Can we increase adherence to treatment recommendations of the consultation psychiatrist working in a general hospital? A systematic review.

BACKGROUND Adherence to advice given by the consultation-liaison (CL) psychiatrist is a prerequisite for the effectiveness and success of psychiatric consultation. It is unknown which factors are associated with better adherence to advice. AIM To review the adherence of consultees with advice given by the psychiatrist during inpatient consultation. METHOD Systematic literature review. RESULTS Eighteen studies reported on the level of adherence with recommendations given by the consultation psychiatrist in a hospital setting. All were retrospective cohort studies conducted before 1998. Thirteen of these reported on the association between clinical variables and the level of adherence. The median level of adherence with diagnostic advice was 56% (range 29-75%), with medication advice 79% (range 68-98%), and with discharge advice 91% (range 85-95%). Patient-related variables were not associated with adherence, nor were consultee-related variables. Consultant-related variables associated with adherence were level of professional expertise, organizing liaison activities, following up on patients after initial consultation, and prescription of medication by the consultant during the consultation. CONCLUSION This review provides evidence for a role of consultant characteristics and an active approach of the consultant in terms of CL activities as well as consultation procedures, in attaining adherence to advice. Prospective qualitative research is needed to identify consultation methods that may further enhance adherence.