使用通用工具对市中心、地区或区域综合医院的会诊联络精神病学服务进行比较：一种模式是否适用于所有情况？

Comparison of consultation-liaison psychiatry services for inner-city, district or regional general hospitals using a common tool: Does one size fit all?

作者信息

Wand Anne P F, Wood Rebecca, Macfarlane Matthew D, Hunt Glenn E

机构信息

South Eastern Sydney Local Health District, NSW, Australia; Faculty of Medicine, University of New South Wales, NSW, Australia.

Sydney Local Health District, NSW, Australia; Discipline of Psychiatry, Sydney Medical School, University of Sydney, NSW, Australia.

出版信息

J Psychosom Res. 2016 May;84:13-21. doi: 10.1016/j.jpsychores.2016.03.007. Epub 2016 Mar 19.

DOI:10.1016/j.jpsychores.2016.03.007

PMID:27095154

Abstract

OBJECTIVE

Consultation-liaison psychiatry (CLP) services vary in terms of structure, function and responsiveness. It is not known whether evaluation measurements can be meaningfully compared across different CLP services to assess value and efficiency. The aim was to develop and test a common tool for measuring process and outcome measures in CLP.

METHODS

A data collection tool was developed using the literature and consultation with CLP clinicians. The tool was used to prospectively gather referral data, response times, health utilisation data and functional outcomes for individuals referred over seven months to three different CLP teams, servicing inner city, district and regional areas.

RESULTS

The structure, staffing, liaison attachments and scope of practice varied between the services. The regional CLP service attended seven hospitals and had the highest referral rate and largest inpatient population pool. The three services received referrals for similar reasons and made similar diagnoses. Multimodal management was the norm, and CLP facilitated follow-up arrangements upon discharge. Only the district CLP service saw all emergency referrals within an hour. Age and need for an interpreter did not affect response times.

CONCLUSION

Despite local differences in geography, CLP roles, hospital and community mental health service pathways and patient populations, the CLP data collection tool was applicable across sites. Staff resourcing and referral demand are key determinants of CLP response times.

摘要

目的

会诊联络精神病学（CLP）服务在结构、功能和响应性方面存在差异。尚不清楚评估指标能否在不同的CLP服务之间进行有意义的比较，以评估其价值和效率。本研究旨在开发并测试一种用于测量CLP过程和结果指标的通用工具。

方法

利用文献资料并与CLP临床医生进行磋商，开发了一种数据收集工具。该工具用于前瞻性收集七个月内转介到三个不同CLP团队的个体的转介数据、响应时间、医疗利用数据和功能结局，这三个团队分别服务于市中心、城区和地区区域。

结果

各服务之间在结构、人员配备、联络附属机构和业务范围方面存在差异。区域CLP服务覆盖七家医院，转诊率最高，住院患者人数最多。三个服务团队收到转诊的原因相似，做出的诊断也相似。多模式管理是常态，CLP促进出院后的随访安排。只有城区CLP服务能在一小时内处理所有紧急转诊。年龄和是否需要口译员并不影响响应时间。