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"referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:8 [ 0 => array:3 [ "entidad" => "Institut Clínic de Psiquiatria i Psicologia. IDIBAPS<a class="elsevierStyleCrossRef" href="#fn0005"><span class="elsevierStyleSup">*</span></a>. Hospital Clínic. Facultad de Medicina. Universitat de Barcelona" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Psicosomàtica y Psiquiatría de Enlace. Hospital Clínico Universitario de Zaragoza." "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Medicina Psicosomática. Instituto Dexeus. Barcelona." "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Psiquiatria. Hospital General de Alicante." "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Servicio de Psiquiatria. Hospital Universitario de la Princesa de Madrid." "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Servicio de Psiquiatria. Hospital Ramón y Cajal. Madrid." "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Universidad de Friburgo. Alemania" "etiqueta" => "<span class="elsevierStyleSup">g</span>" "identificador" => "aff0035" ] 7 => array:3 [ "entidad" => "Free University Hospital. Amsterdam. Holanda." "etiqueta" => "<span class="elsevierStyleSup">h</span>" "identificador" => "aff0040" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "**" "correspondencia" => "Correspondencia: Prof. M. Valdés.Institut Clínic de Psiquiatria i Psicologia. Hospital Clínic de Barcelona.Villarroel, 170. 08036 Barcelona." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Multinational European project and multicenter Spanish study of quality improvement of assistance on consultation-liaison psychiatry in general hospital: clinical profile in Spain" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2000-06-05" "fechaAceptado" => "2000-10-17" "PalabrasClave" => array:1 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec222555" "palabras" => array:12 [ 0 => "Psiquiatría de enlace" 1 => "España" 2 => "Comorbilidad" 3 => "Epidemiología psiquiátrica" 4 => "Complejidad" 5 => "Calidad asistencial" 6 => "Consultation-liaison psychiatry" 7 => "Spain" 8 => "Comorbidity" 9 => "Psychiatric epidemiology" 10 => "Complexity" 11 => "Quality assurance" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Fundamento</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">En el contexto de una investigación multinacional europea sobre gestión de calidad en psiquiatría de enlace (financiada por el programa BIOMED 1 de la Unión Europea), se analiza la naturaleza de la actividad asistencial de las unidades de psicosomàtica y psiquiatría de enlace (UPPE) de los seis hospitales generales españoles que participaron en el estudio.</p> <span class="elsevierStyleSectionTitle">Pacientes y método</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se estudiaron 3.608 pacientes, atendidos consecutivamente por las unidades de psiquiatría de enlace de cinco hospitales generales de la red pública (Clínico de Zaragoza, Clínico de Barcelona, General de Alicante, Ramón y Cajal de Madrid y Princesa de Madrid) y un centro privado monogràfico (Instituto Dexeus de Barcelona), a partir de los datos recogidos con un instrumento de registro (CL-BDok-P) estandarizado y validado en investigaciones previas.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La petición de consulta psiquiátrica se hizo a los 10,6 días (como promedio) del ingreso del paciente, la mitad de las peticiones fueron urgentes y el promedio de tiempo de respuesta de la psiquiatría de enlace fue de 1,9 días. Los principales motivos de petición de consulta fueron la existencia de síntomas psiquiátricos (50,3%), los síntomas somáticos sin explicación médica (15,2%), el abuso de sustancias (9,2%), la existencia de antecedentes psiquiátricos (8,5%), el riesgo de sucidio (6%) y el afrontamiento de la enfermedad (5,8%). Los servicios que hicieron más demandas fueron los de medicina interna (17,2%), traumatología (7,5%) y cirugía general (7,3%). Se documenta una importante actividad asistencial en pacientes a menudo "complejos", con medidas diagnósticas e intervenciones de amplio espectro y seguimientos intrahos-pitalarios y al alta del paciente. Por el contrario, se ponen de manifiesto algunos problemas en el "proceso" de intervención.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">De los resultados se infiere la indudable importancia de la psiquiatría de enlace española en el contexto de la asistencia especializada, pero también la posibilidad de mejorar su eficiencia con la propuesta de modelos integradores, de modificaciones organizativas y de la implementación de un moderno modelo de "gestión de calidad".</p>" ] "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Background</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">In the frame of the European study on quality assurance in consultation liaison psychiatry and psychosomatics (supported by the BIOMED 1 program), the clinical "process" of consultation-liaison psychiatry units pertaining to six Spanish general hospitals is analyzed.</p> <span class="elsevierStyleSectionTitle">Patients and method</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A sample of 3.608 consecutive patients referred to the consultation-liaison psychiatry units of five public general hospitals (Clínico of Zaragoza, Clínico of Barcelona, General of Alicante, Ramón y Cajal of Madrid, Princesa of Madrid) and one private gynecological hospital (Dexeus of Barcelona) was studied. The data were recorded with a standardized instrument (CL-BDoK-P), validated in a previous study.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Consult request took place 10.6 days (on average) after the patients admission ("lagtime 1"), half the requests were urgent, and psychiatric consultants examined the patients 1.9 days (on average) after the request ("lagtime 2"). The most frequent reasons for referral were current psychiatric symptoms (50.3%), unexplained physical symptoms (15.2%), substance abuse (9.2%), psychiatric history (8.5%), suicide risk (6%) and coping with illness (5.8%). The main referral services were internal medicine (17.5%), traumato-logy (7.5%) and general surgery (7.3%). An important clinical activity is documented in patients frequently considered to be "complex", with broad spectrum diagnostic and interventions processes and both in-hospital and out-patient follow-up. However, some problems were also detected in the clinical "process".</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The results outline the clinical importance of Spanish consultation-liaison psychiatry in the general hospital, but the possibility of improving its efficiency through the implementation of integrative models, organizational changes and modern models of "quality assurance" is also emphasized.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "nota" => "<p class="elsevierStyleNotepara">IDIBAPS: Institut d'Investigacions Biomèdiques August Pi i Sunyer.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Referencias bibliográficas" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1." 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