A Follow-Up Study of Psychiatric Consultations in the General Hospital: What Happens to Patients after Discharge?

Abstract

Background: An appropriate follow-up is considered essential in the consultation-liaison psychiatry setting, but it is often neglected. This study evaluated the effectiveness of the psychiatric consultation process in the general hospital, by investigating what occurred to patients 3–5 months after discharge. Methods: We used a three-part questionnaire: (1) the results of the consultation process; (2) a telephone interview with patients, and (3) a telephone interview with the patients’ primary care physician, to whom the patients were referred after discharge from hospital. We contacted all consecutive, unselected patients referred to psychiatric consultation from January to July 1999. Complete data were available for 119 patients from an initial group of 318. Results: The consultation process was well accepted by patients and useful to general hospital physicians to complete the final diagnosis of the patient when discharged from hospital. In most cases (78.9%), the psychiatric letter was attached to the discharge letter. The second part of the questionnaire indicated that most patients were satisfied with the consultation process. They thought it helped focus their problems and 60% asserted that they felt better after following their psychiatrists’ instructions or therapy. The primary care physicians agreed with the diagnostic results of the psychiatric consultation, mainly followed the psychiatrists’ advice, and generally expressed positive comments about the consultation-liaison service. Conclusions: Compliance of hospital physicians, patients, and primary care physicians was good. Follow-up studies on outcome of psychiatric consultations are few and further analysis is strongly recommended.

Postdischarge Impact of C-L Psychiatry Treatment in Obstetrical Inpatients

“…We achieved a participation rate of 45% of all former obstetrical inpatients who had received a consultation during the six-month study period. This response rate is comparable with that reported by others [4, 5, 8]. We acknowledge that our findings are likely biased by the fact that our participants are relatively high functioning, the majority having a university or college qualification.…”

“…For example, an investigation by Rigatelli et al [5] explores the effectiveness of a general hospital's C-L service; telephone interviews with 95 former inpatients and their primary care physicians 3–5 months after discharge indicated that 66% of patients reported high satisfaction with the psychiatric consultation, 22% were indifferent, and 11% expressed negative feelings. As for postdischarge compliance to treatment suggestions, the most common of which was psychopharmacology alone (68%), more than half of patients reported having filled their prescriptions and taken their medication, and half of these noted a positive outcome, a finding generally confirmed by their primary care physicians.…”

Course and outcome of first-admitted patients with acute and transient psychotic disorders (ICD-10:F23)

“…Telephone interviews have been used in several follow-up studies (Carpenter and Strauss 1991;Rigatelli et al 2001;Simon et al 2001). In the present study this interview included questions concerning relapses, rehospitalizations (psychiatric hospitals), social impairment and global functioning.…”

“…First, one can criticize the method of telephone interviews. However, this is a common method in psychiatric research (Carpenter and Strauss 1991;Rigatelli et al 2001;Simon et al 2001). Carpenter and Strauss (1991) examined the comparability of in-person and telephone interview methods: although the telephone interview group had a slightly better outcome than the in-person interview group, both methods were considered quite comparable.…”

Medical Inpatients' Adherence to Outpatient Psychiatric Aftercare: A Prospective Study of Patients Evaluated by an Inpatient Consultation Liaison Psychiatry Service

“…Burstein found that 51% of a group of medical patients from two community hospitals kept their initial psychiatric aftercare appointment; however, these patients were pre-screened for motivation and financial ability prior to referral [6]. More recent European studies report that between 20% and 67.5% of patients seen by a consultation psychiatry service are adherent with psychiatric medications post-discharge [7, 8]. Overall, the differences between European and American systems of care and the age of the American studies render previous research of questionable current relevance.…”