Dataset Information

Evaluating the provision of paediatric liaison psychiatry services in England.

ABSTRACT:

Background

Liaison psychiatry provision for children and young people in England is poorly evaluated.

Aims

We sought to evaluate paediatric liaison psychiatry provision and develop recommendations to improve practice.

Method

The liaison psychiatry surveys of England (LPSE) cross-sectional surveys engage all liaison psychiatry services in England. Services are systematically identified by contacting all acute hospitals with emergency departments in England. Questions are developed in consultation with NHS England and the Royal College of Psychiatrists' Faculty of Liaison Psychiatry, and updated based on feedback. Responses are submitted by email, post or telephone. Questions on paediatric services were included from 2015 (LPSE-2), and we analysed data from this and the subsequent four surveys.

Results

The number of acute hospitals with access to paediatric liaison psychiatry services increased from 29 (15.9%) in 2015 to 46 (26.6%) in 2019, compared with 100% provision for adults. For LPSE-4, only one site met the Core-24 criteria of 11 full-time equivalent mental health practitioners and 1.5 full-time equivalent consultants, and for LPSE-5, just two sites exceeded them. Acute hospitals with access to 24/7 paediatric liaison psychiatry services increased from 12 to 19% between LPSE-4 and LPSE-5. The proportion of paediatric liaison psychiatry services based offsite decreased from 30 to 24%.

Conclusions

There is an unacceptable under-provision of paediatric liaison psychiatry services compared with provision for adults. Number of services, staffing levels and hours of operation have increased, but continued improvement is required, as few services meet the Core-24 criteria.

SUBMITTER: Hines D

PROVIDER: S-EPMC9970163 | biostudies-literature | 2023 Feb

REPOSITORIES: biostudies-literature

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Publications

Evaluating the provision of paediatric liaison psychiatry services in England.

Hines Declan D Ford Tamsin T Westwood Sophie S Barrett Jessica R JR Westphal Birgit B Davies Virginia V Lee William W

BJPsych open 20230201 2

<h4>Background</h4>Liaison psychiatry provision for children and young people in England is poorly evaluated.<h4>Aims</h4>We sought to evaluate paediatric liaison psychiatry provision and develop recommendations to improve practice.<h4>Method</h4>The liaison psychiatry surveys of England (LPSE) cross-sectional surveys engage all liaison psychiatry services in England. Services are systematically identified by contacting all acute hospitals with emergency departments in England. Questions are dev ...[more]

PMID: 36721898

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Project description:ObjectivesTo describe the current provision of hospital-based liaison psychiatry services in England, and to determine different models of liaison service that are currently operating in England.DesignCross-sectional observational study comprising an electronic survey followed by targeted telephone interviews.SettingAll 179 acute hospitals with an emergency department in England.Participants168 hospitals that had a liaison psychiatry service completed an electronic survey. Telephone interviews were conducted for 57 hospitals that reported specialist liaison services additional to provision for acute care.MeasuresData included the location, service structures and staffing, working practices, relations with other mental health service providers, policies such as response times and funding. Model 2-based clustering was used to characterise the services. Telephone interviews identified the range of additional liaison psychiatry services provided.ResultsMost hospitals (141, 79%) reported a 7-day service responding to acute referrals from the emergency department and wards. However, under half of hospitals had 24 hours access to the service (78, 44%). One-third of hospitals (57, 32%) provided non-acute liaison work including outpatient clinics and links to specialist hospital services. 156 hospitals (87%) had a multidisciplinary service including a psychiatrist and mental health nurses. We derived a four-cluster model of liaison psychiatry using variables resulting from the electronic survey; the salient features of clusters were staffing numbers, especially nursing; provision of rapid response 24 hours 7-day acute services; offering outpatient and other non-acute work, and containing age-specific teams for older adults.ConclusionsThis is the most comprehensive study to date of liaison psychiatry in England and demonstrates the wide availability of such services nationally. Although all services provide an acute assessment function, there is no uniformity about hours of coverage or expectation of response times. Most services were better characterised by the model we developed than by current classification systems for liaison psychiatry.

