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Brunn M, Diefenbacher A, Strain J. Are there effects of consultation–liaison-psychiatry on length of stay in the general hospital? A path analysis. THE EUROPEAN JOURNAL OF PSYCHIATRY 2020. [DOI: 10.1016/j.ejpsy.2020.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Holmes A, Handrinos D, Jones S, Huang B. The impact of increasing general hospital admissions on Consultation-Liaison Psychiatry. Australas Psychiatry 2020; 28:459-462. [PMID: 32469643 DOI: 10.1177/1039856220926941] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of this study was to identify changes in patients referred to CLP at a typical inner urban teaching hospital over two decades in the context of increased hospital admissions. METHOD Multivariate analyses were conducted on data collected for all referrals to CLP at Royal Melbourne Hospital between 1998 and 2017. Analyses were conducted with reason for referral, current psychiatric contact, psychiatric diagnosis, discharge destination and follow up as dependent variables, and the year and annual hospital admissions as independent variables. RESULTS Annual hospital admissions grew at a rate (4.6%), greater than the annual increase in beds (2.0%). Psychosis, suicide attempt, past psychiatric history and behaviour became more common reasons for referral, whilst depression and somatisation became less common. Transfers to and from mental health inpatient units increased. CONCLUSIONS An increasing proportion of patients seen by CLP have 'acute' problems. Patients with somatisation and depression are seen less frequently. These findings indicate that CLP services need to provide timely assessment and work closely with other elements of the local mental health service in order to optimise patient flow and ensure continuity of care. Local strategies may be required to ensure an adequate breadth of experience for trainees.
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Affiliation(s)
- Alex Holmes
- Department of Psychiatry, University of Melbourne, Royal Melbourne Hospital, Australia; and Consultation-Liaisons Psychiatry, Royal Melbourne Hospital, Australia
| | - Dennis Handrinos
- Department of Psychiatry, University of Melbourne, Royal Melbourne Hospital, Australia
| | - Simon Jones
- Consultation-Liaisons Psychiatry, Royal Melbourne Hospital, Australia
| | - Beatrice Huang
- Consultation-Liaisons Psychiatry, Royal Melbourne Hospital, Australia
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Saraiva S, Guthrie E, Walker A, Trigwell P, West R, Shuweidi F, Crawford M, Fossey M, Hewison J, Murray CC, Hulme C, House A. The nature and activity of liaison mental services in acute hospital settings: a multi-site cross sectional study. BMC Health Serv Res 2020; 20:308. [PMID: 32293431 PMCID: PMC7157982 DOI: 10.1186/s12913-020-05165-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 03/26/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND To describe the clinical activity patterns and nature of interventions of hospital-based liaison psychiatry services in England. METHODS Multi-site, cross-sectional survey. 18 acute hospitals across England with a liaison psychiatry service. All liaison staff members, at each hospital site, recorded data on each patient they had face to face contact with, over a 7 day period. Data included location of referral, source of referral, main clinical problem, type of liaison intervention employed, staff professional group and grade, referral onto other services, and standard assessment measures. RESULTS A total of 1475 face to face contacts from 18 hospitals were included in the analysis, of which approximately half were follow-up reviews. There was considerable variation across sites, related to the volume of Emergency Department (ED) attendances, number of hospital admissions, and work hours of the team but not to the size of the hospital (number of beds). The most common clinical problems were co-morbid physical and psychiatric symptoms, self-harm and cognitive impairment. The main types of intervention delivered were diagnosis/formulation, risk management and advice. There were differences in the type of clinical problems seen by the services between EDs and wards, and also differences between the work conducted by doctors and nurses. Almost half of the contacts were for continuing care, rather than assessment. Eight per cent of all referrals were offered follow up with the LP team, and approximately 37% were referred to community or other services. CONCLUSIONS The activity of LP services is related to the flow of patients through an acute hospital. In addition to initial assessments, services provide a wide range of differing interventions, with nurses and doctors carrying out distinctly different roles within the team. The results show the volume and diversity of LP work. While much clinical contact is acute and confined to the inpatient episode, the LP service is not defined solely by an assessment and discharge function; cases are often complex and nearly half were referred for follow up including liaison team follow up.
