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Problems with managed psychiatric care without a psychiatrist-manager.
1Department of Psychiatry and Behavioral Sciences, Oklahoma University Health Sciences Center, Oklahoma City 73190.
Hospital & Community Psychiatry
|December 1, 1991
Summary
Patients at high psychiatric risk received inadequate managed care, leading to severe outcomes like suicide or disability. Non-psychiatrists often managed care, with psychotropic medication mismanagement being a key factor in adverse events.
Area of Science:
- Psychiatry
- Managed Care
- Patient Safety
Background:
- Managed care models can present challenges in delivering specialized psychiatric treatment.
- Adequate management of patients with severe mental illness is crucial for preventing adverse outcomes.
Observation:
- Seven cases of critically ill psychiatric patients receiving suboptimal managed care were reviewed.
- Care was primarily managed by non-psychiatrists, including therapists, case managers, physicians, and nurses.
- Psychiatric consultations were often limited to psychopharmacology and recommendations were sometimes ignored or poorly executed.
Findings:
- Five patients died by suicide, one developed psychosis, and one suffered permanent disability.
- Mismanagement of psychotropic medications was implicated in six cases.
- Lack of appropriate psychiatric oversight contributed to the negative patient outcomes.
Implications:
- Highlights critical gaps in managed care for high-risk psychiatric patients.
- Underscores the need for robust psychiatric involvement and adherence to treatment recommendations.
- Suggests a review of non-psychiatrist management protocols for severe mental illness within managed care systems.