In the absence of easy access to second-line ambulatory care, the number of 'inappropriate' psychiatric emergency visits is increasing, with emergency departments becoming the gateway to mental health care.
This is the context in which the 'med@psy' system was set up in the Toulon-Provence-Mediterranean metropolitan area by a private psychiatrist. It facilitates access to psychiatric second referral for General Practitioners (GPs) by pooling the 48-hour supply of psychiatric consultations in real time. It is assumed that this system will facilitate access to outpatient psychiatric care and help to optimize the organisation of patient care and follow-up. The aim of this study is to evaluate the med@psy system in the care pathway for patients with psychiatric disorders.
This study main objective is to compare the proportion of patients with a psychiatric disorder who will receive outpatient follow-up 1 month after a visit to a psychiatric emergency department without hospitalization (Group 1) versus 1 month after a consultation with a psychiatrist within 48 hours via the med@psy system (Group 2).
Patient ≥ 18 years ;
Patient presenting to the Centre hospitalier de Toulon La Seyne sur Mer emergency department, with or without referral, and receiving psychiatric advice with discharge without hospitalization after clinical assessment (Group 1) or patients referred for psychiatric consultation via the Med@psy system (Group 2).
Patient with indication for outpatient follow-up
Patient with open social security rights
Patient's refusal to take part in research ;
Patient currently being followed by a psychiatrist. Psychiatric follow-up is defined as at least one consultation with a psychiatrist in the last 3 months, outside an unscheduled care consultation or in an emergency department;
Patients referred for a suicide attempt, violent or non-violent, serious or non-serious;
Patients without a declared general practioner;
Parallel
Clinical assessment by emergency psychiatrist
Other interventionAfter a clinical assessment by the emergency department psychiatrist which does not lead to hospitalization, the patient will be given a psychiatric interview and sent home.
Psychiatric consultation booked through Med@Psy platform
Other interventionThe patient will be seen within 48 hours after the consultation with his or her general practitioner by a psychiatrist taking part in the study.
Number of patients with a consultation with a psychiatrist, a psychologist or a general practioner one month after the consultation via the med@psy system or the visit to emergency department
Setting up outpatient follow-up from a binary point of view (outpatient follow-up absent or present). This will be defined by whether or not each group has had at least one consultation with a psychiatrist (apart from emergency psychiatric consultations or psychiatric consultations set up at 48 hours with the system), a psychologist or a general practitioner. It will be evaluated by means of a telephone survey carried out among patients 1 month after consultation with a psychiatrist via the med@psy system or a visit to the emergency department.
Outpatient follow-up at three months
Outpatient follow-up will be evaluated by the proportion of patients who have had at least one consultation with a psychiatrist, psychologist or general practitioner, in each group, by means of a telephone survey carried out with patients 3 months after the consultation or visit to the emergency department.
Medical partners commitment (part 1)
Medical partners commitment will be assessed by the number of GPs and psychiatrists registered in the Med@psy program.
Medical partners commitment (part 2)
Medical partners commitment will be assessed by the number of patients treated via the program.
Medical partners commitment (part 3)
Medical partners commitment will be assessed by the frequency of use of Med@psy program.
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