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Caballer-Tarazona V, Zúñiga-Lagares A, Reyes-Santias F. Analysis of hospital costs by morbidity group for patients with severe mental illness. Ann Med 2022; 54:858-866. [PMID: 35318876 PMCID: PMC8956305 DOI: 10.1080/07853890.2022.2048884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVES The goal of this study is to analyse hospital costs and length of stay of patients admitted to psychiatric units in hospitals in a European region of the Mediterranean Arc. The aim is to identify the effects of comorbidities and other variables in order to create an explanatory cost model. METHODS In order to carry out the study, the Ministry of Health was asked to provide data on access to the mental health facilities of all hospitals in the region. Among other questions, this database identifies the most important diagnostic variables related to admission, like comorbidities, age and gender. The method used, based on the Manning-Mullahy algorithm, was linear regression. The results were measured by the statistical significance of the independent variables to determine which of them were valid to explain the cost of hospitalization. RESULTS Psychiatric inpatients can be divided into three main groups (psychotic, organic and neurotic), which have statistically significant differences in costs. The independent variables that were statistically significant (p <.05) and their respective beta and confidence intervals were: psychotic group (19,833.0 ± 317.3), organic group (9,878.4 ± 276.6), neurotic group (11,060.1 ± 287.6), circulatory system diseases (19,170 ± 517.6), injuries and poisoning (21,101.6 ± 738.7), substance abuse (20,580.6 ± 514, 6) and readmission (19,150.9 ± 555.4). CONCLUSIONS Unlike most health services, access to psychiatric facilities does not correlate with comorbidities due to the specific nature of this specialization. Patients admitted to psychosis had higher costs and a higher number of average staysKEY MESSAGESThe highest average hospital expenditure occurred in patients admitted for psychotic disorders.Due to the particularities of psychiatry units and unlike other medical specialties, the number of comorbidities did not influence the number of hospital stays or hospital expenditure.Apart from the main diagnostic group, the variables that were useful to explain hospital expenditure were the presence of poisoning and injuries as comorbidity, diseases of circulatory system as comorbidity, history of substance abuse and readmission.
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van Niekerk M, Walker J, Hobbs H, Magill N, Toynbee M, Steward B, Harriss E, Sharpe M. The Prevalence of Psychiatric Disorders in General Hospital Inpatients: A Systematic Umbrella Review. J Acad Consult Liaison Psychiatry 2022; 63:567-578. [PMID: 35491011 DOI: 10.1016/j.jaclp.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/08/2022] [Accepted: 04/24/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND To inform the future development of consultation-liaison psychiatry services, we need accurate information on the prevalence of psychiatric disorders in the general hospital inpatient setting. Systematic reviews have summarized the literature on specific aspects of this broad topic, but there has been no high-level overview that aggregates their findings and identifies gaps in the relevant literature. OBJECTIVE We aimed to produce a comprehensive overview of the field, summarizing the research literature on the prevalence of psychiatric disorders (i.e., interview-based psychiatric diagnoses) in general hospital inpatients. We did this using a systematic umbrella review (systematic review of systematic reviews), which is the best and most efficient method for summarizing a broad area of research. METHODS We searched Ovid Medline, Ovid Embase, Ovid PsycINFO, EBSCO CINAHL, and Scopus from database inception to September 2021 for systematic reviews that provided a pooled prevalence estimate, or prevalence range, for interview-diagnosed psychiatric disorders in general hospital inpatients. Two reviewers independently assessed articles and extracted data. The review is registered with PROSPERO, number CRD42019125574. RESULTS We screened 11,728 articles and included 10 systematic reviews in our umbrella review. We were able to extract pooled prevalence estimates from these as follows: major depression 12% to 20%, any anxiety disorder 8%, generalized anxiety disorder 5%, panic disorder 3%, delirium 15%. We were only able to extract a prevalence range for dementia, which was 3% to 63%. We found no systematic reviews from which we could extract prevalence data for the other psychiatric disorders that we included in our searches, indicating important gaps. From these data, we estimated that approximately one-third of inpatients have a psychiatric disorder. CONCLUSIONS Psychiatric disorders are very common in general hospital inpatients. While the planning of consultation-liaison psychiatry services will benefit from more research on the prevalence of each of the full range of disorders encountered in the inpatient setting, our findings indicate that we already know enough to justify increased and more population-based service provision.
