The impact of two changes in service delivery on a geriatric psychiatry liaison service

Old age psychiatry in the house: assessing the impact of a service transition from consultation to liaison old age psychiatry

OBJECTIVE

The impact of a change in service delivery in a psychogeriatric service, moving from a consultation model to liaison model of care, was examined in a naturalistic study.

METHODS

The study period was divided into two phases, defined by the change in service delivery. The impact of the change on (1) referral rate, (2) referrals seen, (3) extent of intervention and (4) clinical characteristics was examined.

RESULTS

While we did not see a dramatic improvement in time waiting for assessment (2.9 vs. 2.4 days), the enhanced team provided significantly more clinical input. The number of assessments completed increased by 60% (39 vs. 66). Most significantly, during phase I, more than half of all referrals were not seen (54%), while during phase II only one patient referred was not assessed (1%). The number of reviews undertaken also increased significantly.

CONCLUSIONS

The results of the present study suggest improved outcomes for patients and improved satisfaction in the clinical teams. Further clinical effectiveness and cost-effectiveness studies are needed.

Psychiatric consultation to elderly medical inpatients in a general hospital

Objectives: To determine the reasons for referral of elderly medical inpatients for psychiatric consultation and the appropriateness of such referrals. To determine whether the provision of a consultation service is associated with increases in referral rates over time.

Method: One hundred consecutive referrals seen over an 18-week period were included in the study and data on reason for referral, ICD-10 diagnosis and recommended interventions gathered prospectively. Rates of referral were calculated and compared with a similar study performed in the same location five years previously.

Results: In this location the most frequent reason for referral was for assessment of depressive symptoms (47%). Referrals were generally appropriate and there was a high degree of concordance between reason for referral and psychiatric diagnosis, particularly for depressive symptoms. There was a moderate (22%) increase in referral rates in the five years since the previous study. Concordance rates between reason for referral and psychiatric diagnosis had improved considerably during this period, particularly for depressive symptoms.

Conclusions: Referral rates for psychogeriatric consultation increase over time. Referrals are generally appropriate, and recognition of depressive illness improves. Psychiatric illness may still be under-recognised and increasing workload may indicate a need for more refined models of service delivery.

The rising demand for consultation-liaison psychiatry for older people: comparisons within Liverpool and the literature across time

OBJECTIVES

To compare the rate of referrals of older people for consultation-liaison psychiatry services over time within Liverpool and with the literature.

METHODS

All referrals to the liaison psychiatry service for older people in Liverpool between 1999 and 2004 were used to calculate referral rates and compared with data from the same hospital from 1981 to 1989 previously published. Data related to referral rates was extracted from other published studies to allow cross-national comparisons over time.

RESULTS

Between 1999 and 2004 there were 2760 referrals to the Liverpool liaison psychiatry service for older people producing an average annual referral rate of 2.89%. This compares to a referral rate of 0.7% in 1981 and 1.34% in 1989. Comparison with studies from the UK, North America, Europe, Singapore and Taiwan shows an increasing trend across a 30 year period. The rate of referral increases with increasing age up to age 90.

CONCLUSION

Trends indicate increasing rates of referral of older people to consultation-liaison psychiatry services with greater representation of the older old. Similar effects are likely to be experienced in all nations with an ageing population. Liaison psychiatry services will need professionals trained in old age psychiatry if the needs of this increasing elderly population are to be addressed.

Geropsychiatric consultation in a general hospital in Taiwan

The aim of this study was to characterize clinically significant issues in a psychiatric consultation service for geriatric inpatients in a general hospital in Taiwan. This was a case-control study. During a 5-month period, 100 geriatric (age > or =65 years) inpatients consecutively referred for consultation-liaison psychiatric service from non-psychiatric departments formed the study group. Another 100 medical inpatients, also referred for consultation-liaison to the psychiatric service, but aged 17-50, formed the control (non-geriatric) group. The diagnosis, demography, reason for referral, symptomatology, and other clinical characteristics were determined by consensus between two psychiatrists. Psychiatric diagnosis was made according to criteria in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders. The geropsychiatric consultation rate was 0.9%. Geriatric patients constituted 20.1% of all psychiatric referrals. Common reasons for referral of geriatric inpatients were confusion (32%), depression (17%), disturbing behaviors (14%), and psychosis (14%). The most common psychiatric disorder among geriatric patients was an organic mental disorder (79%), followed by a depressive disorder (13%). More geriatric patients suffered from cancers and cerebrovascular diseases than non-geriatric patients. The geriatric group was more likely to have multiple physical illnesses. Organic mental disorder and depressive disorders are the most common psychiatric diagnoses in the geropsychiatric consultation service of the authors. In the authors' experience, both psychotropic medication treatment and psychosocial intervention are important in geropsychiatric consultation.

Is mental health economics important in geriatric psychiatry in developing countries?

BACKGROUND

limited healthcare budgets and a seamless demand for resources suggests that a formula for allocating resources is needed. Economic evaluation can assist in developing this formula.

METHOD

mental health economic studies (cost minimisation, cost-effectiveness, cost-utility, cost-benefit and cost of illness analysis) in geriatric psychiatry from developed and developed countries were examined along with all mental health economic studies in developed countries.

RESULTS

there were no health economic studies in geriatric psychiatry from developing countries against a background of many such studies in developed countries. There were a greater number of health economic studies in other areas of psychiatry in developing countries. Several reasons for the paucity of such studies, the feasibility of undertaking these studies and their significance are discussed.

CONCLUSION

mental health economic studies in geriatric psychiatry in developing countries are feasible, realistic and may well have an important part to play in the allocation of resources. Also, data sets necessary for such studies are emerging from many developing countries.