Evidence of practice gaps in emergency psychiatric care for borderline personality disorder: how can this be explained?

Autor: Stéphanie Lafont Rapnouil, Adeline Gallini, Cécile Cases, Juliette Salles, Christophe Arbus
Přispěvatelé: CHU Toulouse [Toulouse], Service d'épidémiologie [Toulouse], Epidémiologie et analyses en santé publique : risques, maladies chroniques et handicaps (LEASP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées, Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées, Centre de Physiopathologie Toulouse Purpan (CPTP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service Psychiatrie et psychologie médicale [CHU Purpan]
Rok vydání: 2020
Předmět:
medicine.medical_specialty
MESH: Professional Practice Gaps
Referral
lcsh:RC435-571
Logistic regression
MESH: Borderline Personality Disorder* / therapy
MESH: Referral and Consultation
03 medical and health sciences
0302 clinical medicine
[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases
lcsh:Psychiatry
mental disorders
Practice Gaps
Humans
Medicine
030212 general & internal medicine
Psychiatry
Referral and Consultation
Borderline personality disorder
Care recommendations
MESH: Humans
Emergency department
business.industry
Limiting
medicine.disease
University hospital
Professional Practice Gaps
MESH: Psychotherapy
3. Good health
030227 psychiatry
Psychotherapy
Psychiatry and Mental health
MESH: Emergency Service
Hospital
MESH: Borderline Personality Disorder* / diagnosis
Emergency Service
Hospital
business
Research Article
Zdroj: BMC Psychiatry
BMC Psychiatry, BioMed Central, 2020, 20 (1), ⟨10.1186/s12888-020-02892-7⟩
BMC Psychiatry, Vol 20, Iss 1, Pp 1-9 (2020)
ISSN: 1471-244X
Popis: Background Recent research has highlighted that patients with borderline personality disorder (BPD) could experience symptomatic remissions. This led to the production of guidelines concerning the most appropriate care. In addition, as BPD patients frequently present at an emergency department (ED), specific recommendations concerning how they should be cared for there have also been developed. The recommendations include the referral of patients to inpatient, outpatient or specific crisis care. However, an issue that has not been addressed is the capacity of ED services to apply the care recommendations. The objective of our study, therefore, was to identify the factors limiting their use in the ED of Toulouse University Hospital. Methods A panel of psychiatrists specializing in BPD care examined the medical files of 298 patients with a BPD diagnosis to determine which referrals were consistent or not, according to the care recommendations. A logistic regression was then performed to identify which sociodemographic, clinical, organizational or professional-training factors were associated with inconsistent referrals. Results 32% of patients experienced an inconsistent referral. Consultations performed during an on-call or day-off schedule were linked with inconsistent referrals, while an active follow-up was associated with the provision of consistent care. Conclusion Changing how evaluations of BPD patients in the ED are organized during on-call and day-off schedules could improve the application of the care recommendations regarding the most appropriate referrals.
Databáze: OpenAIRE
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