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Affiliation(s)
- Maike van Niekerk
- Psychological Medicine Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - Jane Walker
- Psychological Medicine Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - Harriet Hobbs
- Psychological Medicine Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - Nicholas Magill
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Mark Toynbee
- Psychological Medicine Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - Ben Steward
- Psychological Medicine Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - Eli Harriss
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Michael Sharpe
- Psychological Medicine Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK.
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Avina RM, Banta JE, Mataya R, Becerra BJ, Becerra MB. Burden of Mental Illness among Primary HIV Discharges: A Retrospective Analysis of Inpatient Data. Healthcare (Basel) 2022; 10:healthcare10050804. [PMID: 35627941 PMCID: PMC9140380 DOI: 10.3390/healthcare10050804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/19/2022] [Accepted: 04/22/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Empirical evidence demonstrates the substantial burden of mental illness among people living with HIV and AIDS (PLWHA). Current literature also notes the co-morbidity of these two illnesses and its impact on quality of life and mortality. However, little evidence exists on patient outcomes, such as hospital length of stay or post-discharge status. Methods: A retrospective analysis of National Inpatient Sample data was conducted. The study population was defined as discharges having a primary diagnosis of HIV based on International Classification of Disease, 10th Revision, Clinical Modification (ICD-10-CM) codes in primary diagnosis field. Clinical Classification Software (CCS) codes are used to identify comorbid mental illness. Length of stay was defined as number of days between hospital admission and discharge. Disposition (or post-discharge status) was defined as routine versus not routine. Patient and hospital characteristics were used as control variables. All regression analyses were survey-weighted and adjusted for control variables. Results: The weighted population size (N) for this study was 26,055 (n = 5211). Among primary HIV discharges, presence of any mental illness as a secondary discharge was associated with 12% higher LOS, when compared to a lack of such comorbidity (incidence rate ratio [IRR] = 1.12, 95% confidence interval [CI] = 1.05, 1.22, p < 0.01). Likewise, among primary HIV discharges, those with mental illness had a 21% lower routine disposition, when compared to those without any mental illness (OR = 0.79, 95% CI = 0.68, 0.91, p < 0.001). Conclusion: Our results highlight the need for improved mental health screening and coordinated care to reduce the burden of mental illness among HIV discharges.
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Affiliation(s)
- Robert M. Avina
- School of Public Health, Loma Linda University, Loma Linda, CA 92354, USA; (J.E.B.); (R.M.)
- Correspondence:
| | - Jim E. Banta
- School of Public Health, Loma Linda University, Loma Linda, CA 92354, USA; (J.E.B.); (R.M.)
| | - Ronald Mataya
- School of Public Health, Loma Linda University, Loma Linda, CA 92354, USA; (J.E.B.); (R.M.)
