at the paucity of psychiatrists working in this field.