Table 4 Summary of articles included, details of the included articles including country, participants, study design and findings
From: Why are hospital doctors not referring to Consultation-Liaison Psychiatry? – a systemic review
Author/s, Date (In order of appearance) | Country, Setting | Participants (type and number) | Study design | Findings |
|---|---|---|---|---|
Brown & Cooper 1987 [30] | UK, general hospital | 1,140 inpatient referrals | Retrospective review of referrals in 1973, 1976, 1979 | Dedicated CLP service increases referrals. |
McCartney et al. 1989 [31] | US, university hospital | 11,713 gynaecologic oncology and other cancer patients | Retrospective review of referrals, before and after introduction of gynaecologic oncology liaison program | Introduction of CLP program increases referrals |
Thompson et al. 1990 [32] | US, Colorado | 200 non-psychiatrist doctors (35 % response rate) | 16 item survey | Most common reasons for not referring: Other mental health practitioners do just as well, lack of communication by psychiatrist, stigma, accessibility |
Mezey & Kellett 1971 [33] | UK, London | 106 consultants from 6 hospitals (83 % response rate) | 10 item survey | Most common reasons for not referring: Patient’s preference, stigma, accessibility, poor rapport with psychiatrist. Surgery, Obstetrics and Gynaecology subspecialty associated with less referrals |
Diefenbacher 2001 [35] | Germany, Berlin, Rudolf Virchow Hospital | 208 inpatient referrals | Observational study of referral patterns over 1 year following introduction of CLP | Increase in referrals from medical and surgical wards. Decrease in urgent referrals, suggesting increased tolerance towards psychiatric conditions. |
Camus et al. 2003 [34] | Switzerland, university hospital | 176 medical inpatients | Prospective cohort study on collaborative CLP screening | Referral rates increase from 4 to 32 %. |
Jo et al. 2011 [36] | Korea, Seoul tertiary general hospitals | 310 patients with suicide attempts | Questionnaire on patients | No significant difference in referral rate between history of suicide attempts and non-suicide attempters. |
Pritchard 1972 [37] | UK, London general hospital | 252 patients | Retrospective chart review of patients with psychiatric diagnosis | Patients with suicidal attempts have highest referral rates. Young age, functional psychosis associated with increased referral. Organic psychosis and previous psychiatric contact associated with decreased referral. |
Caplan et al. 2008 [38] | US | N/A | Opinion piece | Work pressure suggested with increased CLP referrals |
Wood & Bisson 2004 [39] | UK, maxillofacial surgery unit | 58 patients with cancers of head and neck | Subjective reporting of experience with mental health nurse liaison | Increased referrals suggested with use of mental health nurse liaison. |
Cohen-Cole et al. 1982 [40] | US, North Carolina Memorial Hospital | 407 hospital doctors (34 % response rate) | 37 item questionnaire | Physicians in internal medicine and family medicine tend to recognise patients with more psychological issues. Most hospital doctors are comfortable with managing psychiatric illness. |
Lin et al. 2011 [52] | Taiwan, general hospital | 111 obstetric and gynaecologic patients | Retrospective chart review | Low referral rates from obstetric and gynaecologic department. |
Ni Mhaolain et al. 2008 [53] | Ireland, general hospital | 96 surgical patients | Prospective evaluation of anxiety and depression in surgical patients | High prevalence of depression and anxiety in surgical patients. |
Balestrieri et al. 2002 [54] | Italy, general hospital | 1039 general inpatients | Cross sectional investigation of prevalence of depression among hospital patients | Identification of depression by hospital doctors in one third of all cases. |
Fauman 1983 [55] | US, private urban hospital | 265 hospital doctors (41.9 % response rate) | 66 item questionnaire | Internists are more willing to refer suicidal attempts than surgeons. Internists are more willing to ask for consultations than surgeons for all other mental health conditions. |
Hamdieh et al. 2015 [41] | Iran, Tehran, general hospital | 300 non-psychiatric doctors (64.3 % response rate) | 8 item questionnaire | Hospital doctors were more comfortable requesting for psychiatric consultations than managing psychiatric conditions themselves. |