| | - Benjamin J. Becerra
- Center for Health Equity, Department of Information and Decision Sciences, California State University, San Bernardino, CA 92407, USA;
| | - Monideepa B. Becerra
- Center for Health Equity, Department of Health Science and Human Ecology, California State University, San Bernardino, CA 92407, USA;
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Shinjo D, Tachimori H, Maruyama-Sakurai K, Fujimori K, Inoue N, Fushimi K. Consultation-liaison psychiatry in Japan: a nationwide retrospective observational study. BMC Psychiatry 2021; 21:235. [PMID: 33952238 PMCID: PMC8097923 DOI: 10.1186/s12888-021-03241-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 04/27/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Consultation-liaison psychiatry (CLP)-professional psychiatric care provided to coordinate with surgical or medical treatment of inpatients with psychiatric disorders-was included in universal health coverage in Japan in 2012. Despite evidence of benefits of CLP, basic data and geographic distribution information regarding CLP at the national level remain unclear. This study aimed to 1) identify the geographic disparity of CLP in Japan and 2) investigate the association between number of consultations per CLP patient and region. METHODS We retrospectively analyzed anonymized data retrieved from the Japanese administrative inpatient database regarding inpatients who were provided CLP between April 2012 and March 2017. Demographic characteristics were summarized and geographic disparity by prefecture was visualized for fiscal years 2012 and 2016; we also summarized the data according to region. Multivariate linear regression analysis was used to investigate association between the number of consultations per CLP patient and region after adjusting for covariates. RESULTS Data from a total of 46,171 patients who received 138,866 CLP services were included. Results revealed more patients aged 75-84 years received CLPs than any other age group (29.7%) and the overall male/female ratio was 53:47 in 2016. In 2012 and 2016, 24.2 and 30.7% of CLP patients, respectively, were transferred to other hospitals; 9.7 and 8.8%, respectively, discharged due to the death. CLP services were provided in 14 prefectures in 2012 and 33 by 2016; 14 prefectures had no available CLP services. After adjusting for covariates, Tohoku (β = - 0.220, p < 0.034), Chugoku (β = - 0.160, p < 0.026), and Shikoku (β = - 0.555, p < 0.001) had a significant negative correlation with the number of consultations per CLP patient compared with Hokkaido region (an adjusted R square (R2) = 0.274). CONCLUSIONS Our study clarified the characteristics of patients in Japan who received CLPs and the geographic disparity in CLP services. Although 5 years had passed since CLP was introduced, the results imply wide availability of CLP nationally. The analysis data provided may inform future policies to improve CLP services.
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Affiliation(s)
- Daisuke Shinjo
- grid.63906.3a0000 0004 0377 2305Department of Information Technology and Management, The National Center of Child Health and Development, Tokyo, Japan ,grid.265073.50000 0001 1014 9130Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 1138519 Japan
| | - Hisateru Tachimori
- grid.416859.70000 0000 9832 2227Department of Mental Health Policy and Evaluation, National Institute of Mental Health, The National Center of Neurology and Psychiatry, Tokyo, Japan ,grid.45203.300000 0004 0489 0290Institute for Global Health Policy Research, The National Center for Global Health and Medicine, Tokyo, Japan
| | - Keiko Maruyama-Sakurai
- grid.416859.70000 0000 9832 2227Department of Mental Health Policy and Evaluation, National Institute of Mental Health, The National Center of Neurology and Psychiatry, Tokyo, Japan ,grid.45203.300000 0004 0489 0290Institute for Global Health Policy Research, The National Center for Global Health and Medicine, Tokyo, Japan
| | - Kenji Fujimori
- grid.69566.3a0000 0001 2248 6943Department of Health Administration and Policy, Tohoku University, Sendai, Japan
| | - Norihiko Inoue
- grid.63906.3a0000 0004 0377 2305Department of Information Technology and Management, The National Center of Child Health and Development, Tokyo, Japan ,grid.265073.50000 0001 1014 9130Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 1138519 Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 1138519, Japan.
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McBride KE, Solomon MJ, Bannon PG, Glozier N, Steffens D. Surgical outcomes for people with serious mental illness are poorer than for other patients: a systematic review and meta-analysis. Med J Aust 2021; 214:379-385. [PMID: 33847005 DOI: 10.5694/mja2.51009] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/14/2020] [Accepted: 01/05/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the association between having a serious mental illness and surgical outcomes for adults, including in-hospital and 30-day mortality, post-operative complications, and hospital length of stay. STUDY DESIGN Systematic review and meta-analysis of publications in English to 30 July 2018 of studies that examined associations between having a serious mental illness and surgical outcomes for adults who underwent elective surgery. Primary outcomes were in-hospital and 30-day mortality, post-operative complications, and length of hospital stay. Risk of bias was assessed with the Quality in Prognosis Studies (QUIPS) tool. Studies were grouped by serious mental illness diagnosis and outcome measures. Odds ratios (ORs) or mean differences (MDs), with 95% confidence intervals (CIs), were calculated in random effects models to provide pooled effect estimates. DATA SOURCES MEDLINE, EMBASE, PsychINFO, and the Cochrane Library. DATA SYNTHESIS Of the 3824 publications identified by our search, 26 (including 6 129 806 unique patients) were included in our analysis. The associations between having any serious mental illness diagnosis and having any post-operative complication (ten studies, 125 624 patients; pooled effect: OR, 1.44; 95% CI, 1.15-1.79) and a longer stay in hospital (ten studies, 5 385 970 patients; MD, 2.6 days; 95% CI, 0.8-4.4 days) were statistically significant, but not those for in-hospital mortality (three studies, 42 926 patients; OR, 1.21; 95% CI, 0.69-2.12) or 30-day mortality (six studies, 83 013 patients; OR, 1.85; 95% CI, 0.86-3.99). CONCLUSIONS Having a serious mental illness is associated with higher rates of post-operative complications and longer stays in hospital, but not with higher in-hospital or 30-day mortality. Targeted pre-operative interventions may improve surgical outcomes for these vulnerable patients. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42018080114 (prospective).
