Physician and behavioral health provider diagnostic agreement in a general hospital setting

2020 ◽  
Vol 55 (4) ◽  
pp. 249-254
Author(s):  
Tyler J Lawrence ◽  
Jennifer S Harsh ◽  
Liz Lyden
Keyword(s):  
Mental Health ◽  
Behavioral Health ◽  
General Hospital ◽  
Depressive Disorders ◽  
Hospital Setting ◽  
Kappa Statistics ◽  
Health Provider ◽  
Health Providers ◽  
Diagnostic Agreement ◽  
Behavioral Health Provider

Objective Behavioral health providers are often employed in inpatient settings. However, it is unclear if there is mental health diagnosis agreement between referring physicians and behavioral health providers. The purpose of this study is to assess for referring physician and behavioral health provider mental health diagnostic agreement in a general hospital setting. Method An analysis of 60 consecutive inpatient referrals to a behavioral health provider in a general hospital setting was conducted. The initial referral diagnosis from referring internal medicine physicians was compared with the diagnosis made by the behavioral health provider. Results Kappa statistics indicated good diagnostic agreement for substance abuse (.79), anxiety disorders (.82), adjustment disorders (.88), relational conflict (.88), and “other” (.74). There was less agreement for depressive disorders (.55). Conclusions Diagnostic agreement was good overall, suggesting that referrals to inpatient behavioral health providers are often appropriate. Results indicated that depression was underdiagnosed by physicians in the study sample. This is problematic given that depression can be successfully treated through the use of medication and psychotherapy.

scholarly journals Diagnostic Agreement between Physicians and a Consultation–Liaison Psychiatry Team at a General Hospital: An Exploratory Study across 20 Years of Referrals

2021 ◽  
Vol 18 (2) ◽  
pp. 749
Author(s):  
Mattia Marchi ◽  
Federica Maria Magarini ◽  
Giorgio Mattei ◽  
Luca Pingani ◽  
Maria Moscara ◽  
...  
Keyword(s):  
General Hospital ◽  
Depressive Disorders ◽  
Psychiatric Morbidity ◽  
Clinical Signs ◽  
Kappa Statistics ◽  
Comorbid Depression ◽  
Liaison Psychiatry ◽  
Consultation Liaison Psychiatry ◽  
Psychiatric Conditions ◽  
Diagnostic Concordance

Consultation–liaison psychiatry (CLP) manages psychiatric care for patients admitted to a general hospital (GH) for somatic reasons. We evaluated patterns in psychiatric morbidity, reasons for referral and diagnostic concordance between referring doctors and CL psychiatrists. Referrals over the course of 20 years (2000–2019) made by the CLP Service at Modena GH (Italy) were retrospectively analyzed. Cohen’s kappa statistics were used to estimate the agreement between the diagnoses made by CL psychiatrist and the diagnoses considered by the referring doctors. The analyses covered 18,888 referrals. The most common referral reason was suspicion of depression (n = 4937; 32.3%), followed by agitation (n = 1534; 10.0%). Psychiatric diagnoses were established for 13,883 (73.8%) referrals. Fair agreement was found for depressive disorders (kappa = 0.281) and for delirium (kappa = 0.342), which increased for anxiety comorbid depression (kappa = 0.305) and hyperkinetic delirium (kappa = 0.504). Moderate agreement was found for alcohol or substance abuse (kappa = 0.574). Referring doctors correctly recognized psychiatric conditions due to their exogenous etiology or clear clinical signs; in addition, the presence of positive symptoms (such as panic or agitation) increased diagnostic concordance. Close daily collaboration between CL psychiatrists and GH doctors lead to improvements in the ability to properly detect comorbid psychiatric conditions.

scholarly journals The use of benzodiazepines and Z-drugs in the Acute Psychiatric Unit at Cavan General Hospital

