Are Psychiatric Consultants' Recommendations Followed?

Abstract

The extent of adherence to psychiatric consultants' recommendations was calculated through a review of charts. All charts of patients seen in Psychiatric consultation from May 1976 to April 1977 were reviewed and a total of 273 charts contained scoreable consultant recommendations. Recommendations were scored as either actively followed, passively followed or not followed. Results are reported for the extent of adherence 1) between different types of recommendations (medications, disposition, etc.), 2) between medical, surgical and obstetrical-gynecological services and 3) between consultants, two psychiatrists and one psychologist. The results suggest that recommendations more likely to be followed are those easily performed by a consultee and leading to direct, tangible results. Adherence to consultants' recommendations is discussed in the context of resistance to psychiatric consultation.

Concordance with Recommendations in a Consultation-Liaison Psychiatry Service

“…The result in this study is considerably better and it is an equivalent sample. It is closer to that of 77.7% found by Billowitz and Friedson [39] and approaches the figure reported by Van Dyke at al [6] of 90%. However, those studies did not have operational criteria for concordance.…”

Psychiatric consultation for post‐liver‐transplantation patients

“…The psychiatric C–L service could provide special knowledge about central nervous system complications after transplant and drug interactions between immunosuppressant and psychotropic medication 8,9 . But are recommendations from psychiatric consultation followed? 10,11 It has been reported that the surgeon has the highest concordance rate (62.3%) with the recommended psychotropic medications among all consultees in Taiwan 12 . The patients with post‐transplant psychiatric consultation are different in some aspects from other medical–surgical consultation inpatients 13 .…”

Can we increase adherence to treatment recommendations of the consultation psychiatrist working in a general hospital? A systematic review

“…One study (n=394) reported better adherence by surgeons when compared to internists [4]; two other studies (combined n=1345) reported less adherence by surgeons and gynecologists when compared to internists [6,7]. A fourth study (n=90) reported no difference between the requesting physicians' discipline, with the exception of less adherence by surgeons [11].…”

“…All 18 included studies were retrospective cohort studies carried out in order to provide a naturalistic description of clinical practice [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. All these studies can be classified as type C studies according to the grades of recommendation as formulated by the Oxford Centre for Evidence-Based Medicine.…”

“…The nature of advice given As stated above, medication advice is better followed than diagnostic advice or advice about communication strategies and attitudes advice [4,6,7,9,14,18]. The nature of the medication and the type of medication-related advice do not seem to matter [5,11,16], although one study reported better adherence when changing the dose or discontinuation is advised when compared to starting new medication [3].…”