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A prospective multicenter study of competency evaluations by psychiatric consultation services
P S Masand1, A J Bouckoms, S V Fischel
1Department of Psychiatry, SUNY Health Science Center at Syracuse 13210, USA.
Psychosomatics
|April 16, 1998
Summary
Psychiatric consultations assess patient competency for decisions like signing out against medical advice. Concordance between psychiatric consultants and referring physicians predicted male sex, single status, psychotropic recommendations, and hospital discharge.
Area of Science:
- Forensic Psychiatry
- Clinical Psychiatry
- Medical Ethics
Background:
- Psychiatric consultations for competency assessment are frequent but understudied.
- Previous research relied on retrospective chart reviews.
Purpose of the Study:
- To prospectively investigate the characteristics and outcomes of psychiatric consultations for competency evaluations.
- To identify factors associated with concordance between psychiatric consultants and referring physicians.
Main Methods:
- Prospective study of 88 consecutive psychiatric consultations across 3 centers.
- Evaluations focused on specific decision-making capacities: signing out against medical advice (AMA), informed consent, self-care, medical care refusal, and other matters.
- Analysis of concordance between consultant and referring physician assessments.
Main Results:
- Patients with favorable risk-benefit ratios were more likely to receive consultations.
- Concordance (N=61) was associated with male gender, single marital status, psychotropic recommendations, signing out AMA, and hospital discharge.
- Disagreement between consultant and referring physician warrants further investigation.
Conclusions:
- Prospective study provides insights into psychiatric competency evaluations.
- Concordance in assessments is linked to specific patient demographics and clinical outcomes.
- Further research is needed to understand discrepancies in competency assessments.