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Affiliation(s)
- Sonia Saraiva
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Elspeth Guthrie
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Andrew Walker
- Clinical Research Network National Coordinating Centre, National Institute of Health Research Clinical Research Network, Leeds, UK
| | - Peter Trigwell
- National Inpatient Centre for Psychological Medicine, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Robert West
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Farag Shuweidi
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Mike Crawford
- College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
- Department of Brain Sciences, Faculty of Medicine, Imperial College, London, UK
| | - Matt Fossey
- Veterans and Families Institute for Military Research, Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK
| | - Jenny Hewison
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Claire Hulme
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Allan House
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Smith C, Hewison J, West RM, Guthrie E, Trigwell P, Crawford MJ, Czoski Murray CJ, Fossey M, Hulme C, Tubeuf S, House A. Liaison psychiatry-measurement and evaluation of service types, referral patterns and outcomes (LP-MAESTRO): a protocol. BMJ Open 2019; 9:e032179. [PMID: 31767593 PMCID: PMC6887012 DOI: 10.1136/bmjopen-2019-032179] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION We describe the protocol for a project that will use linkage of routinely collected NHS data to answer a question about the nature and effectiveness of liaison psychiatry services in acute hospitals in England. METHODS AND ANALYSIS The project will use three data sources: (1) Hospital Episode Statistics (HES), a database controlled by NHS Digital that contains patient data relating to emergency department (ED), inpatient and outpatient episodes at hospitals in England; (2) ResearchOne, a research database controlled by The Phoenix Partnership (TPP) that contains patient data relating to primary care provided by organisations using the SystmOne clinical information system and (3) clinical databases controlled by mental health trusts that contain patient data relating to care provided by liaison psychiatry services. We will link patient data from these sources to construct care pathways for patients who have been admitted to a particular hospital and determine those patients who have been seen by a liaison psychiatry service during their admission.Patient care pathways will form the basis of a matched cohort design to test the effectiveness of liaison intervention. We will combine healthcare utilisation within care pathways using cost figures from national databases. We will compare the cost of each care pathway and the impact of a broad set of health-related outcomes to obtain preliminary estimates of cost-effectiveness for liaison psychiatry services. We will carry out an exploratory incremental cost-effectiveness analysis from a whole system perspective. ETHICS AND DISSEMINATION Individual patient consent will not be feasible for this study. Favourable ethical opinion has been obtained from the NHS Research Ethics Committee (North of Scotland) (REF: 16/NS/0025) for Work Stream 2 (phase 1) of the Liaison psychiatry-measurement and evaluation of service types, referral patterns and outcomes study. The Confidentiality Advisory Group at the Health Research Authority determined that Section 251 approval under Regulation 5 of the Health Service (Control of Patient Information) Regulations 2002 was not required for the study 'on the basis that there is no disclosure of patient identifiable data without consent' (REF: 16/CAG/0037).Results of the study will be published in academic journals in health services research and mental health. Details of the study methodology will also be published in an academic journal. Discussion papers will be authored for health service commissioners.
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Affiliation(s)
- Chris Smith
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Jenny Hewison
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Robert M West
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Elspeth Guthrie
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Peter Trigwell
- National Inpatient Centre for Psychological Medicine, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Mike J Crawford
- Centre for Psychiatry, Department of Medicine, Imperial College London, London, UK
- College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | | | - Matt Fossey
- Veterans and Families Institute for Military Research, Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK
| | - Claire Hulme
- University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Sandy Tubeuf
- Institute of Health and Society, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Allan House
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
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Chadda RK, Deb KS, Mahapatra A, Gupta R. Referral patterns in a consultation liaison psychiatry service in India: A comparison with the Western world. Gen Hosp Psychiatry 2019; 59:76-77. [PMID: 30745228 DOI: 10.1016/j.genhosppsych.2018.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 10/14/2018] [Accepted: 10/31/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Rakesh Kumar Chadda
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi 110029, India.
