Crossing the bridge – A prospective comparative study of the effect of communication between a hospital based consultation-liaison service and primary care on general practitioners' concordance with consultation-liaison psychiatrists' recommendations

• We compared 3 different ways of communicating psychiatric consultation-liasion (CL) -recommendations to general practitioners (GPs): telephone calls by the CL-psychiatrist, copies of CL-reports and standard hospital discharge letters
• Telephone calls worked best to strengthen GPs´ concordance with CL-psychiatrists’ recommendations, especially with regard to medication and psychotherapy. Copies of CL-reports showed lesser GP-concordance, whereas standard discharge letters led to significant losses of information and low GP-concordance rates
• In our survey, 70% of GPs´ preferred telephone calls to both other ways of communication
• At follow-up after 6 weeks, high GP-concordance was associated with greater reduction of patients´ depression scores, as compared to both other ways of communication

ObjectiveConcordance with consultation-liaison (CL) psychiatrists' recommendations by general practitioners (GP) has hardly been studied systematically. We studied if telephone calls or written notes from a hospital based CL-service to GPs, whose patients were treated on medical-surgical wards, can improve GP-concordance, as compared to the usual communication pathway by standard discharge letters written by hospital physicians, and if higher GP-concordance improves outcomes of depressive and anxious symptoms.Methods116 inpatients of a general hospital referred to a CL-service with depression and anxiety were allocated to three groups of communication pathways between CL-service and GPs: (1) A telephone call (TC) by CL-psychiatrists with GPs, (2) a copy of the psychiatric consultation report (CR) was handed out to patients, (3) GPs received standard discharge letters of the hospital physicians (communication as usual, CAU). Six weeks after the CL-episode, patients were phoned at home and asked about implementation of recommendations by their GP's. The Hospital Anxiety and Depression Scale (HADS) was used to monitor anxious and depressive symptoms.ResultsGP-concordance was highest in the TC group, followed by the CR group with significant improvements in medication and psychotherapeutic recommendations compared to CAU. Higher concordance was associated with a significant greater decrease in HADS depression scores but not anxiety scores after 6 weeks.ConclusionTelephone communication between CL-psychiatrists and GPs improve GPs' concordance with psychiatric recommendations. This easy-to-implement intervention takes about 10 min time but prevents loss of information. It may enhance quality of GPs' mental health care and lead to improved outcomes.