A brief computerised discharge summary in old age psychiatry: general practitioner reactions

In an attempt to provide data for medical audit, to standardise the information on discharge letters and to speed communication, a computerised discharge form was introduced for a catchment area of 20,000 people over 65 years. The programme, based on a surgical audit programme using DBASE II, was developed by one of us to run on an Amstrad PCW. This produced a discharge summary on a standard layout which gave the date of admission, the patient's name, date of birth and address as well as the consultant and GP's name. The patient's diagnosis (according to ICD-9), and a list of disciplines and facilities involved in follow-up preceded brief notes on history and progress. Date of discharge was followed by a list of medication and a space for ‘other information’. All this was contained on one side of A4 paper.

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Should old age psychiatry develop memory clinics? A comparison with domiciliary work

Psychiatric Bulletin ◽

10.1192/pb.28.3.78 ◽

2004 ◽

Vol 28 (3) ◽

pp. 78-82 ◽

Cited By ~ 9

Author(s):

S. Simpson ◽

D. Beavis ◽

J. Dyer ◽

S. Ball

Keyword(s):

Old Age ◽

Clinical Implications ◽

Memory Clinic ◽

Retrospective Case ◽

Memory Clinics ◽

Old Age Psychiatry ◽

Psychiatric Complications ◽

To Receive ◽

Case Note Review

Aims and MethodMemory clinics have become very popular in old age psychiatry and there is some pressure for them to be developed in old age services. However, there is little evidence to suggest that they are more advantageous over the traditional domiciliary visits or who should be seen in clinic. This was a naturalistic comparison of 76 consecutive new referrals to a memory clinic, with 74 consecutive new domiciliary requests within the same service over the same period of time. A retrospective case note review collected the clinical features and an 18-month prospective follow-up examined the subsequent clinical management.Clinical ImplicationsThe two groups were characterised more by their similarities than their differences. However, the domiciliary group had greater behavioural and psychological complications. The memory clinic patients were less likely to receive psychotropic medication and here more likely to be followed up.ResultsWe conclude that memory clinics might be less suitable for patients with prominent psychiatric complications. Memory clinics could complement the domiciliary model by providing early psychosocial/neuropsychiatric approaches, although this is likely to lead to an increased clinical case-load.

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Old age psychiatry and geriatric medicine admissions and elderly suicide rates in England

International Psychogeriatrics ◽

10.1017/s1041610209991700 ◽

2010 ◽

Vol 22 (3) ◽

pp. 502-504 ◽

Cited By ~ 3

Author(s):

Ajit Shah

Keyword(s):

Mental Health ◽

Mental Illness ◽

General Practitioner ◽

Old Age ◽

Geriatric Medicine ◽

Healthcare Services ◽

Suicide Rates ◽

Old Age Psychiatry ◽

Elderly Suicide ◽

Almost All

Almost all elderly suicide victims have mental illness, and up to 90% have depression (Shah and De, 1998). A significant number of elderly suicide victims in Western countries consult their general practitioner or psychiatrist or contact mental health services between one week and six months prior to the suicide (Catell, 1988; Conwell et al., 1990; 1991; Catell and Jolley, 1995; Vassilas and Morgan, 1993; 1994). This offers an opportunity for identification and treatment of the mental illness. Thus, the availability of appropriate healthcare services may be an important factor associated with elderly suicide rates.

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Fund-holding general practices and old age psychiatry

Psychiatric Bulletin ◽

10.1192/pb.18.5.263 ◽

1994 ◽

Vol 18 (5) ◽

pp. 263-265 ◽

Cited By ~ 11

Author(s):

Christopher F. Fear ◽

Howard R. Cattell

Keyword(s):

Retrospective Study ◽

General Practitioner ◽

Old Age ◽

Local Practices ◽

Old Age Psychiatry ◽

General Practices

In a retrospective study, referrals to a community old age psychiatry service were obtained for local practices a year before and a year subsequent to the introduction of prospective general practitioner (GP) fund-holding. Although overall patterns of referral were the same, there was a significant reduction in domiciliary consultations requested by fund-holding GPs which was not balanced by a rise in other referrals. The findings suggest a shortfall in the number of referrals to old age psychiatry services in the light of GP fund-holding, prompting speculation as to the fate of those who would otherwise have been referred.

