Interventions in consultation/liaison psychiatry. Part II: Concordance

The psychiatric consultant is dependent upon the consultee for the implementation of many of his or her recommendations. Therefore, research as to the fate of recommendations suggested to the consultee is of eminent importance. The concordance (performing a suggested recommendation) paradigm, as developed by Popkin et al. is further elaborated for biologic and psychologic, as well as social, recommendations that were described in an earlier study. The results of the assessment of consultee concordance for 317 psychiatric consultation patients are described. Specific attention is directed to the development of criteria, the method of assessment, the mechanisms underlying nonconcordance, and the description of methods to enhance concordance. This study indicates that assessment of and control for concordance needs to be an integrated part of all consultation/liaison psychiatry (C/L) intervention studies in order to document the actual implementation of recommendations, accurately assess the findings of C/L outcome research, and avoid error measurement.