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The purpose of this paper is to review the findings from an audit of the implementation of a consultation-liaison psychiatry (CLiP) database in all inpatients referred to a CLiP service at the largest hospital in Malaysia with the aim of improving the quality CLiP services.

All inpatient referrals to the CLiP team were recorded over a three-month period and compared to previous audit data from 2017. Four audit standards were assessed: the reporting of referrals, timeliness of response indication of reason for referral and presence of a management plan.

The compliance of reporting using the CLiP form was 70.1 per cent compared to 28 per cent in the audit data from 2017 after interventions were conducted. Analysis of the completed CLiP form reveals that 89 per cent of referrals were seen within the same working day. All referrals included the reason for referral. The most common reason for referral was for depressive disorders, but post-assessment, delirium was the most common diagnosis. In total, 87.8 per cent satisfied the audit criteria for a completed written care plan.

Specialised CLiP services are relatively new in Malaysia and this is the first paper to examine the quality of such services in the country. Interventions were effective in improving the compliance of reporting using the CLiP database. The findings suggest that the CLiP services are on par with international audit standards. Furthermore, data from this clinical audit can serve as a benchmark for the development of national operating policies in similar settings.

Young men of African‐Caribbean origin are over‐represented in mental health services (MHSs), often entering these services by coercive routes, such as under the Mental Health Act or via the criminal justice system. This pilot study focused on patients' narratives of their journey from first contact with primary care services. Our principal aim was to describe and compare early experiences of help‐seeking for serious mental health problems among young men of white and black ethnicity.In‐depth interviews were conducted (using a topic guide) with black and white men aged 18‐30 years old and who were accessing secondary care mental health services for the first time for a psychotic illness. Participants were recruited from the early intervention services serving inner‐city Birmingham. Seven participants were interviewed, and 12 themes were identified from transcripts. Six of these individuals had consulted their GP prior to accessing the early intervention service. Only one attendee received medication at initial consultation, and none were referred to specialist mental health services. Participants described the manner in which family or friends interceded on their behalf to advocate for and secure specialist help ‐ either by accompanying them to see their GP, contacting mental health services directly or taking them to the local accident and emergency department. The latter route was accessed by black but not white participants. Three out of four black participants and one out of three white participants were subsequently admitted to hospital. None of the participants were particularly satisfied with their experience of primary care. Communication was less than ideal, and participants were able to reflect on their own failure to disclose critical information to their doctor. By contrast, all participants confided in family or in their trusted friends that they were becoming aware that they were experiencing mental distress.Our findings confirm the difficulties faced by GPs and those who consult them in the early stages of first onset psychotic episodes, and the importance of having family or friends who are able to advocate on other people's behalf at times of crisis. Despite the advent of universal early intervention services across the UK, those most in need may still not be receiving the help that they need in the timeliest manner.

Considering the great need for palliative care in hospitals, it is essential for hospital staff to have palliative care knowledge. Palliative consultations have been shown to have positive effects on in-hospital care. However, barriers to contact with and uptake of palliative consultation advice are reported, posing a need for further knowledge about the process of palliative consultations. The purpose of this study therefore was to examine how palliative consultations in hospitals are practised, as perceived by consultants and health care professionals on receiving wards.

Focus groups with palliative care consultation services, health care personnel from receiving wards and managers of consultation services. Interpretive description and constant comparative method guided the analysis.

Variations were seen in several aspects of practice, including approach to practice and represented professions. The palliative consultants were perceived to contribute by creating space for palliative care, adding palliative knowledge and approach, enhancing cooperation and creating opportunity to ameliorate transition. Based on a perception of carrying valuable perspectives and knowledge, a number of consultation services utilised proactive practices that took the initiative in relation to the receiving wards.

A lack of policy and divergent views on how to conceptualise palliative care appeared to be associated with variations in consultation practices, tentative approaches and a bottom-up driven development. This study adds knowledge, implying theoretical transferability as to how palliative care consultations can be practised, which is useful when designing and starting new consultation services.

This paper aims to identify more advanced criteria for identifying referral opportunities and improve understanding of when to refer through developing and defining distinct question categories and related criteria.

