An Economic Evaluation of a Proactive Consultation-Liaison Psychiatry Pilot as Compared to Usual Psychiatric Consultation On-Demand for Hospital Medicine

Author(s):  
Brian D. Bronson ◽  
Abdulkader Alam ◽  
Teresa Calabrese ◽  
Frances Knapp ◽  
Joseph E. Schwartz
2020 ◽  
Vol 31 (2) ◽  
pp. 38-42
Author(s):  
Nasim Jahan ◽  
Mohammad Muntasir Maruf ◽  
Sharmin Kauser ◽  
Mekhala Sarkar ◽  
Md Masud Rana Sarker ◽  
...  

There is a dearth of studies related to consultation-liaison psychiatry in Bangladesh. The psychiatric referral rates in this country are very low, considering the higher rates of psychiatric morbidity in patients who attend various departments of a general hospital. This was a descriptive study consisting of all the cases referred for psychiatric consultation from inpatient units of various departments of BIRDEM General Hospital, Dhaka from July 2017 to June 2018. Patients of any age and of either gender were included. A total of 673 patients (1.97% of total admission) were referred from different departments of the hospital for psychiatric consultation within the study period. Majority of the respondents were female. The mean age of the respondents was 59.47 (±1.98) years. Among the referred, Generalized anxiety disorder (GAD) was the diagnosis in 24.96%, followed by Major depressive disorder (MDD) in 9.95% cases. Referral from the department of Medicine and allied was 92.86 %, followed by department of Surgery and allied (6.38%) & department of Obstetrics and Gynaecology (0.74%). Frequency of referral was the lowest in the months of November to January. There is a need to encourage multi-disciplinary interaction in the management of patients who attend general hospitals, so as to better identify the psychiatric morbidity. Bang J Psychiatry December 2017; 31(2): 38-42


1996 ◽  
Vol 30 (1) ◽  
pp. 82-89 ◽  
Author(s):  
Nicole Phillips ◽  
Lorraine Dennerstein ◽  
Stephen Farish

Objective: Recently we described the establishment and first 6 months of a psychiatric consultation-liaison service to a Melbourne obstetric-gynaecology teaching hospital. The follow-up report evaluates the service in two ways: first, it compares referral data for the 12 months of 1992 with that of the first 6 months of operation in 1990; and second, it reports on results of a survey of referrer and patient satisfaction with the service. Method: Referral data were collected for the data comparison from the consultation-liaison referral book and patients' files. Referrer and patient satisfaction was evaluated by questionnaires sent to 45 medical staff, 7 charge nurses, and 100 consecutive patients. Result: A fairly constant referral rate for inpatients has emerged at 0.8%, this very low referral rate being some cause for concern. An internal shift in the type of referrals over time has developed, with an increase in obstetric and a decrease in gynaecology referrals. High referrer satisfaction, with 86% of the doctors finding the consultation(s) “very” or “quite” helpful, and high patient satisfaction, with 83% of respondents having found the consul tat ion(s) “very” or “quite” helpful, was found. Conclusions: Despite high referrer and consumer satisfaction, and objective evidence of need, this pioneering consultation-liaison service in obstetric-gynaecology continues to be grossly under-utilised. Increasing the referral rate will be one of the greatest challenges in the future of this service.


1988 ◽  
Vol 17 (3) ◽  
pp. 213-221 ◽  
Author(s):  
Joseph Schwartz ◽  
Nancy Speed ◽  
Michael Kuskowski

To assess the impact of psychiatric consultation, the authors reviewed the charts of patients referred from a neurology clinic to an outpatient consultation/liaison psychiatry clinic. The patients were found to have both significant neurologic and psychiatric disorders. Only 46 percent returned to see their neurologists within six months of the referral. This finding highlights a major problem in outpatient consultation.


