Crossing the bridge – A prospective comparative study of the effect of communication between a hospital based consultation-liaison service and primary care on general practitioners' concordance with consultation-liaison psychiatrists' recommendations

Abstract

ObjectiveConcordance with consultation-liaison (CL) psychiatrists' recommendations by general practitioners (GP) has hardly been studied systematically. We studied if telephone calls or written notes from a hospital based CL-service to GPs, whose patients were treated on medical-surgical wards, can improve GP-concordance, as compared to the usual communication pathway by standard discharge letters written by hospital physicians, and if higher GP-concordance improves outcomes of depressive and anxious symptoms. Methods116 inpatients of a general hospital referred to a CL-service with depression and anxiety were allocated to three groups of communication pathways between CL-service and GPs: (1) A telephone call (TC) by CL-psychiatrists with GPs, (2) a copy of the psychiatric consultation report (CR) was handed out to patients, (3) GPs received standard discharge letters of the hospital physicians (communication as usual, CAU). Six weeks after the CL-episode, patients were phoned at home and asked about implementation of recommendations by their GP's. The Hospital Anxiety and Depression Scale (HADS) was used to monitor anxious and depressive symptoms. ResultsGP-concordance was highest in the TC group, followed by the CR group with significant improvements in medication and psychotherapeutic recommendations compared to CAU. Higher concordance was associated with a significant greater decrease in HADS depression scores but not anxiety scores after 6weeks. ConclusionTelephone communication between CL-psychiatrists and GPs improve GPs' concordance with psychiatric recommendations. This easy-to-implement intervention takes about 10min time but prevents loss of information. It may enhance quality of GPs' mental health care and lead to improved outcomes.