Chat transcripts were analyzed and coded using a rubric developed on the basis of published research and original criteria developed for the study. Coding focused on whether a referral was made, if an opportunity was missed (termed “referral gap”), and what factors influenced its presence or absence.

Quantitative and qualitative factors that influence when referrals are successfully made were identified. Questions higher on the reference effort assessment data scale and those relating to subject-based research tended to have a higher referral gap, while the presence of instruction in evaluating resources had a positive impact on referrals being made. Recognizing patron-based factors such as knowledge of library policies also impacted the presence of referrals.

Limitations include the data, which were taken from a single institution and primarily reflect questions occurring in academic libraries.

Suggestions are provided for training and reference management approaches to improve the presence, substance and quality of referrals.

The study introduces a new measure for evaluating referrals, termed the “referral gap.” The methodology also expands on traditional data points used to measure when referrals should occur, which typically focus on patron and staff affiliations.

The purpose of this study is to learn what factors liaison librarians in academic research libraries consider in determining whether to refer chat reference patrons to subject specialists.

Subject specialists were asked what policies guided their decisions to refer to a specialist and then assessed unreferred chat session transcripts both within and outside their specializations to determine need for a referral.

Few respondents were guided by formal policies. Contrary to an initial hypothesis, subject area was not a key factor in referring chat. A broader set of criteria included reference interviewing, provision of relevant resources and information literacy instruction. Respondents valued both the depth that subject specialists can provide to reference interactions and the ability of a skilled generalist to support information literacy.

Findings are most applicable to large, public doctoral universities with liaison librarian programs. Assignment of respondents to subject specialist categories was complicated by their broad range of background and expertise.

The study contributes new understanding of referrals to subject specialists who have potential to guide development of formal referral policies in academic library virtual reference services.

The study is the first empirical examination of chat reference referral decisions.

Visit time is a crucial aspect of patient–physician interaction; its inadequacy can negatively impact the efficiency of treatment and diagnosis. In addition, visit time is a fundamental demand of patients, and it is one of the rights of every patient. The purpose of this paper is to determine factors influencing the consultation length of physicians and to compare consultation length in different countries.

MEDLINE (PubMed), Web of Science, Cochrane, ProQuest, Scopus, and Google Scholar were searched. In addition, references of references were checked, and publication lists of individual scholars in the field were examined. We used data sources up to June 2018, without language restriction. We used a random-effects model for the meta-analyses. Meta-analyses were conducted using Comprehensive Meta-Analysis Version (CMA) 3.0.

Of 16,911 identified studies, 189 studies were assessed of which 125 cases (67 percent) have been conducted in the USA. A total of 189 studies, 164 (86.77 percent) involved face-to face-consultations. The effects of three variables, physician gender, patient gender, and type of consultation were analyzed. According to moderate and strong evidence studies, no significant difference was found in the consultation lengths of female and male doctors (Q=42.72, df=8, I²=81.27, p=0.891) and patients’ gender (Q=55.98, df=11, I²=80.35, p=0.314). In addition, no significant difference was found in the telemedicine or face-to-face visits (Q=41.25, df=5, I²=87.88, p=0.170).

In this systematic review and meta-analysis, all of physicians’ visits in 34 countries were surveyed. The evidence suggests that specified variables do not influence the length of consultations. Good relationship is essential to a safe and high-quality consultation and referral process. A high-quality consultation can improve decisions and quality of visits, treatment effectiveness, efficiency of service, quality of care, patient safety and physician and patient satisfaction.

To improve outcomes for people with co-occurring mental health and substance use disorders, the Eastern Health Mental Health Service implemented an integrated treatment model known as the dual diagnosis clinician shared care model. This study aims to provide evidence for a relatively unexplored model in clinical mental health services within the state of Victoria, Australia.

Dual diagnosis clinicians were placed into community mental health clinics in a shared-care, modified case management role, to provide primary and secondary consultations to select consumers and/or their carers, as well as to provide capacity-building training to the mental health staff facing real world clinical challenges in dual diagnosis service delivery.

