Can we increase adherence to treatment recommendations of the consultation psychiatrist working in a general hospital? A systematic review.
BACKGROUND
Adherence to advice given by the consultation-liaison (CL) psychiatrist is a prerequisite for the effectiveness and success of psychiatric consultation. It is unknown which factors are associated with better adherence to advice.


OBJECTIVE
To review the adherence of consultees with advice given by the psychiatrist during inpatient consultation.


METHODS
Systematic literature review.


RESULTS
Eighteen studies reported on the level of adherence with recommendations given by the consultation psychiatrist in a hospital setting. All were retrospective cohort studies conducted before 1998. Thirteen of these reported on the association between clinical variables and the level of adherence. The median level of adherence with diagnostic advice was 56% (range 29-75%), with medication advice 79% (range 68-98%), and with discharge advice 91% (range 85-95%). Patient-related variables were not associated with adherence, nor were consultee-related variables. Consultant-related variables associated with adherence were level of professional expertise, organizing liaison activities, following up on patients after initial consultation, and prescription of medication by the consultant during the consultation.


CONCLUSIONS
This review provides evidence for a role of consultant characteristics and an active approach of the consultant in terms of CL activities as well as consultation procedures, in attaining adherence to advice. Prospective qualitative research is needed to identify consultation methods that may further enhance adherence.
Leentjens
Albert F G
AF
Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands. a.leentjens@np.unimaas.nl
Boenink
Annette D
AD
van der Feltz-Cornelis
Christina M
CM
D017408:Guidelines as Topic; D006769:Hospitals, General; D006801:Humans; D001523:Mental Disorders / Q000188:drug therapy / Q000628:therapy*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011570:Psychiatry / Q000379:methods*; D012017:Referral and Consultation