von Gunten A, Villoz F
Policlinique Universitaire de Psychogériatrie et consultation de la Mémoire, Lausanne.
Rev Med Suisse Romande. 1998 Jun;118(6):569-75.
The effectiveness of CLP (Consultation and liaison psychiatry) interventions in a general hospital is difficult to evaluate; parameters potentially determinant as to effectiveness are numerous. Effectiveness evaluations are almost exclusively restricted to the duration of hospitalization. Since CLP may and often should be manifest beyond discharge, we intended to determine the agreement between our proposition and its execution as a measure of effectiveness.
We based our analyses principally on the general practitioner's appreciation of the CLP impact, a measure of effectiveness at distance from the consultation by a judge not directly involved in the consulting process. This qualitative assessment is based on a population of 50 patients.
Our results suggest that agreement between our proposal and its complete execution is good concerning medication (90%) and referral rate after the hospitalization (85%), average as to liaison suggestions (65%) and clearly weak as to propositions regarding further investigations (< 30%).
CLP proposals must be as close as possible to the in-patient physician's preoccupations to enhance the probability that they be executed. The concordance as to the proposal and its execution as well as the CLP impact estimation need be evaluated at distance. This evaluation must imply the general practitioner's assessment.
综合医院中联络会诊精神病学(CLP)干预措施的有效性难以评估;可能决定有效性的参数众多。有效性评估几乎完全局限于住院时间。由于CLP可能而且通常应该在出院后显现效果,我们旨在确定我们的提议与其实施之间的一致性,以此作为有效性的一种衡量标准。
我们的分析主要基于全科医生对CLP影响的评估,这是一种由未直接参与会诊过程的评判者在远离会诊的情况下对有效性的衡量。这种定性评估基于50名患者。
我们的结果表明,在用药方面(90%)以及住院后的转诊率方面(85%),我们的提议与其完全实施之间的一致性良好,联络建议方面平均为(65%),而关于进一步检查的提议方面则明显较弱(<30%)。
CLP提议必须尽可能贴近住院医师所关注的问题,以提高其被执行的可能性。提议与其实施之间的一致性以及CLP影响评估需要在远离实际情况的条件下进行。这种评估必须包含全科医生的评估。