Geropsychiatric consultation-liaison services. An answer to the challenges of dementia?

The care for people suffering from dementia is difficult, independent from the setting they live in or are cared for (at home, in nursing homes, or in general hospitals).This study looks at the possibility to achieve sustained quality improvement as well as cost-offset effects by the implementation of psychogeriatric consultation-liaison services in these settings. We compare effects of psychogeriatric consultation-liaison services in primary care patients, nursing homes, and general hospital inpatients. We re-analyze longitudinal data drawn from our own studies conducted in the respective settings. Our comparison shows that many patients in all settings show benefits with regard to several measures following the consultation-liaison interventions. Patient-specific improvement in delivery of services can be seen in primary care, while in both nursing homes as well as in general hospitals, we found improvement in staff competency with regard to the improvement in knowledge and expertise in dementia care practice. Cost-offset effects can be observed in all three settings. For consultation-liaison services to reach their optimum in efficiency in Germany, the transgression of sector boundaries (e.g., between primary care and general hospitals) must be addressed and improved by specific integrated service delivery contracts that help all participants to achieve a solid legal basis.