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Greenberg NR, Jakobson E, Dickerman AL. Milieu therapy in the treatment of a medically-complex patient receiving care on a medical-psychiatry unit and consultation-liaison psychiatry service: a case report. J Acad Consult Liaison Psychiatry 2024:S2667-2960(24)00070-3. [PMID: 39019168 DOI: 10.1016/j.jaclp.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/25/2024] [Accepted: 07/14/2024] [Indexed: 07/19/2024]
Affiliation(s)
- Norman R Greenberg
- Department of Psychiatry, Weill Cornell Medical Center, 525 E 68(th) St, New York, NY, 10065, USA; NewYork-Presbyterian Hospital/Weill Cornell Medical Center, 525 E 68(th) St, New York, NY, 10065, USA.
| | - Erika Jakobson
- Department of Psychiatry, Weill Cornell Medical Center, 525 E 68(th) St, New York, NY, 10065, USA; NewYork-Presbyterian Hospital/Weill Cornell Medical Center, 525 E 68(th) St, New York, NY, 10065, USA
| | - Anna L Dickerman
- Department of Psychiatry, Weill Cornell Medical Center, 525 E 68(th) St, New York, NY, 10065, USA; NewYork-Presbyterian Hospital/Weill Cornell Medical Center, 525 E 68(th) St, New York, NY, 10065, USA
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Yankova L, Berkwitt A, Loyal J. Low-Value Care for Hospitalized Children With Dual Medical and Behavioral Complexity. Hosp Pediatr 2024; 14:e245-e248. [PMID: 38651257 DOI: 10.1542/hpeds.2024-007766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Affiliation(s)
- Lyubina Yankova
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| | - Adam Berkwitt
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| | - Jaspreet Loyal
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
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Heinrich TW, DeMoss DS. Dual-Boarded Physicians and Consultation-Liaison Psychiatrists: Striving Together Toward Common Goals. J Acad Consult Liaison Psychiatry 2024; 65:123-125. [PMID: 38458398 DOI: 10.1016/j.jaclp.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Affiliation(s)
- Thomas W Heinrich
- Department of Psychiatry and Behavioral Medicine, Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, WI.
| | - Dustin S DeMoss
- Department of Psychiatry and Behavioral Health, Department of Internal Medicine, University of North Texas Health Science Center, Fort Worth, TX
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Wittink M, Chan AC, Padrino S, Silverstein SM. The Undervalued Potential of Medical-Psychiatry Units to Improve Care for People With Severe Mental Illnesses. Psychiatr Serv 2023; 74:991-993. [PMID: 36820518 DOI: 10.1176/appi.ps.202200039] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Affiliation(s)
- Marsha Wittink
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Wittink, Silverstein); Medical-Psychiatry Unit Consortium, Association of Medicine and Psychiatry, Fresno, California (Wittink, Chan, Padrino); Departments of Psychiatry and Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City (Chan); Departments of Psychiatry and Internal Medicine, University Hospitals Cleveland Medical Center, and AbsoluteCare Cleveland, Cleveland (Padrino)
| | - Aubrey C Chan
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Wittink, Silverstein); Medical-Psychiatry Unit Consortium, Association of Medicine and Psychiatry, Fresno, California (Wittink, Chan, Padrino); Departments of Psychiatry and Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City (Chan); Departments of Psychiatry and Internal Medicine, University Hospitals Cleveland Medical Center, and AbsoluteCare Cleveland, Cleveland (Padrino)
| | - Susan Padrino
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Wittink, Silverstein); Medical-Psychiatry Unit Consortium, Association of Medicine and Psychiatry, Fresno, California (Wittink, Chan, Padrino); Departments of Psychiatry and Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City (Chan); Departments of Psychiatry and Internal Medicine, University Hospitals Cleveland Medical Center, and AbsoluteCare Cleveland, Cleveland (Padrino)
| | - Steven M Silverstein
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Wittink, Silverstein); Medical-Psychiatry Unit Consortium, Association of Medicine and Psychiatry, Fresno, California (Wittink, Chan, Padrino); Departments of Psychiatry and Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City (Chan); Departments of Psychiatry and Internal Medicine, University Hospitals Cleveland Medical Center, and AbsoluteCare Cleveland, Cleveland (Padrino)
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Robbins-Welty GA, Gagliardi JP. Integrated Care for Complicated Patients: A Role for Combined Training and Practice. Am J Geriatr Psychiatry 2023; 31:222-231. [PMID: 36437177 DOI: 10.1016/j.jagp.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 10/29/2022] [Accepted: 10/31/2022] [Indexed: 11/09/2022]
Abstract
Patients with chronic medical disease frequently have comorbid psychiatric illness, yet mental and physical healthcare is frequently siloed in the United States. Integrated behavioral healthcare models, such as medicine-psychiatry services, are feasible, improve patient outcomes, and reduce costs. The Duke University Hospital medicine-psychiatry service provides holistic patient care and serves as a model for those interested in developing combined services or training programs elsewhere. Combined residency training in psychiatry is a way to provide a workforce of physician-scientist educators adept at providing coordinated, integrated care for complex patients with comorbid illness.