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Consultation—liaison in an old age psychiatry service

Psychiatric Bulletin ◽

10.1192/pb.22.4.217 ◽

1998 ◽

Vol 22 (4) ◽

pp. 217-220 ◽

Cited By ~ 3

Author(s):

Ruth Loane ◽

Peter Jefferys

Keyword(s):

Nursing Home ◽

Retrospective Study ◽

Hospital Admission ◽

Social Services ◽

Old Age ◽

Care Facility ◽

Continuing Care ◽

Functional Disorder ◽

Old Age Psychiatry

This retrospective study looks at the outcome of 71 consecutive liaison referrals. Placement was noted at three-month follow-up and further use of medical, psychiatric and social services, compliance with clinical management and recommendations was also measured. Nearly half the patients had dementia and about half had a functional disorder. In 90% of referrals the recommendations were followed. At three-month follow-up 17% had died, 26% had further medical hospital admission, 39% had moved into a continuing care facility (residential/nursing home), and over half had further contact with the old age psychiatry services.

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Lithium monitoring in patients over 65 in NHS Greater Glasgow and Clyde

BJPsych Open ◽

10.1192/bjo.2021.138 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S32-S32

Author(s):

Catriona Ingram ◽

Karli Dempsey ◽

Gillian Scott ◽

Joe Sharkey

Keyword(s):

Old Age ◽

Catchment Area ◽

Current Practice ◽

High Variability ◽

Health Board ◽

Data Set ◽

Number Of Patients ◽

Adult Psychiatry ◽

Old Age Psychiatry ◽

Plasma Monitoring

AimsOur aim was to identify current practice for Lithium monitoring for >65s in NHS GGC and assess compliance to local Lithium monitoring guidelines.MethodA retrospective analysis was undertaken of patient data (demographics, diagnosis, biochemistry results) with Caldicott approval at two points over the course of 2018/19. For the first analysis, old age Community Mental Health Teams (CMHTs) were approached and asked to provide a list of their patients on Lithium. This was then assessed for compliance to Lithium monitoring guidelines.For the second analysis, pharmacy provided data for every patient in the health board dispensed lithium, regardless of whether they were open to a CMHT or not. We were then able to identify patients who we had not picked up on our initial analysis, and re-assess the entire data set for compliance to Lithium monitoring guidelines.ResultFrom our first analysis, 13 CMHTs identified 155 patients on Lithium. There was a high variability in how these patients were identified. 44% of patients were monitored by CMHTs who took bloods and chased them, 38% were monitored by GPs who were prompted by CMHTs in routine clinic letters, and 14% were monitored by GPs who were prompted by CMHTs more assertively using a lithium register. Overall, Lithium plasma monitoring was done well irrespective of method (91%), however compliance to the local standards was poor (58%) with proactive CMHT prompting GPs appearing to be the most effective method (71%).In our second analysis, we identified 508 patients >65 in NHS GGC prescribed Lithium. Of those, 44% were open to old age psychiatry, 25% general adult psychiatry and 19% were not open to anyone. Of those open to old age services, only 58% had been identified in the previous audit. Lithium monitoring compliance was better in those open to a CMHT versus those not (61% to 23%), and better in CMHTs where monitoring was done by CMHTs rather than GPs. For each CMHT, there were roughly 7 patients per catchment area on Lithium not open to psychiatry.ConclusionLithium monitoring does appear to be highly variable and not particularly compliant with local standards. CMHTs have inconsistent methods of identifying patients prescribed Lithium. There are a significant number of patients not open to old age CMHTs prescribed Lithium, and these patients have poorer compliance to Lithium monitoring. Of patients open to CMHTs, CMHT-led monitoring appears superior to other forms.