| | - Koushik Sinha Deb
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Ananya Mahapatra
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Rishi Gupta
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi 110029, India
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House A, Guthrie E, Walker A, Hewsion J, Trigwell P, Brennan C, Crawford M, Murray CC, Fossey M, Hulme C, Martin A, Quirk A, Tubeuf S. A programme theory for liaison mental health services in England. BMC Health Serv Res 2018; 18:742. [PMID: 30261875 PMCID: PMC6161457 DOI: 10.1186/s12913-018-3539-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 09/13/2018] [Indexed: 11/11/2022] Open
Abstract
Background Mechanisms by which liaison mental health services (LMHS) may bring about improved patient and organisational outcomes are poorly understood. A small number of logic models have been developed, but they fail to capture the complexity of clinical practice. Method We synthesised data from a variety of sources including a large national survey, 73 in-depth interviews with acute and liaison staff working in hospitals with different types of liaison mental health services, and relevant local, national and international literature. We generated logic models for two common performance indicators used to assess organisational outcomes for LMHS: response times in the emergency department and hospital length of stay for people with mental health problems. Results We identified 8 areas of complexity that influence performance, and 6 trade-offs which drove the models in different directions depending upon the balance of the trade-off. The logic models we developed could only be captured by consideration of more than one pass through the system, the complexity in which they operated, and the trade-offs that occurred. Conclusions Our findings are important for commissioners of liaison services. Reliance on simple target setting may result in services that are unbalanced and not patient-centred. Targets need to be reviewed on a regular basis, together with other data that reflect the wider impact of the service, and any external changes in the system that affect the performance of LMHS, which are beyond their control.
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Affiliation(s)
- Allan House
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Elspeth Guthrie
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
| | - Andrew Walker
- Clinical Research Network National Coordinating Centre, National Institute of Health Research Clinical Research Network, Leeds, UK
| | - Jenny Hewsion
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Peter Trigwell
- National Inpatient Centre for Psychological Medicine, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Cathy Brennan
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Mike Crawford
- Faculty of Medicine, Department of Medicine, Imperial College, London, UK
| | | | - Matt Fossey
- Veterans and Families Institute for Military Research, Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK
| | - Claire Hulme
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Adam Martin
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Alan Quirk
- College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Sandy Tubeuf
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Chen KY, Evans R, Larkins S. Why are hospital doctors not referring to Consultation-Liaison Psychiatry? - a systemic review. BMC Psychiatry 2016; 16:390. [PMID: 27829386 PMCID: PMC5103418 DOI: 10.1186/s12888-016-1100-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 10/28/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Consultation-Liaison Psychiatry (CLP) is a subspecialty of psychiatry that provides care to inpatients under non-psychiatric care. Despite evidence of benefits of CLP for inpatients with psychiatric comorbidities, referral rates from hospital doctors remain low. This review aims to understand barriers to CLP inpatient referral as described in the literature. METHODS We searched on Medline, PsychINFO, CINAHL and SCOPUS, using MESH and the following keywords: 1) Consultation-Liaison Psychiatry, Consultation Liaison Psychiatry, Consultation Psychiatry, Liaison Psychiatry, Hospital Psychiatry, Psychosomatic Medicine, the 2) Referral, Consultation, Consultancy and 3) Inpatient, Hospitalized patient, Hospitalized patient. We considered papers published between 1 Jan 1965 and 30 Sep 2015 and all articles written in English that contribute to understanding of barriers to CLP referral were included. RESULTS Thirty-five eligible articles were found and they were grouped thematically into three categories: (1) Systemic factors; (2) Referrer factors; (3) Patient factors. Systemic factors that improves referrals include a dedicated CLP service, active CLP consultant and collaborative screening of patients. Referrer factors that increases referrals include doctors of internal medicine specialty and comfortable with CLP. Patients more likely to be referred tend to be young, has psychiatric history, live in an urban setting or has functional psychosis. CONCLUSION This is the first systematic review that examines factors that influence CLP inpatient referrals. Although there is research in this area, it is of limited quality. Education could be provided to hospital doctors to better recognise mental illness. Collaborative screening of vulnerable groups could prevent inpatients from missing out on psychiatric care. CLP clinicians should use the knowledge gained in this review to provide quality engagement with referrers.