2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
A. Diefenbacher ◽  
U. Golombek ◽  
J.J. Strain

Up to now hardly any quantitative research regarding diagnosis of personality disorders in the environment of Consultation-Liaison Psychiatry and Psychosomatic Medicine is available.The data of 3032 patients aged 17-65 years seen between 1988 and 1997 at the Mount Sinai Hospital in New York, NY, were recorded and analyzed using the Micro-Cares Database System.19,7% (N=598) of patients exhibited a personality disorder. Out of those 7,7% distributed to Cluster A (Odd or Eccentric Behavior), 54,3% to Cluster B and 38,0% to Cluster C.89% of patients with personality disorders showed at least one additional specific psychiatric disorder.Patients with a personality disorder had a lower incidence of somatic disease, but exhibited a higher level in psychosocial impairment and a higher comorbidity in substance abuse. During the previous year they used psychiatric treatment more often and were in need of a more intense social and psychotherapeutical treatment.The age group of 17-40 year old patients with a personality disorder was hospitalized shorter and had less of a lag between hospitalization and time of psychiatric consultation.More reasons for a psychiatric consultation were given when patients with a personality disorder were referred.In the environment of Consultation-Liaison Psychiatry and Psychosomatic Medicine every 5th to 6th patient requires a specific, psychiatric, psychotherapeutic or social treatment because of a personality disorder.The classification of personality disorders into clusters did not yield an additional benefit.


2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1 ◽  
Author(s):  
A. Diefenbacher ◽  
U. Golombek ◽  
J.J. Strain

Up to now hardly any quantitative research regarding diagnosis of personality disorders in the environment of Consultation-Liaison Psychiatry and Psychosomatic Medicine is available.The data of 3032 patients aged 17-65 years seen between 1988 and 1997 at the Mount Sinai Hospital in New York, NY, were recorded and analyzed using the Micro-Cares Database System.19,7% (N=598) of patients exhibited a personality disorder. Out of those 7,7% distributed to Cluster A (Odd or Eccentric Behavior), 54,3% to Cluster B and 38,0% to Cluster C.89% of patients with personality disorders showed at least one additional specific psychiatric disorder.Patients with a personality disorder had a lower incidence of somatic disease, but exhibited a higher level in psychosocial impairment and a higher comorbidity in substance abuse. During the previous year they used psychiatric treatment more often and were in need of a more intense social and psychotherapeutical treatment.The age group of 17-40 year old patients with a personality disorder was hospitalized shorter and had less of a lag between hospitalization and time of psychiatric consultation.More reasons for a psychiatric consultation were given when patients with a personality disorder were referred.In the environment of Consultation-Liaison Psychiatry and Psychosomatic Medicine every 5th to 6th patient requires a specific, psychiatric, psychotherapeutic or social treatment because of a personality disorder.The classification of personality disorders into clusters did not yield an additional benefit.


1993 ◽  
Vol 38 (9) ◽  
pp. 595-598 ◽  
Author(s):  
Nadia D. Toffoli ◽  
Nathan Herrmann

The aging of our population will require physicians to become more aware of the issues surrounding the determination of financial competence. This retrospective study involved the review of 46 medical or surgical patients in a university teaching hospital that were referred to the psychiatric consultation-liaison team for assessment of financial competency. Charts were reviewed for completeness of documentation using suggested criteria for determination of financial competence. The study found that while many criteria were frequently documented, documentation was incomplete for important criteria, such as calculating abilities, judgement, the patient's appreciation of the consequences of financial competence, presence of delusions with regard to finances and the patient's awareness of debt. Concerns are expressed regarding a physician's ability to recall details pertaining to cases before a tribunal without complete and careful documentation. The importance of establishing formal criteria for the determination of financial competence is also discussed.


