When in-patients need both medical and psychiatric care – what’s the best form of co-management to offer? Speakers at an APA symposium on co-managed care were keen to share their views. We report.
Many psychiatric in-patients need concurrent medical care and a high proportion of medical in-patients may require psychiatric consultations and care.
A care ‘plaza’ approach
Dr Philip Muskin of Columbia University Medical Centre believes that truly collaborative Med-Psych care needs to be viewed than more than just ‘a two-way street’. He said that in-patients requiring both medical and psychiatric care should instead have a ‘plaza’ of care, with access to all services and expertise they might require.
Speaking during an APA symposium entitled “Co-managed inpatient care: there is more than one way to skin a cat – case presentation and panel discussion for Med-Psych inpatient care”, Dr Muskin stressed that co-managed inpatient care should not be about deciding who’s patient is whose but about a cooperative and collaborative care plan and services.
Chairman of the symposium, Dr Gen Shinozaki of the University of Iowa, agreed that concurrent and coordinated patient care is key to co-management of medical and psychiatric conditions in in-patient settings. He described the pioneering work at the University of Iowa to establish a truly Med-Psych facility for in-patients, staffed by clinicians and a multidisciplinary care team with both medical and psychiatric expertise.
Better practices better outcomes
Med-Psych care: more than just ‘a two-way street’
Dr Shinozaki said that concurrent care is better than sequential care – not just for patients but for hospitals too. For patients with complex Med-Psych needs, he said that sequential patient care – where the patient moves between two specialties can be more cumbersome – with patients being transferred between locations, perhaps needing sitters or close monitoring while on medical wards, or needing to move to a psychiatric setting for therapy and security.
Dr Shinozaki said that integrated Med-Psych care could equate to uninterrupted and more complete patient management. Indeed both he and other speakers reported that care in a Med-Psych facility can decrease patient length of stay, with appreciable long-term cost savings for hospitals willing to invest in such facilities and services.
Speakers at the symposium also highlighted the professional satisfaction that can be had for psychiatrists and healthcare team members in developing dual skills and psych-liaison expertise through working in Med-Psych care.
