Evaluating the Proactive C-L Model: Insights and Unanswered Questions From the UK HOME Study

IF 2.7 4区 心理学 Q2 PSYCHIATRY Journal of the Academy of Consultation-Liaison Psychiatry Pub Date : 2024-09-01 DOI:10.1016/j.jaclp.2024.09.001
Mark A. Oldham M.D., F.A.C.L.P. , Patrick Triplett M.D. , Hochang B. Lee M.D., F.A.C.L.P.
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Abstract

The HOME Study is the largest and among the most important trials in the history of consultation-liaison psychiatry, and its study team is to be commended for this landmark study. In this article, we provide context for the HOME Study and consider several aspects of the study critical to understanding the nature of the intervention and interpreting its results. First, we compare the model of proactive integrated consultation-liaison psychiatry as implemented in the HOME Study with versions of proactive consultation-liaison psychiatry as commonly practiced in the US. Key distinctions of proactive integrated consultation-liaison psychiatry include a direct assessment of all study arm participants by a consultation-liaison psychiatrist rather than the use of initial screening for acute psychiatric issues, the unique inclusion of an occupational therapist as a member of the proactive integrated consultation-liaison psychiatry team, and patient-level randomization as opposed to unit-based approaches as commonly practiced in the US. Next, we consider several characteristics of the HOME Study sample relevant to its generalizability. These include an average age of 82 years, limited ethnic and racial diversity, and a high prevalence of both cognitive and functional impairment. Third, we review how study methodology informs study interpretation. These include early trial termination due to COVID, which limits power to detect a 1-day reduction in hospital, a mean 3.5-day delay from hospital admission to study enrollment, and the exclusion of patients who had already received a psychiatric consultation, which likely reduced the acuity of mental health issues addressed in this study. Despite these considerations, the HOME Study is a truly remarkable contribution to the literature, and its results will be discussed for years to come. In view of the aging global population, the HOME Study set about to tackle an especially ambitious and forward-looking question by focusing exclusively on older hospitalized adults. Like all good studies, this trial raises many important questions. As the first randomized trial of proactive consultation-liaison psychiatry of any form, the HOME Study is an encouragement to the field to consider the range of potential benefits of providing proactive, integrated mental health care to medical and surgical inpatients with mental health needs.
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评估积极主动的 C-L 模型:英国 HOME 研究的启示和未解之谜。
居家研究 "是会诊联络精神病学历史上规模最大、最重要的试验之一,其研究团队因这项具有里程碑意义的研究而备受赞誉。在本文中,我们将介绍 "居家 "研究的背景,并对该研究中对理解干预的性质和解释其结果至关重要的几个方面进行探讨。首先,我们将 "居家研究 "中实施的主动综合咨询-联络精神病学模式与美国通常实施的主动咨询-联络精神病学模式进行比较。前瞻性综合会诊-联络精神病学的主要区别包括:由会诊-联络精神病学医生对所有研究组参与者进行直接评估,而不是对急性精神病问题进行初步筛查;将职业治疗师作为前瞻性综合会诊-联络精神病学团队的成员之一;患者层面的随机化,而不是美国通常采用的以单位为基础的方法。接下来,我们将考虑 "居家 "研究样本中与可推广性相关的几个特点。这些特点包括:平均年龄 82 岁、种族和民族多样性有限、认知和功能障碍发生率高。第三,我们回顾了研究方法如何影响研究解释。这些因素包括:由于 COVID 导致试验提前结束,从而限制了检测住院时间减少 1 天的能力;从入院到加入研究的平均延迟时间为 3.5 天;排除了已经接受过精神科咨询的患者,这可能降低了本研究中精神健康问题的严重性。尽管有这些考虑因素,但 "居家 "研究确实为文献做出了卓越的贡献,其结果也将在未来数年内得到讨论。鉴于全球人口老龄化的趋势,"居家 "研究专门针对住院的老年人,着手解决一个雄心勃勃且具有前瞻性的问题。与所有优秀的研究一样,这项试验也提出了许多重要问题。作为首例任何形式的主动咨询-联络精神病学随机试验,"居家 "研究鼓励该领域考虑为有心理健康需求的内科和外科住院患者提供主动、综合的心理健康护理可能带来的一系列益处。
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来源期刊
CiteScore
5.80
自引率
13.00%
发文量
378
审稿时长
50 days
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