Introduction
Without question, the medical community recognises that many patients with organic diseases and other forms of bodily illness also suffer from psychiatric and psychological problems. Various models of medical care to address these needs have been proposed, with some showing greater efficacy than others, even as the models continue to evolve and new ones are developed. One model that has gained the attention of researchers worldwide is proactive psychosomatic medicine (PPM), a qualitative approach to providing psychological-psychiatric services to patients in non-psychiatric departments of general hospitals. PPM is based on the biopsychosocial theory and its clinical implementation—consultation-liaison psychiatry. The main principles include initiative, purposefulness, intensity and integration with general medical care.1 2
The psychological-psychiatric care system evolved in general medical practice because of the need for new mechanisms to manage the psychological and social aspects associated with diseases. If insufficiently addressed, inpatients’ unmet psychosocial needs interfere with their medical treatment effectiveness. Consequently, some patients may experience a more severe course of the disease and increase their length of hospitalisation while simultaneously placing a greater burden on the healthcare system.3 Meta-analyses findings on the concept of proactive psychiatric counselling, with confirmation by medical experts’ consensus,2–5 showed that from 2011 to 2018, 20% to 40% of patients in multidisciplinary hospitals also had a mental illness, significantly complicating the course of somatic pathology, the effectiveness of therapy and the prognosis, especially for non-communicable diseases.6–8
It is indisputable that patients’ mental illness in multidisciplinary hospitals often hinders timely discharge, leads to additional specialist consultations and increases total medical care costs. Based on the studies mentioned above, evidence supports psychological-psychiatric counselling as an important method for monitoring somatic patients. The main features of the proactive model of consultation-liaison psychiatry were identified: multidisciplinary care that includes joint supervision and close patient observation by a psychiatrist, primary care physician, psychologist, nurse and social worker. This team not only makes recommendations for treatment, risk reduction and crisis management—typical of the traditional care models—but also exerts efforts to prevent behavioural barriers to care, avoid crises and boost the synergy of patients.4
In 2019, HOME Study,9 a randomised controlled trial, compared the addition of proactive psychological medicine to usual care and then measured the amount of time older, acutely ill patients spent in the hospital. It also formulated the following specific recommendations for the organisation of inpatient psychiatric services and psychological and psychiatric interventions for patients of general medical practice, using the model of consultation-liaison psychiatry:
An early proactive biopsychosocial assessment of recently hospitalised patients to identify all problems, including mental illness.
The creation of a plan for comprehensive supervision and systematic management of the specific problems likely to cause potential obstacles to a rapid hospital discharge.
The implementation of a comprehensive treatment plan, including daily psychosomatic examinations to measure the patient’s progress.
Integrated work with the staff of various departments (doctors, nurses, other counsellors and social work specialists) and outpatient services to ensure the implementation of the comprehensive care plan.
In December 2020, a resource document on proactive consultation-liaison psychiatry, initiated by the Council of the American Psychiatric Association, was approved for publication. This document1 emphasises the implementation of a model of proactive consultation-liaison psychiatry that contains the following four elements:
Systematic screening focusing on current mental health problems in somatic patients (patients hospitalised in certain health facilities are systematically checked for signs of active mental health problems, especially those who may be at higher risk).
Early clinical intervention (proactive measures tailored to individual patients with a combination of interventions for somatic and mental disorders).
Providing care based on a multidisciplinary team approach (the mental health team is part of a multidisciplinary hospital and provides comprehensive mental healthcare directly in a general hospital).
Integration of care with primary teams and services (a proactive psychological-psychiatric team closely coordinates the work with primary services in real time between clinicians with relevant experience: doctor to doctor, nurse to doctor/nurse, social worker to social worker/rehabilitation specialist and vice versa).
Proactive models of psychiatric care are now increasingly recognised and widespread because of the effectiveness of their implementation in treating patients during the coronavirus disease 2019 (COVID-19) pandemic. For example, some hospitals created separate departments specifically for treating patients with COVID-19 with acute psychiatric needs10; others chose to develop psychological-psychiatric units or consultation-liaison psychiatry care within the established structure of multidisciplinary hospitals.11 12 The positive effects of reducing the treatment costs and length of hospital stay of patients with COVID-19 were emphasised.13–16 Based on the recent success of these approaches during the pandemic, proactive models of psychological-psychiatric care have been widely implemented in general practice as an essential link in managing somatic pathology. However, current scientific literature lacks information regarding their effectiveness in treating the anxiety associated with chronic non-communicable diseases. Therefore, this study aimed to evaluate the effectiveness of the proactive consultation-liaison psychiatry model, using the PPM conceptualisation, for the relief of subclinical symptoms of anxiety in patients with chronic non-communicable diseases.