Jourdan & Glickman 1991 [57] | US, general hospital | 380 psychiatric referrals | Retrospective chart review | High referral rates for determination of competency. Fear of medico-legal consequences and referrer’s anxiety suggested as reasons for referral rates. |
Cepoiu et al. 2008 [42] | N/A | 36 articles (comprising of 50935 inpatients) | Meta-analysis of recognition of depression in inpatients by non-psychiatric doctors | Sensitivity was found to be 36.4 % and specificity was 83.7 % |
Clarke et al. 1995 [43] | Australia, Melbourne, Monash Medical Centre | 987 medical and surgical patients | Prospective patient review, comparing diagnosis of depression made by psychiatrists and non-psychiatrists | Diagnostic concordance of depression 74 %, 41 % false positive rate and 15 % false negative rate. |
Dilts et al. 2003 [44] | UK, York Hospital | 346 medical inpatient consultations | Retrospective review comparing initial impression of primary medical providers to final psychiatric diagnosis | Initial diagnosis of cognitive disorders and substance use disorder is likely to be correct. Initial diagnosis of depression is wrong in half the cases. |
Judd et al. 1997 [45] | Australia, Melbourne | 392 HIV/AIDS patients referred for CLP | Retrospective chart review | Diagnostic concordance of depression was 79 %, 20 % false positive rate and 23 % false negative rate |
Ryan et al. 1995 [46] | UK, Castle Hill Hospital | 50 geriatric inpatients | Prospective cohort study examining agreement between psychiatrist and geriatricians on depression and dementia | Some evidence suggesting lower recognition of depression by geriatricians. |
Yamada et al. 2012 [47] | Japan, Tokyo Metropolitan Geriatric Hospital | 172 geriatric inpatients | Prospective diagnostic review of CLP consultations | Almost half of patients with depression diagnosed by referrers were found to be delirium. |
Boland et al. 1996 [48] | US, teaching hospital | 4396 inpatients referred for consultations | Retrospective chart review | 40 % of patients initially identified by referrer to be depressed were found not to be depressed by psychiatry consultants |
Canuto et al. 2015 [49] | Switzerland, University hospital of Geneva | 148 inpatients over age of 60 | Prospective cohort study | 40 % of patients initially referred for depression were diagnosed with depression by CLP. |
Smith et al. 1995 [50] | Australia, Melbourne, Monash Medical Centre | 2347 inpatient referrals | Retrospective chart review | 56 % of patients suspected by psychiatrist for substance use disorder were missed by referrers. |
Su et al. 2011 [51] | Taiwan, region general hospital | 1007 inpatient referrals | Retrospective chart review | Only 41.5 % of initial physician’s impression matches with psychiatrist’s final impression |
De-Nour 1979 [56] | Israel | 77 hospital doctors | Survey | Surgeons prefer consultation service, Physicians prefer liaison service. |
Fenichel & Murphy 1985 [58] | US, Hospital of the University of Pennsylviania emergency department | 12095 patients presenting to emergency department | Retrospective chart review | Patient with psychiatric history were associated with psychiatric referral |
Marcus et al. 1987 [59] | US, 327 general hospitals | 37221 patients with diabetes, 19484 patients with hip fractures, 25116 patients with COPD, 11770 patients with CABG | Retrospective chart review | Age negatively correlated to psychiatric consultation. Patients in urban settings are more likely to receive psychiatric consultation |
Popkin et al. 1984 [60] | US | 111 geriatric inpatients | Retrospective chart review | Compared to younger population, geriatric population was less often referred |
Handrinos et al. 1998 [62] | Australia, Dandenong hospital | 712 inpatient referrals | Retrospective chart review | Personality disorder predicts earlier referral. Depression predicts delayed referral. |
Craig 1982 [63] | US, university hospital (not named) | 362 inpatient referrals | Retrospective chart review | White patients are more likely to be referred. Once referred, there is no difference in care to white or non-white population. |
Collins et al. 1992 [64] | US, San Diego Medical Centre | 476 patients receiving psychiatric consultations compared with 14620 without psychiatric consultations | Retrospective chart review | Low referral rate for Hispanic patients. |
Klein et al. 1996 [65] | US, Montefiore Medical Centre | 48 inpatients | Survey | 81 % agreeable to psychiatric consultation if their primary care doctor felt it was indicted |