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Affiliation(s)
- Gregg A Robbins-Welty
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center (GAR-W, JPG), Durham, NC; Department of Medicine, Duke University Medical Center (GAR-W, JPG), Durham, NC.
| | - Jane P Gagliardi
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center (GAR-W, JPG), Durham, NC; Department of Medicine, Duke University Medical Center (GAR-W, JPG), Durham, NC
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Ellison AG, Jansen LAW, Nguyen F, Martina A, Spencer J, Wierdsma AI, Kathol RG, van Schijndel MA. Specialty Psychiatric Services in US Emergency Departments and General Hospitals: Results From a Nationwide Survey. Mayo Clin Proc 2022; 97:862-870. [PMID: 35410751 DOI: 10.1016/j.mayocp.2021.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 10/26/2021] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To explore the handling of psychiatric patients in medical hospitals and emergency departments (EDs) as well as hospital characteristics associated with the availability of psychiatric services in these settings. METHODS From October 1, 2017, to April 1, 2018, a telephone survey regarding the presence and nature of psychiatric services was attempted among all US registered Medicare hospitals. RESULTS Of the included 4812 US hospitals, 2394 (50%) were surveyed. Of these hospitals, 1108 (46%) have some psychiatric services available, either in medical EDs or through psychiatric consultation on general medical inpatient wards. If medical ED patients with active psychiatric issues need admission, 59% of hospitals transfer the patient to a different hospital and 28% admit the patient to a medical ward. Exploration by logistic regression analysis of the association of selected variables and available psychiatric expertise suggested that larger hospitals, nonprofit services, or hospitals in urban settings were more likely to have psychiatrists on staff or available for consultation. CONCLUSION Despite the growing number of psychiatric patients seeking help in medical EDs and general hospitals, more than 50% of the EDs and general hospitals lack psychiatric services. These results suggest that accessibility to psychiatric care in medical settings requires improvement.
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Affiliation(s)
- Ashley G Ellison
- Department of Psychiatry, Novant Health, Winston Salem, NC; Department of Internal Medicine and Psychiatry, Tulane University School of Medicine, New Orleans, LA
| | - Luc A W Jansen
- Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; DC Klinieken, Almere, The Netherlands.
| | - Francis Nguyen
- Department of Psychiatry, Louisiana State University School of Medicine, New Orleans
| | - Andrew Martina
- Department of Psychiatry, University of Rochester Medical College, Rochester, NY
| | - Jordan Spencer
- Department of Internal Medicine and Psychiatry, Medical University of South Carolina, Charleston
| | - André I Wierdsma
- Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Roger G Kathol
- Department of Psychiatry, University of Minnesota, Burnsville
| | - Maarten A van Schijndel
- Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Psychiatry, Rijnstate Hospital, Arnhem, The Netherlands
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