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Affiliation(s)
- Kate E McBride
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, NSW.,Sydney Medical School, University of Sydney, Sydney, NSW
| | - Michael J Solomon
- Surgical Outcomes Research Centre, Royal Prince Alfred Hospital and University of Sydney, Sydney, NSW
| | - Paul G Bannon
- Sydney Medical School, University of Sydney, Sydney, NSW
| | | | - Daniel Steffens
- Surgical Outcomes Research Centre, Royal Prince Alfred Hospital and University of Sydney, Sydney, NSW
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Proactive C-L Psychiatry Beyond Academic Hospital Settings: A Pilot Study of Effectiveness in a Suburban Community Hospital. PSYCHOSOMATICS 2020; 61:688-697. [DOI: 10.1016/j.psym.2020.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/14/2020] [Accepted: 05/14/2020] [Indexed: 11/24/2022]
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Ronaldson A, Elton L, Jayakumar S, Jieman A, Halvorsrud K, Bhui K. Severe mental illness and health service utilisation for nonpsychiatric medical disorders: A systematic review and meta-analysis. PLoS Med 2020; 17:e1003284. [PMID: 32925912 PMCID: PMC7489517 DOI: 10.1371/journal.pmed.1003284] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 08/10/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Psychiatric comorbidity is known to impact upon use of nonpsychiatric health services. The aim of this systematic review and meta-analysis was to assess the specific impact of severe mental illness (SMI) on the use of inpatient, emergency, and primary care services for nonpsychiatric medical disorders. METHODS AND FINDINGS PubMed, Web of Science, PsychINFO, EMBASE, and The Cochrane Library were searched for relevant studies up to October 2018. An updated search was carried out up to the end of February 2020. Studies were included if they assessed the impact of SMI on nonpsychiatric inpatient, emergency, and primary care service use in adults. Study designs eligible for review included observational cohort and case-control studies and randomised controlled trials. Random-effects meta-analyses of the effect of SMI on inpatient admissions, length of hospital stay, 30-day hospital readmission rates, and emergency department use were performed. This review protocol is registered in PROSPERO (CRD42019119516). Seventy-four studies were eligible for review. All were observational cohort or case-control studies carried out in high-income countries. Sample sizes ranged from 27 to 10,777,210. Study quality was assessed using the Newcastle-Ottawa Scale for observational studies. The majority of studies (n = 45) were deemed to be of good quality. Narrative analysis showed that SMI led to increases in use of inpatient, emergency, and primary care services. Meta-analyses revealed that patients with SMI were more likely to be admitted as nonpsychiatric inpatients (pooled odds ratio [OR] = 1.84, 95% confidence interval [CI] 1.21-2.80, p = 0.005, I2 = 100%), had hospital stays that were increased by 0.59 days (pooled standardised mean difference = 0.59 days, 95% CI 0.36-0.83, p < 0.001, I2 = 100%), were more likely to be readmitted to hospital within 30 days (pooled OR = 1.37, 95% CI 1.28-1.47, p < 0.001, I2 = 83%), and were more likely to attend the emergency department (pooled OR = 1.97, 95% CI 1.41-2.76, p < 0.001, I2 = 99%) compared to patients without SMI. Study limitations include considerable heterogeneity across studies, meaning that results of meta-analyses should be interpreted with caution, and the fact that it was not always possible to determine whether service use outcomes definitively excluded mental health treatment. CONCLUSIONS In this study, we found that SMI impacts significantly upon the use of nonpsychiatric health services. Illustrating and quantifying this helps to build a case for and guide the delivery of system-wide integration of mental and physical health services.