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S309-S310
Author(s):  
Salah Ateem ◽  
Rachael Cullivan
Keyword(s):  
Mental Health ◽  
General Hospital ◽  
Hospital Setting ◽  
Severity Of Illness ◽  
Prescribing Practices ◽  
Duration Of Treatment ◽  
Dose Frequency ◽  
Admission Status ◽  
Term Administration ◽  
Acute Psychiatric Wards

AimsBenzodiazepines and Z-drugs are used frequently in acute psychiatric wards, however long-term administration can result in undesirable consequences. Guidelines recommend prescription of the lowest effective dose for the shortest period and if possible to prescribe “as required” rather than regularly. The 25-beded inpatient unit at Cavan General Hospital admits adult patients requiring acute care from the counties of Cavan and Monaghan. Admissions are accepted from four community mental health teams, two psychiatry of old age teams and the rehabilitation and mental health of intellectual disability teams. In order to evaluate the potential to improve our practice of prescribing benzodiazepine and Z-drugs, it was decided to evaluate current use.MethodThe NICE guidelines were consulted, and we retrospectively reviewed the use of these agents from mid-January to the end of May 2020. Demographic variables included age, gender, and county. Patients were stratified into three groups, the benzodiazepine group, the Z-drugs group, and the combined benzodiazepine and Z-drugs group. In each group therapeutic variables were recorded including the medication type, dose, frequency, prescriber, and duration of treatment. Other variables included psychiatric diagnoses, length of inpatient admission, status on admission, and recommendations on dischargeResultThere were 101admissions during that period, and 74 of them were prescribed these agents (n = 74; 73.3%). Fifty one (n = 51; 68.9%) received benzodiazepines only, twenty-three (n = 23; 31.1%) were prescribed Z-drugs, and twelve (n = 12; 16.2%) received both benzodiazepines and Z-drugs. Forty two patients (n = 42; 56.8%) were commenced on hypnotics in the APU, 23 patients (n = 23; 31.1%) already received hypnotics from the CMHTs, and the rest were prescribed by both. Thirty two patients (n = 32; 43.2%) were discharged on hypnotics. Patients admitted involuntarily and female patients had longer admissions (mean of 16.62 ± 3.26 days and 16.16 ± 2.89 days respectively). Schizophrenia and BPAD were the commonest diagnoses.ConclusionIt appears that large amounts of these agents are used in the Acute Hospital Setting which is not overly surprising given the severity of illness and clinical indications however improved awareness could still lead to more appropriate and hopefully reduced use. We therefore recommend:A formal audit including appropriate interventions i.e., educate staff and patients, highlight guidelines, and review subsequent practice.Train staff in safer prescribing practices including prn rather than regular use if appropriate.Regularly review discharge prescriptions indicating recommended duration of use.

Gaps in Mental Health Care for Youth With Rheumatologic Conditions: A Mixed Methods Study of Perspectives From Behavioral Health Providers

2019 ◽  
Vol 71 (5) ◽  
pp. 591-601 ◽  
Author(s):  
Andrea Knight ◽  
Michelle Vickery ◽  
Lauren Faust ◽  
Eyal Muscal ◽  
Alaina Davis ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mixed Methods ◽  
Mental Health Care ◽  
Behavioral Health ◽  
Mixed Methods Study ◽  
Health Providers

scholarly journals 2135

2017 ◽  
Vol 1 (S1) ◽  
pp. 69-69
Author(s):  
Kathryn E. Kanzler ◽  
Patricia Robinson ◽  
Mariana Munante ◽  
Donald McGeary ◽  
Jennifer Potter ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Behavioral Health ◽  
Control Group ◽  
Health Provider ◽  
Care Clinic ◽  
Integrated Behavioral Health ◽  
Behavioral Health Provider ◽  
Chronic Pain Patients ◽  
Pain Patients