Project description:BackgroundConsultation-liaison psychiatry (CLP)-professional psychiatric care provided to coordinate with surgical or medical treatment of inpatients with psychiatric disorders-was included in universal health coverage in Japan in 2012. Despite evidence of benefits of CLP, basic data and geographic distribution information regarding CLP at the national level remain unclear. This study aimed to 1) identify the geographic disparity of CLP in Japan and 2) investigate the association between number of consultations per CLP patient and region.MethodsWe retrospectively analyzed anonymized data retrieved from the Japanese administrative inpatient database regarding inpatients who were provided CLP between April 2012 and March 2017. Demographic characteristics were summarized and geographic disparity by prefecture was visualized for fiscal years 2012 and 2016; we also summarized the data according to region. Multivariate linear regression analysis was used to investigate association between the number of consultations per CLP patient and region after adjusting for covariates.ResultsData from a total of 46,171 patients who received 138,866 CLP services were included. Results revealed more patients aged 75-84 years received CLPs than any other age group (29.7%) and the overall male/female ratio was 53:47 in 2016. In 2012 and 2016, 24.2 and 30.7% of CLP patients, respectively, were transferred to other hospitals; 9.7 and 8.8%, respectively, discharged due to the death. CLP services were provided in 14 prefectures in 2012 and 33 by 2016; 14 prefectures had no available CLP services. After adjusting for covariates, Tohoku (β = - 0.220, p < 0.034), Chugoku (β = - 0.160, p < 0.026), and Shikoku (β = - 0.555, p < 0.001) had a significant negative correlation with the number of consultations per CLP patient compared with Hokkaido region (an adjusted R square (R2) = 0.274).ConclusionsOur study clarified the characteristics of patients in Japan who received CLPs and the geographic disparity in CLP services. Although 5 years had passed since CLP was introduced, the results imply wide availability of CLP nationally. The analysis data provided may inform future policies to improve CLP services.

Project description:BackgroundThe COVID-19 pandemic created pressure to implement telepsychiatry across practice models.ObjectiveWe sought to evaluate the overall success of this change and to identify what types of practice settings, provider groups, and patient groups were best served by telepsychiatry and telepsychotherapy utilization. We were particularly interested in how providers of consultation-liaison psychiatry adapted to remote care.MethodsAn anonymous provider survey querying demographics, education, training, technological experience, practice setting, treatment modalities, patient groups, transition process, and outcomes was made openly available via social media and professional listservs. We used multivariable regression modeling to evaluate for predictors of the positive outcomes of overall satisfaction, subjective ability to diagnose and treat patients adequately using exclusively telepsychiatric platforms, and patient satisfaction by proxy.ResultsThree hundred thirty-three respondents, mostly young (59.4% younger than 50 years), female (69.7%), and physicians (67.9%), completed the survey. One hundred ninety-seven (59.1%) worked in consultation-liaison psychiatry. Of the total, 85.9% gave affirmative answers to overall satisfaction. Multivariable linear regression models found that satisfaction was predicted by general comfort with technology (P < 0.001), but negatively correlated with having technical issues (P < 0.001), a priori skepticism (P < 0.001), clinician being male (P = 0.004), and treating LGBTQ+ patients (P = 0.022). Completeness was associated with having training in telehealth (P = 0.039) and general comfort with technology (P < 0.001) but negatively associated with treating LGBTQ+ patients (P = 0.024) or inpatients (P = 0.002). Patient satisfaction by proxy was positively associated with general comfort with technology (P < 0.001) and the respondent being a nonphysician (P = 0.004) and negatively associated with encountering a technical issue (P = 0.013) or treating inpatients (P = 0.045). Consultation-liaison psychiatrists had similar results overall and were more likely to have other staff assist in making televisits effective (mean [standard deviation]: -1.25 [3.57] versus -2.76 [3.27], P < 0.001) especially if consultative (mean [standard deviation]: -0.87 [3.67] versus -2.39 [3.01], P = 0.010).ConclusionsThis study suggests high rates of overall satisfaction in telepsychiatry adoption, even in consultation-liaison psychiatry. There is distinct benefit in bolstering training, providing technical support, and addressing skepticism. Future research should include patient surveys and control groups and should focus on vulnerable populations such as sexual and gender minorities.

Dataset Information

Evaluating the provision of paediatric liaison psychiatry services in England.

Background

Aims

Method

Results

Conclusions

Publications

Evaluating the provision of paediatric liaison psychiatry services in England.

Similar Datasets

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