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Affiliation(s)
- Amy Ronaldson
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine, Queen Mary University of London, London, United Kingdom
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Lotte Elton
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Simone Jayakumar
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Anna Jieman
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Kristoffer Halvorsrud
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Kamaldeep Bhui
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine, Queen Mary University of London, London, United Kingdom
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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von der Warth R, Hehn P, Wolff J, Kaier K. Hospital costs associated with post-traumatic stress disorder in somatic patients: a retrospective study. HEALTH ECONOMICS REVIEW 2020; 10:23. [PMID: 32653959 PMCID: PMC7354685 DOI: 10.1186/s13561-020-00281-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 07/05/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Post-traumatic stress disorder is likely to affect clinical courses in the somatic hospital ward when appearing as comorbidity. Thus, this study aimed to assess the costs associated with comorbid post-traumatic stress disorder in a somatic hospital and to analyze if reimbursement appropriately compensated additional costs. METHODS The study used data from a German university hospital between 2011 and 2014, analyzing 198,819 inpatient episodes. Inpatient's episodes were included for analysis if they had a somatic primary diagnosis and a secondary diagnosis of post-traumatic stress disorder. Costs were calculated based on resource use and compared to reimbursement. Analyses were adjusted for sex, age and somatic comorbidities. RESULTS N = 219 Inpatient's episode were found with primary somatic disorder and a comorbid post-traumatic stress disorder. Inpatients episodes with comorbid post-traumatic stress disorder were compared to 34,229 control episodes, which were hospitalized with the same main diagnosis. Post-traumatic stress disorder was associated with additional hospital costs of €2311 [95%CI €1268 - €3355], while reimbursement rose by €1387 [€563 - €2212]. Results indicate that extra costs associated with post-traumatic stress disorder are not fully reimbursed. Male patients showed higher hospital costs associated with post-traumatic stress disorder. On average, post-traumatic stress disorder was associated with an extra length of stay of 3.4 days [2.1-4.6 days]. CONCLUSION Costs associated with post-traumatic stress disorder were substantial and exceeded reimbursement, indicating an inadequate reimbursement for somatic patients with comorbid post-traumatic stress disorder.
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Affiliation(s)
- Rieka von der Warth
- Section of Health Care Research and Rehabilitation Research, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany.
| | - Philip Hehn
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - Jan Wolff
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Klaus Kaier
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
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Matsumoto Y, Ayani N, Narumoto J. Frequency and predictors of perioperative psychiatric symptom worsening among patients with psychiatric disorders. Compr Psychiatry 2019; 95:152138. [PMID: 31671352 DOI: 10.1016/j.comppsych.2019.152138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 09/14/2019] [Accepted: 10/12/2019] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE This study aimed to clarify the frequency of perioperative psychiatric symptom worsening among patients with psychiatric disorders and investigate factors predictive of symptom aggravation. METHOD This study adopted a retrospective cohort study design. The sample consisted of perioperative inpatients who were diagnosed with psychiatric disorders on admission and received psychiatric intervention between January 1, 2015 and November 31, 2017. RESULTS Of 176 inpatients who met our inclusion criteria, 15 (8.5%) exhibited symptom worsening. Factors associated with symptom worsening included changes in surface morphology during surgery (p<0.01; odds ratio (OR)=10.58; 95% confidence interval (CI), 3.40-32.87), otolaryngological surgery (p=0.01; OR=6.95; 95% CI, 1.81-26.75), stay in the intensive care unit (p<0.01; OR=5.65; 95% CI, 1.79-17.81), and surgery duration longer than 180min (p=0.03; OR=3.40; 95% CI, 1.04-11.13). CONCLUSION This was the first retrospective analysis to focus on the perioperative worsening of psychiatric symptoms. As only few inpatients exhibited symptom aggravation, general hospitals without psychiatric beds can receive perioperative patients with psychiatric comorbidity. However, caution should be exercised to address the potential worsening of symptoms in cases of surface-morphology changing surgery, otolaryngological surgery, long-duration operations, and when ICU stay is required.
