The rising demand for consultation‐liaison psychiatry for older people: comparisons within Liverpool and the literature across time

Anderson, D. N.; Nortcliffe, Margaret; Dechenne, Sophie; Wilson, Kenneth

doi:10.1002/gps.2667

Cited by 19 publications

(13 citation statements)

References 22 publications

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“…This implied that other patient groups such as geriatric population or patients with delirium or dementia may be neglected. Although there is an increasing demand for CLP services by the geriatric population in recent years [76, 77], these patients are at risk of missing on psychiatric care.…”

Section: Discussionmentioning

confidence: 99%

Why are hospital doctors not referring to Consultation-Liaison Psychiatry? – a systemic review

2016

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BackgroundConsultation-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.MethodsWe 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.ResultsThirty-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.ConclusionThis 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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Section: Discussionmentioning

confidence: 99%

Why are hospital doctors not referring to Consultation-Liaison Psychiatry? – a systemic review

2016

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“…Models based on more integrated multidisciplinary working include the shared care ward, in which patients with complicated physical and mental health needs are managed by both relevant teams. There are increasing rates of referral of older people to consultation-liaison psychiatry services, which is an effect likely to be experienced in all nations with an aging population 41. Old age liaison remains in its relative infancy, and there is a lack of qualitative and quantitative studies worldwide in this area of service.…”

Section: Discussionmentioning

confidence: 99%

The Rapid Assessment Interface and Discharge service and its implications for patients with dementia

Singh

Ramakrishna²,

Williamson³

2013

CIA

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The rising prevalence of dementia will have an effect on acute care hospitals around the world. At present, around 40% of patients older than 70 years with acute medical admissions have dementia, but only half of these patients have been diagnosed. Patients with dementia have poorer health outcomes, longer hospital stays, and higher rates of readmissions and institutionalization. Worldwide, health care budgets are severely constrained. National Institute for Health and Care Excellence (NICE) has listed ten quality standards for supporting people in living well with dementia. NICE resource implications and commissioning support to implement these guidelines and improve dementia services have been recently published. Although most of the frail elderly patients with dementia are cared for by geriatricians, obstacles to making a diagnosis and to the management of dementia have been recognized. To provide a timely diagnosis of dementia, better care in acute hospital settings, and continuity of care in the community, services integrating all these elements are warranted. Extra resources also will be required for intermediate, palliative care, and mental health liaison services for people with dementia. The Birmingham Rapid Assessment Interface and Discharge service model uses a multiskilled team that provides comprehensive assessment of a person’s physical and psychological well-being in a general hospital setting. It has been shown to be an effective model in terms of reducing both length of stay and avoiding readmission. The aim of this review is to discuss the implications of the Rapid Assessment Interface and Discharge model in people with dementia and to critically compare this model with similar published service provisions.

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“…Validity of this increase can be found in the National Audit of Dementia when 88% of general hospitals in England reported access to a liaison psychiatry service that can assess older people and 81% of those provided by a dedicated team. 27 This is an area of rising demand 28 that has received a particular focus by old age psychiatrists, 29,30 subsequently translated into national guidance. [31][32][33] The economic and clinical benefits of liaison services is now being realised, with 90% of substantial cost savings arising from the care of older people.…”

Section: Discussionmentioning

confidence: 99%

Mental health service discrimination against older people

et al. 2013

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Aims and methodTo provide a picture of availability and equality of access to mental health services for older people prior to the Equality Act. In 2010, a questionnaire was sent to health commissioners in England, Scotland and Wales under a Freedom of Information request.ResultsOverall, 132 (76%) replied. Of 11 services, 7 were either unavailable or did not provide equality of access to older people in more than a third of commissioning areas. When provided by specialist older people's mental health, services were more often considered to ensure equality.Clinical implicationsIncreasing need resulting from an ageing population is unlikely to be met in the face of current inequality. Inequality on the basis of age is the result of government policy and not the existence of specialist services for older people. Single age-inclusive services may create indirect age discrimination. Availability alone is insufficient to demonstrate equality of access. Monitoring the effects of legislation must take this into account.

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The rising demand for consultation‐liaison psychiatry for older people: comparisons within Liverpool and the literature across time

Cited by 19 publications

References 22 publications

Why are hospital doctors not referring to Consultation-Liaison Psychiatry? – a systemic review

Why are hospital doctors not referring to Consultation-Liaison Psychiatry? – a systemic review

The Rapid Assessment Interface and Discharge service and its implications for patients with dementia

Mental health service discrimination against older people

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