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Affiliation(s)
- Kai Yang Chen
- James Cook University, 1 James Cook Drive, Townsville, QLD 4811, Australia. .,Townsville Hospital and Health Service, 100 Angus Smith Drive, Townsville, QLD 4814, Australia.
| | - Rebecca Evans
- James Cook University, 1 James Cook Drive, Townsville, QLD 4811 Australia
| | - Sarah Larkins
- James Cook University, 1 James Cook Drive, Townsville, QLD 4811 Australia
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Abstract
OBJECTIVE To describe the reshaping of the German system of psychiatric services in the wake of the international social psychiatric movement and the beginnings of separate consultation-liaison (C-L) psychiatry and C-L psychosomatics services, to outline the differences and similarities of these two disciplines, and to see whether there are lessons to be learned from this unique development that may be relevant to other countries. METHOD The author draws on material published in German and international publications, and on his experience as co-chair of the Section of Behavioral Medicine and Consultation Liaison Psychiatry of the German Society for Psychiatry, Psychotherapy and Neurology. RESULTS Consultation-liaison psychiatry services are provided in virtually all German general hospitals, mainly by the medical specialty of psychiatry and psychotherapy and to a lesser extent by the specialty of psychosomatics and psychotherapeutic medicine, exclusively so in 5%. The latter specialty includes non-psychiatric physicians. The unique history of combined neurology and psychiatry training until 1992, and of mandated psychotherapy training in both specialties shapes the service provided but also sets up tensions. CONCLUSIONS Lack of empirical evidence prevents objective assessment of the advantages and/or shortcomings of this two-stranded system, but its existence may sharpen the ongoing debate about how C-L services should be structured in other countries.
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Affiliation(s)
- Albert Diefenbacher
- Department of Psychiatry and Psychotherapy, Ev. Krankenhaus Königin Elisabeth Herzberge (University affiliated hospital of the Charité at Berlin), Herzbergstr. 79, D-10362 Berlin, Germany.
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Chiu NM, Strain JJ, Sun TF, Strain JJ, Lee Y, Chong MY, Wen JK. Development of a Taiwanese computerized database for psychiatric consultation in a general hospital. Gen Hosp Psychiatry 2005; 27:292-7. [PMID: 16050065 DOI: 10.1016/j.genhosppsych.2005.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the applicability of a modified questionnaire in psychiatric consultation and a new computerized software at one general hospital in Taiwan. METHOD The Micro-Cares Clinical Information System for Consultation/Liaison Psychiatry (CISCL), an English language-based patient management application, has multiple clinical variables that were translated into Mandarin Chinese. The Mandarin Chinese version of the Micro-Cares Questionnaire (MCMQ) was further modified after extensive testing and clinical use by two staff psychiatrists and eight senior resident doctors. In addition, the structure of the Mandarin Chinese version of the Micro-Cares CISCL Program (MCMP) was created for direct information entry through a specialized Microsoft Access-based support module. RESULTS The MCMQ has been adapted to regular medical practice. Up to 66% of the consultation cases (618/913 patients) were recorded in 2003. Among those registered, 519 (84%) received psychiatric diagnoses. Eight of the 10 participants evaluated agreed that the MCMQ was clinically applicable. CONCLUSION MCMQ and MCMP have been routinely applied in the clinical, administrative, research and educational services of our psychiatric consultation.
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Affiliation(s)
- Nien-Mu Chiu
- Department of Psychiatry, Chang Gang Memorial Hospital, Kaohsiung, Niao-Sung Hsiang, kaohsiung County 833, Taiwan
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Schneider G, Wachter M, Driesch G, Kruse A, Nehen HG, Heuft G. Subjective body complaints as an indicator of somatization in elderly patients. PSYCHOSOMATICS 2003; 44:91-9. [PMID: 12618530 DOI: 10.1176/appi.psy.44.2.91] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The authors examined the correlation of subjective body complaints (measured by the Giessen Subjective Complaints List) with sociodemographic data, objective health measures, measures of subjective well-being, and clinicians' ratings of somatization and psychological impairment in 251 cognitively unimpaired general hospital inpatients aged >/=60 years. The level of subjective body complaints correlated most highly with self-assessed life satisfaction and age-related changes and with the clinicians' rating of somatization. The results suggest that the level of subjective body complaints is determined by subjective well-being rather than by objective health measures, and thus subjective body complaints may be an indicator of somatization in elderly inpatients.
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Affiliation(s)
- Gudrun Schneider
- Department of Psychosomatics and Psychotherapy, University Hospital Münster, Germany.
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