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Affiliation(s)
- Yoshihiro Matsumoto
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Nobutaka Ayani
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Jin Narumoto
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
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Siddiqui N, Dwyer M, Stankovich J, Peterson G, Greenfield D, Si L, Kinsman L. Hospital length of stay variation and comorbidity of mental illness: a retrospective study of five common chronic medical conditions. BMC Health Serv Res 2018; 18:498. [PMID: 29945622 PMCID: PMC6020383 DOI: 10.1186/s12913-018-3316-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 06/19/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND With the increasing burden of mental illness globally, it is becoming common for hospitalised patients with chronic medical conditions to have a comorbidity of mental illness. This combination could prolong length of stay (LOS) of this patient cohort. We conducted an investigation in Tasmania, Australian hospitals to characterise this cohort and assess if co-morbidity of mental illness is a distinguishing factor that generates LOS variation across different chronic medical conditions. METHODS The retrospective study analysed 16,898 admissions of patients with a primary diagnosis of one of five chronic medical conditions: lung or colorectal cancer, chronic obstructive pulmonary disease (COPD), type II diabetes, ischaemic heart disease (IHD) and stroke. Data were from July 2010 to June 2015, across four hospitals that collectively cover 95% of public hospital admissions in Tasmania, Australia. Descriptive statistics were used to compare characteristics of patients between the scenarios of with and without co-morbidity of mental illness. We used negative binomial regression models to assess whether co-morbidity of mental illness, along with its sub-types, after adjustment for potential confounding variables, associated with LOS variation in patients of each medical condition. Based on the adjusted LOS variation, we estimated differences in bed days' use between patients with and without comorbidity of mental illness. RESULTS Patients with co-morbidity of mental illness were significantly younger in comparison to patients without mental illness. With each medical condition, patients with comorbidity of mental illness had incurred higher bed days' use than for those without mental illness. In cancer and stroke cohorts, co-morbidity of mental illness unfavourably affected the LOS variation by as high as 97% (CI: 49.9%-159%) and 109% (78%-146%), respectively. Though mental and behavioural disorders due to psychoactive substances was a dominant sub-type of mental illness across the medical conditions, it contributed significant unfavourable LOS variation only in the stroke patients i.e. 36.3% (CI: 16.2%-59.9%). CONCLUSIONS Mental illness consistently produced unfavourable LOS variation. Upskilling of healthcare teams and greater reporting and analysis of LOS variation for this patient cohort, and the sub-cohorts within it, are necessary to provide improved medical care and achieve system efficiencies.
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Affiliation(s)
- Nazlee Siddiqui
- Australian Institute of Health Services Management (AIHSM), Tasmanian School of Business and Economics, University of Tasmania, Rozelle campus, Cnr Glover and Church Streets, Sydney, NSW 2039 Australia
| | - Mitchell Dwyer
- School of Health Sciences, University of Tasmania, Tasmania, Australia
| | - Jim Stankovich
- Health Services Innovation Tasmania, School of Medicine, University of Tasmania, Tasmania, Australia
| | - Gregory Peterson
- Health Services Innovation Tasmania, School of Medicine, University of Tasmania, Tasmania, Australia
| | - David Greenfield
- Australian Institute of Health Services Management (AIHSM), Tasmanian School of Business and Economics, University of Tasmania, Rozelle campus, Cnr Glover and Church Streets, Sydney, NSW 2039 Australia
| | - Lei Si
- Centre for the Health Economy, Macquarie University, Sydney, Australia
| | - Leigh Kinsman
- Conjoint appointment, University of Tasmania and Tasmanian Health Service (North), Tasmania, Australia
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Łaszewska A, Österle A, Wancata J, Simon J. Prevalence of mental diseases in Austria : Systematic review of the published evidence. Wien Klin Wochenschr 2018; 130:141-150. [PMID: 29368240 PMCID: PMC5816100 DOI: 10.1007/s00508-018-1316-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 01/08/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Addressing the growing burden of mental diseases is a public health priority. Nevertheless, many countries lack reliable estimates of the proportion of the population affected, which are crucial for health and social policy planning. This study aimed to collect existing evidence on the prevalence of mental diseases in Austria. METHODS A systematic review was conducted using MeSH, EMTREE and free-text terms in seven bibliographic databases. In addition, the references of included papers and relevant Austria-specific websites were searched. Articles published after 1996 pertaining to the Austrian adult population and presenting prevalence data for mental diseases were included in the analysis. RESULTS A total of 2612 records were identified in the database search, 19 of which were included in the analysis, 13 were community-based studies and 6 examined institutionalized populations. Sample sizes ranged from 200 to 15,474. The evidence was centered around depression (n = 6, 32%), eating disorders (n = 4, 21%) and alcohol dependence (n = 3, 16%). While most studies (n = 10, 53%) used questionnaires and scales to identify mental diseases, seven studies used structured clinical interviews, and two studies examined use of psychotropic drugs. Due to the diversity of methodologies, no statistical pooling of prevalence estimates was possible. CONCLUSION Information on the prevalence of mental diseases in Austria is limited and comparability between studies is restricted. A variety of diagnostic instruments, targeted populations and investigated diseases contribute to discrepancies in the prevalence rates. A systematic, large-scale study on the prevalence of mental diseases in Austria is needed for comprehensive and robust epidemiological evidence.
