challenge of integration care of clp (acpm 2014)
TRANSCRIPT
Challenge of Consultation and Liaison Psychiatric Service in General Hospital in Indonesia
Division of Psychiatry, Faculty of Medicine Krida Wacana Christian University,
JAKARTA,INDONESIA
Background
• The prevalence of psychiatric disorders in general medical inpatient settings has been estimated to be between 20% and 40%
• Up to 60% of hospitalized patients aged 65 years and older diagnosed with dementia, delirium, or depression.
• Unfortunately, studies show that psychiatric disorders are often unrecognized by non–mental health physicians.
Hussain M, Seitz D. Integrated Models of Care for Medical Inpatients With Psychiatric Disorders: A Systematic Review . Psychosomatics 2014;55:315–325
International of Medicine Report 2001
• Poor coordination of care
• Fragmentation of responsibilities
• Poor communication of care among providers
• Poor communication of care between providers and patients
Committee on Quality of Healthcare in America, 2001; Relman A, NEJM 2001
Problems Resulting from Poor Integration of Care
• Poor integration of medical care leads to excess mortality and increased costs of medical care
Need for integration of Care
• Integrated care is needed at all levels of health care to avoid fragmentation and waste
• At the clinical level, integrated care with better communication among care givers and patients is needed to improve clinical outcomes, prevent medical errors, and reduce costs.
Kathol R, et al. 2006, Epidemiologic Trends and Costs of Fragmentation: Med Clin of N. Amer
Generic Model of Integrated Care
• Pro-active early identification of disorders
• Interdisciplinary communication
• Needs assessment
• Evidence based treatment plan
• Communication between team and patient
• Interdisciplinary collaborative care
• Continuity of care between different settings
Huyse FJ &Stiefel FC, Preface, Med Clin N Am 90, 2006
Survey Overview
• Based internet survey provided by www.surveymonkey.net , respondents were health care provider in general hospital (type A,B,C,D)
• 75 respondents, voluntary participation• Survey was opened for public on Feb 1st 2013
until July 17th 2013. Facebook was the“respondents collector”.
• We did not process this survey using sophisticated statistic tools. All data were direct description from the survey we conducted
Respondents Characteristics
61
15.3
12.5
6.9
2.8
1.4
0 10 20 30 40 50 60 70
Dr Spec
Dr Internship
NS
GP
Number of Beds in Hospital
0 5 10 15 20 25 30 35
< 50
50-100
100-300
300-500
> 500
50 – 100 beds
> 500 beds
< 50 beds
300 – 500 beds
100 – 300 beds
Was there any psychiatrist in the hospital ?
• 38 respondents (52.8%) : Yes
• 22 respondents (30.6%) : None
• 12 respondents : Visiting psychiatrist
52 respondents (72.2%) said that psychiatric problem in medical patients were often seen in medical setting
How often (in a month) ?
• 40 respondents (55.6%) : 1 – 5 cases
• 19 respondents (26.4%) : 6 – 10 cases
• 4 respondents (5.6%) : 11-20 cases
• 1 respondents : 21 – 30 cases
• 5 respondents (6.9%) : > 30 cases
• 3 respondents : none
Acute psychotic , 9.7
Delirium , 4.2
Depression , 34.7
Anxiety Disorder, 27.8
Insomnia, 11.1
tDemensia, 1.4
Substance disorder 4.2
0
5
10
15
20
25
30
35
40
Pe
rse
n (
%)
Prevalence of Psychiatric Disorder in Medical Patient According to Health Care Providerin General Hospital
Who is the physician in charge?
• 33 respondents (45.8%) said : Psychiatrist
• However, GPs took care of 25% psychiatric cases in their health institution
• 98.6% respondents said the need of CLP team in general hospital but 75% respondents said that there were not such team in their hospital
Future direction
• There is preliminary evidence that integrated medical service may improve a number of outcomes for medical inpatients with psy-chiatric disorders
Hussain M, Seitz D. Integrated Models of Care for Medical Inpatients With Psychiatric Disorders: A Systematic Review . Psychosomatics 2014;55:315–325