Author(s):  
Zhang LL ◽  
◽  
Zhao JP ◽  

Objective: To comprehensively analyze cases of psychiatric consultation in a general hospital and provide a primary reference for the development of consultation-liaison psychiatry. Method: A retrospective study was conducted by analyzing data collected over a two-year period regarding psychiatric consultations from the inpatient registry in a general hospital. Results: A total of 926 and 774 psychiatric consultations were recorded in 2016 and 2017, respectively. The most common reason for consultation was unexplained somatic symptoms. Consultations based on psychological evaluation, and mental/behavioral disorders due to organic diseases and perioperative stress were significantly higher in 2017 than those in 2016 (P<0.01). Diagnoses of neurotic, stress-related and somatoform disorders were significantly lower in 2017 compared to those in 2016 (269 (34.8%) cases in 2017 vs. 373 (40.3%) cases in 2016; P=0.019). Among specific diagnoses, generalized anxiety disorder was the most common. Conclusion: Most patients with depressive or anxiety disorders visit a general hospital due to somatic symptoms. It is necessary to train nonpsychiatrists to identify mental disorders efficiently, as well as to extend the comprehensive consultation model to include more clinical departments.


1979 ◽  
Vol 24 (8) ◽  
pp. 717-723 ◽  
Author(s):  
Graeme Taylor ◽  
Kenneth Doody

This paper reports a survey of psychiatric referral patterns on the inpatient wards of a Canadian general hospital over a 5-year period. The results demonstrate the useful contributions which psychiatric consultants can make to the care of physically ill patients. The most frequent consultation requests were for assistance with diagnostic problems and the management of depression or other psychopathology accompanying physical illness. The majority of consultation patients, 69.4%, had concurrent physical and psychiatric diagnoses and could be managed collaboratively on the services from which they were referred. Only 6.64% of the referred patients were transferred to a psychiatric ward, which reflected the philosophy of the consultation-liaison service to treat the psychiatric problems of the physically ill in the medical setting. The findings from the survey are compared with reports from general hospitals in Britain and the United States where the underutilization of psychiatric consultation services has been well demonstrated. Factors influencing the referral process, including liaison activities, are discussed and the limitations of consultation-liaison psychiatry, acknowledged. Changes in medical and nursing education are suggested to promote the wider practice of comprehensive patient care.


1983 ◽  
Vol 28 (5) ◽  
pp. 329-338 ◽  
Author(s):  
Z.J. Lipowski

Consultation-liaison psychiatry has grown rapidly and become a subspecialty of psychiatry in the past decade. The author reviews the history of this field at the interface of psychiatry and medicine, offers its definition, and discusses current trends pertaining to the organization of liaison services and to the teaching and research activities of liaison psychiatrists. He concludes that a liaison service has become a recognized division of a general hospital psychiatric unit for the provision of psychiatric consultation and teaching to the nonpsychiatric departments of the hospital. Consultation-liaison psychiatry (or liaison psychiatry for short) has emerged in the past decade as a subspecialty of psychiatry, one concerned with mental health problems among medical and surgical patients. Diagnosis, treatment, study and prevention of psychiatric disorders in those patients constitute the proper domain of liaison psychiatry. I will review in this article the major current trends in this field as they pertain to matters of organization, education, and research. A brief historical note and a definition of liaison psychiatry will introduce my review.


2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
A. Diefenbacher ◽  
D. Georgescu ◽  
W. Gaebel

Background and aims:Psychiatric comorbidity of general hospitals inpatients leads to complicated courses of illness and to increased health car costs as compared to patients that suffer from somatic illnesses alone. Such patients are cared for by psychiatric Consultation-Liaison (CL) services. When analyze guidelines that deal with the organization of psychiatric CL-services in USA and the UK, as well with a guideline developed for psychosomatic CL-services in Germany, and an Dutch guideline released in 2008Methods:Literature search and review of guidelines.Results:Existing guidelines in CL-psychiatry are in part controversial with regard to recommendation for treatments, preferences as to concentrate on clinical, or on organizational issues, and differ even in the grade of evidence given to single topics, such as effectiveness of CL-interventions.Conclusions:To improve the efficiency of CL-psychiatry, guidelines might be important, as well for the treatment of psychiatric diseases in general, but even more so for diseases that are frequent in general hospitals such as delirium. However, reliability of guidelines in CL-psychiatry differing among countries should be improved.


Sign in / Sign up

Export Citation Format

Share Document