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Affiliation(s)
- Agata Łaszewska
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/I, 1090 Vienna, Austria
| | - August Österle
- Institute for Social Policy, Vienna University of Economics and Business, Welthandelsplatz 1, 1020 Vienna, Austria
| | - Johannes Wancata
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18–20, 1090 Vienna, Austria
| | - Judit Simon
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/I, 1090 Vienna, Austria
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Wolff J, Heister T, Normann C, Kaier K. Hospital costs associated with psychiatric comorbidities: a retrospective study. BMC Health Serv Res 2018; 18:67. [PMID: 29382387 PMCID: PMC5791176 DOI: 10.1186/s12913-018-2892-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 01/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Psychiatric comorbidities are relevant for the diagnostic and therapeutic regimes in somatic hospital care. The main aim of this study was to analyse the association between psychiatric comorbidities and hospital costs per inpatient episode. A further aim was to discuss and address the methodological challenges in the estimation of these outcomes based on retrospective data. METHODS The study included 338,162 inpatient episodes consecutively discharged between 2011 and 2014 at a German university hospital. We used detailed resource use data to calculate day-specific hospital costs. We adjusted analyses for sex, age, somatic comorbidities and main diagnoses. We addressed potential time-related bias in retrospective diagnosis data with sensitivity analyses. RESULTS Psychiatric comorbidities were associated with an increase in hospital costs per episode of 40% and an increase of reimbursement per episode of 28%, representing marginal effects of 1344 € and 1004 €, respectively. After controlling for length of stay, sensitivity analyses provided a lower bound increase in daily costs and reimbursement of 207 € and 151 €, respectively. CONCLUSION If differences in hospital costs between patient groups are not adequately accounted for in DRG-systems, perverse incentives are created that can reduce the efficiency of care. Therefore, we suggest intensifying the inclusion of psychiatric comorbidities in the German DRG system. Future research should investigate the appropriate inclusion of psychiatric comorbidities in other health care systems' payment schemes.