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Rates and predictors of general practitioner (GP) follow-up postdischarge from a tertiary hospital cardiology unit: a retrospective cohort study

BMJ Open ◽

10.1136/bmjopen-2019-031627 ◽

2019 ◽

Vol 9 (10) ◽

pp. e031627 ◽

Cited By ~ 1

Author(s):

Luke Y I Huang ◽

Samuel J Fogarty ◽

Arnold C T Ng ◽

William Y S Wang

Keyword(s):

Cohort Study ◽

General Practitioner ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Hospital Readmissions ◽

Discharge Summary ◽

Tertiary Hospital ◽

Single Centre ◽

Hospital Factors

ObjectivePrevious studies in cardiac patients noted that early patient follow-up with general practitioners (GPs) after hospital discharge was associated with reduced rates of hospital readmissions. We aimed to identify patient, clinical and hospital factors that may influence GP follow-up of patients discharged from a tertiary cardiology unit.DesignSingle centre retrospective cohort study.SettingAustralian metropolitan tertiary hospital cardiology unit.Participants1079 patients discharged from the hospital cardiology unit within 3 months from May to July 2016.Outcome measuresGP follow-up rates (assessed by telephone communication with patients’ nominated GP practices), demographic, clinical and hospital factors predicting GP follow-up.ResultsWe obtained GP follow-up data on 983 out of 1079 (91.1%) discharges in the study period. Overall, 7, 14 and 30-day GP follow rates were 50.3%, 66.5% and 79.1%, respectively. A number of patient, clinical and hospital factors were associated with early GP follow-up, including pacemaker and defibrillator implantation, older age and having never smoked. Documented recommendation for follow-up in discharge summary was the strongest predictor for 7-day follow-up (p<0.001).ConclusionAfter discharge from a cardiology admission, half of the patients followed up with their GP within 7 days and most patients followed up within 30 days. Patient and hospital factors were associated with GP follow-up rates. Identification of these factors may facilitate prospective interventions to improve early GP follow-up rates.

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A study of severe domestic squalor: 173 cases referred to an old age psychiatry service

International Psychogeriatrics ◽

10.1017/s1041610210000906 ◽

2010 ◽

Vol 23 (2) ◽

pp. 308-314 ◽

Cited By ~ 24

Author(s):

John Snowdon ◽

Graeme Halliday

Keyword(s):

Old Age ◽

Referral Rate ◽

Term Care ◽

Old Age Psychiatry ◽

One Year ◽

Severe Degree ◽

Made In ◽

At Home

ABSTRACTBackground: Although community psychiatric services commonly encounter cases where intervention is needed due to persons’ unclean or cluttered living conditions, evidence concerning the referral rate and prevalence of severe domestic squalor is sparse.Methods: Between 2000 and 2009, ratings of cleanliness and clutter have been made in all cases of people living in squalor who have been referred to an old age psychiatry service in Central Sydney. Where possible, one-year follow-up was arranged.Results: 173 persons aged 65 years or more were referred to the service during the ten years and assessed as living in squalor (120 moderate or severe, two thirds of whom showed a moderate or severe degree of hoarding/clutter). Of 157 followed up after one year, 47% were still at home, 32% were in long-term care homes, 12% had moved elsewhere, and 9% had died. The annual new referral rate was close to 1 per 1000 elderly people in the catchment area, and of moderate or severe squalor was 0.66 per 1000. Limiting follow-up to those in moderate or severe squalor, 41% were still at home one year later. Current findings suggest that the minimum prevalence in the community of older people living in moderate or severe squalor in Sydney is 1 per 1000.Conclusions: The costs of intervening in cases of severe domestic squalor are considerable. Increased attention and funding are warranted, as the incidence and prevalence are higher than had previously been estimated.

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Prescribing for patients attending old age psychiatry day hospitals

Psychiatric Bulletin ◽

10.1192/pb.20.6.335 ◽

1996 ◽

Vol 20 (6) ◽

pp. 335-337

Author(s):

Margaret M. Semple ◽

Brian R. Ballinger ◽

Elizabeth Irvine

Keyword(s):

General Practitioner ◽

Drug Treatment ◽

Old Age ◽

General Practitioners ◽

Day Hospital ◽

Old Age Psychiatry ◽

Day Hospitals

A review of the drug treatment of 163 patients attending two old age psychiatric day hospitals showed that 29 received medication from the day hospital, 44 from general practitioners and 60 from both sources. Many of the patients' knowledge of their drug treatment was incomplete. Of those individuals interviewed, approximately equal numbers expressed a preference for day hospital and general practitioner prescriptions. The origin of the prescription did not bear any obvious relationship to subsequent admission to hospital or continued attendance at the day hospital.

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