ABSTRACT
BACKGROUND: There is currently an increasing recognition of and focus on structural and institutional racism and its impacts on health disparities. In psychiatry and mental health, research has focused on racial and ethnic disparities in the availability and utilization of mental health services, care in emergency departments, and inpatient psychiatric services. Little is known about disparities in care on general hospital psychiatry consultation-liaison (CL) services. METHODS: In this exploratory study, we conducted a retrospective chart review using electronic health record (EHR) data of all adults (≥ 18 years of age) admitted to inpatient medical or surgical floors at an urban academic medical center for whom a psychiatric consultation was requested during the study period. We examined differences by race and ethnicity in: rates of consultation requests; use of legal holds, constant observation, restraints; follow-up by the CL service; and ultimate disposition. RESULTS: The service received 310 unique consults during the study period. Compared to hospital-wide numbers, Black-identifying patients were over-represented in our sample (11.9% vs 6.6%), while Latinx patients were underrepresented (6.1% vs 9.8%). Of the clinical and outcome variables collected, there were higher odds of being placed on a legal hold both prior to (OR 2.6) and after the consult question (OR 2.98) and in the odds of having a one-to-one observer prior to (OR 2.47) and after (OR 2.9) the initial consult visit for Black-identifying patients, when adjusting for confounders. There were no other measurable differences in care or outcomes by racial or ethnic categories. CONCLUSION: Black-identifying patients may be more likely to receive psychiatric consultation and be placed on legal holds because of a combination of chronic adverse social determinants of health and race-based bias. Conversely, Latinx patients may be less likely to receive psychiatric consultation because of language barriers among other factors. The lack of disparities identified in other domains may be encouraging, but larger studies are needed. Further research is also needed to identify causality and interventions that could help close the gap in care and outcomes for racial and ethnic minorities.
Subject(s)
Academic Medical Centers , Ethnicity , Adult , Humans , Retrospective Studies , Hospitals , Referral and ConsultationABSTRACT
RESUMEN El Síndrome de Parkes Weber se caracteriza por sobrecrecimiento de una extremidad asociado a malformación capilar, venosa, linfática y arteriovenosa. Se presenta el caso de una paciente de 23 años de edad que acudió al Servicio de Dermatología por presentar una úlcera de novodesarrollada sobre malformación capilar congénita.Nos fue posible arribar al diagnóstico utilizando diversos estudios de imágenes, mientras que la medida terapéutica, con el carácter de profilaxis terciaria, consistió en embolizaciones múltiples.
SUMMARY Parkes Weber Syndrome is characterized by overgrowth of a limb with capillary, venous, lymphatic, and arteriovenous malformation. We present the case of a 23-year-old patient who came to the dermatology service for an ulcer on congenital capillary malformation.We were able to arrive at the diagnosis using various imaging studies, while the therapeutic measure, with the character of tertiary prophylaxis, consisted of multiple embolizations.