OBJECTIVES/SPECIFIC AIMS: This study seeks to test the feasibility and effectiveness of a brief acceptance and commitment therapy (ACT) treatment for chronic pain patients in a primary care clinic METHODS/STUDY POPULATION: Primary care patients aged 18 years and older with at least 1 pain condition for 12 weeks or more in duration will be recruited. Patients will be randomized into (a) ACT intervention or (b) control group. Participants in the ACT arm will attend 1 individual visit with an integrated behavioral health provider, followed by 3 weekly ACT classes and a booster class 2 months later. Control group will receive enhanced primary care that includes patient education handouts informed by cognitive behavioral science. Data analysis will include 1-way analysis of covariance (ANCOVA), multiple regression with bootstrapping. RESULTS/ANTICIPATED RESULTS: The overall hypothesis is that brief ACT treatment reduces physical disability, improves functioning, and reduces medication misuse in chronic pain patients when delivered by an integrated behavioral health provider in primary care. In addition, it is anticipated that improvements in patient functioning will be mediated by patient change in pain acceptance and patient engagement in value-consistent behaviors. DISCUSSION/SIGNIFICANCE OF IMPACT: This pilot study will establish preliminary data about the effectiveness of addressing chronic pain in a generalizable integrated primary care setting. Data will help support a larger trial in the future. Findings have potential to transform the way chronic pain is currently managed in primary care settings, with results that could decrease disability and improve functioning among patients suffering from chronic pain.

The Role of the Mental Health Counselor in the Psychiatric Liaison Service of the General Hospital

1974 ◽  
Vol 5 (1) ◽  
pp. 1-16 ◽  
Author(s):  
Bernard R. Shochet
Keyword(s):  
Mental Health ◽  
General Hospital ◽  
Case Reports ◽  
Hospital Setting ◽  
Acute Illness ◽  
Supportive Psychotherapy ◽  
Psychosocial Services ◽  
Mental Health Counselor ◽  
Number Of Patients ◽  
Health Counselor

A substantial number of patients admitted to the medical and surgical services of the general hospital experience significant and obvious psychological difficulties associated with their acute illness. This is more likely to be recognized overtly on a medical than on a surgical service; on both, a significant number of patients need psychological services during their acute illness and convalescence. The mental health counselor serves an important function on the medical and surgical units: screening new admissions and identifying those patients in need of psychosocial services, providing supportive psychotherapy to selected patients and consulting with the nursing staff and house staff concerning day to day management. By participating in walking rounds with the medical staff, the counselor is also able to facilitate the request and use of formal psychiatric consultative services. As demonstrated through statistics and case reports, the mental health counselor, trained to operate in the general hospital setting, makes a valuable contribution in the care of medical and surgical patients in the general hospital.

Collaborative Care Models in Psychiatry

2019 ◽  
Author(s):  
Danielle M. Gainer ◽  
Karley B. Fischer ◽  
Parvaneh K. Nouri
Keyword(s):  
Behavioral Health ◽  
Integrated Care ◽  
Collaborative Care ◽  
Cost Effective ◽  
Stepped Care ◽  
Health Provider ◽  
Behavioral Health Provider ◽  
Care Approach ◽  
Care Models ◽  
Barriers To Implementation

Integrated care models allow a team of providers to interact in a systematic manner, producing cost-effective and superior outcomes for patients. The collaborative care model (CCoM), one type of integrated care, has emerged as one approach with over 80 randomized controlled trials to support its efficacy. In this model, a behavioral health provider offers evidence-based, brief interventions but also serves as a liaison between the patient, medical providers, and the psychiatric consultant. The team also monitors outcomes through a registry and provides a stepped care approach to adjust interventions collaboratively, as needed. If the barriers to integrated care implementation are surmounted, psychiatrists working as consultants in this model can provide care in an efficient and sustainable manner. This review contains 5 figures, 5 tables, and 48 references. Key Words: barriers to implementation, behavioral health provider, collaborative care, cost-effective, integrated care, psychiatric consultant, cost-effective, registry, stepped care

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