Factors influencing the admission decision for Medical Psychiatry Units: A concept mapping approach

English version

Autoři: P. J. Caarls ^aff001; M. A. van Schijndel ^aff001; G. van den Berk ^aff003; A. D. Boenink ^aff004; D. Boerman ^aff002; J. G. Lijmer ^aff003; A. Honig ^aff003; M. Terra ^aff004; A. Thijs ^aff004; B. Verwey ^aff002; J. A. van Waarde ^aff002; J. van Wijngaarden ^aff005; J. J. van Busschbach ^aff001;
Působiště autorů: Erasmus Medical Center, University Medical Center, Rotterdam, The Netherlands ^aff001; Rijnstate Hospital, Arnhem, The Netherlands ^aff002; Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands ^aff003; Amsterdam University Medical Center, Amsterdam, The Netherlands ^aff004; Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands ^aff005
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0221807

Souhrn

Objective

Medical Psychiatry Units (MPUs), also known as Complexity Intervention Units (CIUs), provide care for complex patients suffering from both psychiatric and physical disorders. Because there is no consensus on the indications for admission to an MPU, daily practice and effectiveness research are hampered. This study therefore used a concept mapping approach to investigate which organizational and medical factors determine the decision to admit a patient to an MPU.

Methods

The first step of the concept mapping approach was to create a list of factors determining MPU admission from literature. Secondly, clinical experts sorted and ranked these factors. The sorted and ranked data were then analyzed, and a draft conceptual framework was created. A final conceptual MPU admission framework was then drawn during an expert consensus meeting and recommendations for implementation were suggested.

Results

Thirteen clinical experts defined 90 factors from literature, which were sorted and ranked by 40 experts from 21 Dutch hospitals. This concept mapping approach resulted in a five-cluster solution for an MPU admission framework based on: 1. Staff competencies and organizational pre-requisites; 2. Patient context; 3. Patient characteristics; 4. Medical needs and capabilities; and 5. Psychiatric symptoms and behavioral problems. Furthermore, three inclusion and two exclusion criteria were formulated to help the clinicians decide whether or not to admit patients to an MPU. These criteria can be implemented in daily practice.

Conclusion

Implementing the five criteria derived from this conceptual framework will help make the admission decision for complex patients with psychiatric and physical disorders to an MPU more correct, consistent, and transparent.

Klíčová slova:

Biology and life sciences – Neuroscience – Cognitive science – Cognitive psychology – Psychology – Social sciences – People and places – Population groupings – Professions – Geographical locations – Europe – Medicine and health sciences – Health care – Health care facilities – Hospitals – Health care providers – Medical doctors – Physicians – Nurses – Patients – Medical personnel – Economics – Mental health and psychiatry – Cognition – Economic analysis – Cost-effectiveness analysis – Inpatients – Decision making

Zdroje

1. Kathol RG, Kunkel EJ, Weiner JS, McCarron RM, Worley LL, Yates WR, et al. Psychiatrists for medically complex patients: bringing value at the physical health and mental health/substance-use disorder interface. Psychosomatics. 2009;50(2):93–107. doi: 10.1176/appi.psy.50.2.93 19377017.

2. Fava GA, Wise TN, Molnar G, Zielezny M. The medical-psychiatric unit: A novel psychosomatic approach. PSYCHOTHER PSYCHOSOM. 1985;43(4):194–201. doi: 10.1159/000287879 4034890

3. Kathol RG. Medical psychiatry units: the wave of the future. Gen Hosp Psychiatry. 1994;16(1):1–3. Epub 1994/01/01. 8039678.

4. Chiu A, Nguyen HV, Reutens S, Grace D, Schmidtman R, Shen Q, et al. Clinical outcomes and length of stay of a co-located psychogeriatric and geriatric unit. Arch Gerontol Geriatr. 2009;49(2):233–6. doi: 10.1016/j.archger.2008.08.008 18976823.

5. Leue C, Driessen G, Strik JJ, Drukker M, Stockbrugger RW, Kuijpers PM, et al. Managing complex patients on a medical psychiatric unit: An observational study of university hospital costs associated with medical service use, length of stay, and psychiatric intervention. J Psychosom Res. 2010;68(3):295–302. doi: 10.1016/j.jpsychores.2009.04.010 20159217

6. Alberque C, Gex-Fabry M, Whitaker-Clinch B, Eytan A. The Five-Year Evolution of a Mixed Psychiatric and Somatic Care Unit: A European Experience. Psychosomatics. 2009;50(4):354–61. doi: 10.1176/appi.psy.50.4.354 19687176

7. Kathol RG. Cost outcomes on a medical psychiatry unit. J Psychosom Res. 2010;68(3):293–4. doi: 10.1016/j.jpsychores.2009.06.012 20159216

8. Eytan A, Bovet L, Gex-Fabry M, Alberque C, Ferrero F. Patients' satisfaction with hospitalization in a mixed psychiatric and somatic care unit. Eur Psychiatry. 2004;19(8):499–501. doi: 10.1016/j.eurpsy.2004.09.004 15589710

9. Buckley P, Freyne A, Walshe N. The medical-psychiatry unit: A pilot study of conjoint care within an Irish general hospital. PSYCHOSOMATICS. 1994;35(6):515–9. doi: 10.1016/S0033-3182(94)71719-9 7809353

10. Van Waarde JA, Richter C, Muller METM, Verwey B. The medical-psychiatric unit: Added value for patients, physicians and hospitals. Ned Tijdschr Geneeskd. 2004;148(5):209–11. 14983574

11. Marra D, Allilaire JF, Piette JC. Medical-psychiatric unit, a concept to be developped. Rev Med Interne. 2003;24(5):279–81. doi: 10.1016/s0248-8663(03)00051-1 12763172

12. van Schijndel MA, Jansen LAW, Caarls PJ, van 't Veer F, Wierdsma AI, van Wijngaarden JDH, et al. [Medical Psychiatric Units in the Netherlands: an investigation into distribution and quality] Medisch-psychiatrische units in Nederland. Ned Tijdschr Geneeskd. 2017;161(0):D890. 28659196.

