Psychological Medicine Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK.
Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK.
Gen Hosp Psychiatry. 2021 Jul-Aug;71:11-19. doi: 10.1016/j.genhosppsych.2021.04.003. Epub 2021 Apr 19.
To systematically review randomized trials of the effectiveness of inpatient Consultation-Liaison (C-L) Psychiatry service models in improving patient outcomes, reducing length of hospital stay and decreasing healthcare costs.
We searched databases including Ovid Medline, Ovid Embase, Ovid PsycINFO and EBSCO CINAHL for relevant trials. Two independent reviewers assessed articles and extracted data. The review is registered with PROSPERO, number CRD42019120827.
Eight trials were eligible for inclusion. All had methodological limitations and all were published more than ten years ago. None reported clear evidence that the C-L Psychiatry service model evaluated was more effective than usual medical care alone. All the service models tested focused on providing a consultation for patients identified by screening. Clinical heterogeneity precluded meta-analysis.
Whilst we found no evidence that any of the inpatient C-L Psychiatry service models evaluated is effective, the sparseness of the literature and its methodological limitations preclude strong conclusions. The trials do, however, suggest that purely consultation-based service models may not be effective. A new generation of robust clinical trials of a wider range of C-L Psychiatry service models is now required to inform future service developments.
系统评价住院联络精神病学服务模式在改善患者预后、缩短住院时间和降低医疗成本方面的有效性的随机试验。
我们检索了包括 Ovid Medline、Ovid Embase、Ovid PsycINFO 和 EBSCO CINAHL 在内的数据库，以寻找相关试验。两名独立的评审员评估了文章并提取了数据。本综述已在 PROSPERO 注册，编号为 CRD42019120827。
八项试验符合纳入标准。所有试验均存在方法学局限性，且均发表于十年前。没有试验报告明确证据表明所评估的联络精神病学服务模式比单纯常规医疗更有效。所有测试的服务模式都专注于为通过筛查确定的患者提供咨询。临床异质性排除了荟萃分析。
尽管我们没有发现任何所评估的住院联络精神病学服务模式有效的证据，但文献的稀缺性及其方法学局限性限制了我们的结论。然而，这些试验表明，单纯基于咨询的服务模式可能无效。现在需要开展新一代更广泛的联络精神病学服务模式的稳健临床试验，以为未来的服务发展提供信息。
