Leentjens A F G, van der Feltz-Cornelis C M, Boenink A D, van Everdingen J J E
Academisch Ziekenhuis Maastricht, afd. Psychiatrie, Postbus 5800, 6202 AZ Maastricht.
Ned Tijdschr Geneeskd. 2008 Aug 30;152(35):1914-7.
Psychiatric consultation in primary care as well as in the hospital is both effective and cost-effective if certain procedures are followed. With the professional guideline 'Consultation psychiatry', the Dutch Psychiatric Association aims at setting a standard for psychiatric consultations in non-psychiatric settings. In general practice, the psychiatric consultation is preferably embedded in 'collaborative care', an integrated care model including the general practitioner and a case manager (usually a nurse), with the consultant psychiatrist being regularly available for clearly defined indications. The psychiatrist should see the patient himself or herself, establish a diagnosis and treatment plan, and provide the general practitioner and the patient with a so-called 'consultation letter', which is then discussed with both. In a general hospital, systematic screening of patients at risk of psychiatric comorbidity can be organised. Early detection of complex patients can further improve the effectiveness of psychiatric consultation. Follow-up contacts and investing in liaison contacts improve adherence to the advice provided.
如果遵循某些程序,在初级保健机构以及医院进行精神科会诊既有效又具有成本效益。荷兰精神科协会以专业指南《会诊精神病学》为目标,旨在为非精神科环境中的精神科会诊设定标准。在全科医疗中,精神科会诊最好融入“协作式护理”,这是一种包括全科医生和个案管理员(通常是护士)的综合护理模式,会诊精神科医生应定期为明确的适应症提供服务。精神科医生应亲自查看患者,做出诊断并制定治疗计划,并向全科医生和患者提供一份所谓的“会诊信”,然后与双方进行讨论。在综合医院,可以组织对有精神科合并症风险的患者进行系统筛查。早期发现复杂患者可以进一步提高精神科会诊的有效性。后续随访以及投入联络工作可以提高对所提供建议的依从性。