Since the commencement of this service, more than 800 consumers of the adult mental health service have been supported to concurrently address their harmful substance use, while receiving recovery-focused community mental health care. Preliminary findings include previously unknown figures on the prevalence for co-occurring substance use at the point of referral and a demonstrated preference by consumers for treatment of both disorders at the same time by the same service (in-house treatment).

The establishment of a dedicated, integrated dual diagnosis team has significantly increased the capacity of a community-based clinical mental health service to engage with and treat consumers with dual diagnosis disorders. This model is beginning to produce evidence challenging traditional siloed approaches to mental health and alcohol and drug treatment.

The medical consultation is one of the requirements in diseases diagnosis and patient treatment. In addition, a high-quality consultation is a fundamental demand of patients, and it is one of the rights of every patient. The purpose of this paper is to identify factors affecting the high-quality consultation in medical communications.

The following electronic databases were searched: MEDLINE (via PubMed), Web of Science, Cochrane, EMBASE, Scopus and ProQuest until December 2018. In addition, the authors searched Google Scholar. Qualitative and quantitative studies were assessed using the Critical Appraisal Skills Programme, Qualitative Checklist and the Center for Evidence-Based Management appraisal checklist, respectively. A stepwise approach was conducted for data synthesis.

Of 3,826 identified studies, 29 met the full inclusion criteria. Overall, after quality assessment of studies, 25 studies were included. The studies were conducted in the USA (n=6), the UK (n=6), the Netherlands (n=4), Canada (n=2), Belgium (n=2), Poland (n=2), Germany (n=1), Iran (n=1), Finland (n=1), Austria (n=1), Qatar (n=1), Denmark (n=1) and China (n=1), and five studies were excluded. Data synthesis showed that high-quality consultation consisted of three main categories: structural (4 main themes with 26 sub-themes), process (2 main themes with 33 sub-themes) and outcome (3 main themes with 12 sub-themes) quality.

Using the indicators of consultation quality improvement can develop physicians’ clinical competence and skills. Decision makers can use them to monitor and evaluate physicians’ performance. A high-quality consultation can be useful in social prescribing that helps patients to manage their disease.

The Mental Health Professionals Network (MHPN) was established to support and enhance collaborative care among health professionals working in primary mental healthcare. The MHPN has two primary arms: face-to-face network meetings and online webinars. The purpose of this paper is to investigate attitudinal and practice changes amongst health professionals after participation in MHPN’s network meetings.

In April 2016, an online survey was e-mailed to health professionals who had attended at least one network meeting during 2015. The survey asked about practice changes across seven key areas relating to increased awareness of and interaction with professionals from other disciplines. Interdisciplinary differences were investigated using the χ² statistic (p<0.05).

A total of 1,375 health professionals participated in the survey. For each of the seven practice changes investigated, between 74 and 92 per cent of respondents had made the change. Those who attended more network meetings were significantly more likely to have made changes. General practitioners were significantly more likely than other professionals to have made changes.

Attendance at MHPN network meetings has a positive impact on health professionals’ attitudes and practices towards a more collaborative approach to mental healthcare.

MHPN is a unique, national platform successfully delivering opportunities for interdisciplinary professional development in the primary mental health sector. The model is unique, cost-effective, practitioner driven and transferable to other settings.

The purpose of this paper is to examine Canadian organizational and systemic factors that made it possible to keep wait times within federally established limits for at least 18 months.

The research design is a multiple cases study. The paper selected three cases: Case 1 – staff were able to maintain compliance with requirements for more than 18 months; Case 2 – staff were able to meet requirements for 18 months, but unable to sustain this level; Case 3 – staff were never able to meet the requirements. For each case the authors interviewed persons involved in the strategies and collected documents. The paper analysed systemic and organizational-level factors; including governance and leadership, culture, resources, methods and tools.

Findings indicate that the hospital that was able to maintain compliance with the wait time requirements had specific characteristics: an exclusive mandate to do only hip and knee replacement surgery; motivated staff who were not distracted by other concerns; and a strong team spirit.

The authors’ research highlights an important gradient between three cases regarding the factors that sustain waiting times. The paper show that the hospital factory model seems attractive in a super-specialized surgery context. However, patients are selected for simple surgeries, without complications, and so this cannot be considered a unique model.