13. van Schijndel MA, Caarls PJ, van Wijngaarden JDH, Wierdsma AI, Lijmer JG, Boenink AD, et al. Identifying value-based quality indicators for general hospital psychiatry. Gen Hosp Psychiatry. 2018;55:27–37. doi: 10.1016/j.genhosppsych.2018.09.009 30296675.

14. van Schijndel MA, Jansen LAW, Caarls PJ, van 't Veer F, Wierdsma AI, van Wijngaarden JDH, et al. [Medical Psychiatric Units in the Netherlands: an investigation into distribution and quality] Medisch-psychiatrische units in Nederland. Ned Tijdschr Geneeskd. 2017;161:D890. 28659196.

15. van Schijndel MA, Jansen LAW, van de Klundert JJ. Empirical Types of Medical Psychiatry Units. Psychother Psychosom. 2018:1–2. doi: 10.1159/000485001 30343290.

16. Bruns W, Stoudemire A. Development of a medical-psychiatric program within the private sector. Potential problems and strategies for their resolution. GEN HOSP PSYCHIATRY. 1990;12(3):137–47. 2110542

17. Gertler R, Kopec-Schrader EM, Blackwell CJ. Evolution and evaluation of a medical psychiatric unit. Gen Hosp Psychiatry. 1995;17(1):26–31. Epub 1995/01/01. 7737491.

18. Stoudemire A, Hales RE, Thomas CR. Medical-psychiatry units: an economic alternative for consultation-liaison psychiatry? Psychiatric Services. 1987;38(8):815–8.

19. Regan J, Prince T, Wilhoite K, Acton RJ, Hamer G, Wright A. Integrating medicine and psychiatry: Psychiatric Medical Units (PMUs). Tennessee medicine: journal of the Tennessee Medical Association. 2005;98(9):448.

20. Guthrie E, McMeekin A, Thomasson R, Khan S, Makin S, Shaw B, et al. Opening the 'black box': liaison psychiatry services and what they actually do. BJPsych Bull. 2016;40(4):175–80. doi: 10.1192/pb.bp.115.051771 27512583.

21. Kathol RG. Cost outcomes on a medical psychiatry unit. Journal of psychosomatic research. 2010;68(3):293–4. doi: 10.1016/j.jpsychores.2009.06.012 20159216

22. Johnsen JA, Biegel DE, Shafran R. Concept mapping in mental health: Uses and adaptations. Evaluation and Program Planning. 2000;23(1):67–75.

23. van Manen JG, Kamphuis JH, Goossensen A, Timman R, Busschbach JJ, Verheul R. In search of patient characteristics that may guide empirically based treatment selection for personality disorder patients-a concept map approach. J Pers Disord. 2012;26(4):481–97. doi: 10.1521/pedi.2012.26.4.481 22867501.

24. Beckers T. K, B., Hutschemaekers G., Tiemens B. Potential predictive factors for successful referral from specialist mental-health services to less intensive treatment: A concept mapping study. PLoS One. 2018;13(6):e0199668. doi: 10.1371/journal.pone.0199668 29944699

25. Beckers T, Koekkoek B, Hutschemaekers G, Tiemens B. Potential predictive factors for successful referral from specialist mental-health services to less intensive treatment: A concept mapping study. PLoS One. 2018;13(6):e0199668. doi: 10.1371/journal.pone.0199668 29944699.

26. Trochim WMK. An introduction to concept mapping for planning and evaluation. Evaluation and program planning. 1989;12(1):1–16.

27. Ward JH. Hierarchical Grouping to Optimize an Objective Function. Journal of the American Statistical Association. 1963;58(301):236–44. doi: 10.1080/01621459.1963.10500845

28. van Schijndel MA, Jansen LAW, van de Klundert JJ. Empirical Types of Medical Psychiatry Units. Psychother Psychosom. 2019;88(2):127–8. doi: 10.1159/000493689 30343290.

29. Kathol RG. Models of care for patients with comorbid medical and psychiatric illness. In: Matsushita M, Fukunishi I, editors. Cutting Edge Medicine and Liaison Psychiatry: Psychiatric Problems of Organ Transplantation, Cancer, Hiv/Aids and Genetic Therapy. International Congress Series. 1174. Amsterdam: Elsevier Science Bv; 1999. p. 13–22.

30. Kathol RG, Harsch HH, Hall RC, Shakespeare A, Cowart T. Categorization of types of medical/psychiatry units based on level of acuity. Psychosomatics. 1992;33(4):376–86.

31. Kishi Y, Kathol RG. Integrating medical and psychiatric treatment in an inpatient medical setting: The type IV program. Psychosomatics. 1999;40(4):345–55. doi: 10.1016/S0033-3182(99)71230-2 10402882

32. Faught DD, Gray DP, DiMeglio C, Meadows S, Menzies V. Creating an integrated psychiatric-mental health nursing clinical experience. Nurse educator. 2013;38(3):122–5. doi: 10.1097/NNE.0b013e31828dc27b 23608915

33. Wulsin LR, Söllner W, Pincus HA. Models of Integrated Care. Medical Clinics of North America. 2006;90(4):647–77. doi: 10.1016/j.mcna.2006.05.005 16843767