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Affiliation(s)
- Jan Wolff
- Department of Psychiatry and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
- Department of Controlling, Evangelical Foundation Neuerkerode, Braunschweig, Germany
| | - Thomas Heister
- Institute for Medical Biometry and Statistics, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Claus Normann
- Department of Psychiatry and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Klaus Kaier
- Institute for Medical Biometry and Statistics, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
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Chen KY, Evans R, Larkins S. Why are hospital doctors not referring to Consultation-Liaison Psychiatry? - a systemic review. BMC Psychiatry 2016; 16:390. [PMID: 27829386 PMCID: PMC5103418 DOI: 10.1186/s12888-016-1100-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 10/28/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Consultation-Liaison Psychiatry (CLP) is a subspecialty of psychiatry that provides care to inpatients under non-psychiatric care. Despite evidence of benefits of CLP for inpatients with psychiatric comorbidities, referral rates from hospital doctors remain low. This review aims to understand barriers to CLP inpatient referral as described in the literature. METHODS We searched on Medline, PsychINFO, CINAHL and SCOPUS, using MESH and the following keywords: 1) Consultation-Liaison Psychiatry, Consultation Liaison Psychiatry, Consultation Psychiatry, Liaison Psychiatry, Hospital Psychiatry, Psychosomatic Medicine, the 2) Referral, Consultation, Consultancy and 3) Inpatient, Hospitalized patient, Hospitalized patient. We considered papers published between 1 Jan 1965 and 30 Sep 2015 and all articles written in English that contribute to understanding of barriers to CLP referral were included. RESULTS Thirty-five eligible articles were found and they were grouped thematically into three categories: (1) Systemic factors; (2) Referrer factors; (3) Patient factors. Systemic factors that improves referrals include a dedicated CLP service, active CLP consultant and collaborative screening of patients. Referrer factors that increases referrals include doctors of internal medicine specialty and comfortable with CLP. Patients more likely to be referred tend to be young, has psychiatric history, live in an urban setting or has functional psychosis. CONCLUSION This is the first systematic review that examines factors that influence CLP inpatient referrals. Although there is research in this area, it is of limited quality. Education could be provided to hospital doctors to better recognise mental illness. Collaborative screening of vulnerable groups could prevent inpatients from missing out on psychiatric care. CLP clinicians should use the knowledge gained in this review to provide quality engagement with referrers.
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Affiliation(s)
- Kai Yang Chen
- James Cook University, 1 James Cook Drive, Townsville, QLD 4811, Australia. .,Townsville Hospital and Health Service, 100 Angus Smith Drive, Townsville, QLD 4814, Australia.
| | - Rebecca Evans
- James Cook University, 1 James Cook Drive, Townsville, QLD 4811 Australia
| | - Sarah Larkins
- James Cook University, 1 James Cook Drive, Townsville, QLD 4811 Australia
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Freidl M, Benda N, Friedrich F. Psychiatric illness and length of stay in general hospitals: do case finding methods matter? NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT ÖSTERREICHISCHER NERVENÄRZTE UND PSYCHIATER 2015; 29:77-83. [PMID: 25917540 DOI: 10.1007/s40211-015-0144-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 03/17/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Several prior studies have investigated whether patients with "non-cognitive" mental disorders (i.e., organic disorders, substance abuse, delirium, and psychotic disorders excluded) have longer Length Of Stay (LOS) than mentally healthy individuals in nonpsychiatric hospital settings. These studies yielded contrasting results. The present paper aims to examine whether methods of psychiatric case finding can explain these differences. METHODS Using the Clinical Interview Schedule (CIS) and the General Health Questionnaire (GHQ), 462 in-patients of medical, surgical, gynecological, and rehabilitation departments were assessed for the presence of psychiatric disorders. RESULTS In multiple regression analysis, all CIS-cases together did not show an association with LOS. Of the diagnostic groups assessed by CIS only major depression showed a significantly prolonged LOS. Using the GHQ sum-score as a continuous variable, LOS was significantly increased while using the GHQ as a dichotomous variable did not show such an association. After removing those suffering from multiple psychiatric diagnoses (such as major depression co-morbid with organic mental illness), none of the case definitions showed a significant association with LOS. CONCLUSIONS It seems that different case finding methods yield different results concerning the association of psychiatric disorders with LOS. When interpreting these results the small size of some subsamples must be taken into consideration.
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Affiliation(s)
- Marion Freidl
- Klinische Abteilung für Sozialpsychiatrie, Univ.-Klinik für Psychiatrie und Psychotherapie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Vienna, Austria,
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Maeda T, Babazono A, Nishi T, Tamaki K. Influence of psychiatric disorders on surgical outcomes and care resource use in Japan. Gen Hosp Psychiatry 2014; 36:523-7. [PMID: 24973124 DOI: 10.1016/j.genhosppsych.2014.05.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 05/13/2014] [Accepted: 05/14/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of this study was to quantify the effects of psychiatric disorders on major surgery outcomes and care resource use. METHODS This study adopted a retrospective cohort study design. The samples consisted of hospital stays. Subjects were patients who had undergone major surgery. We used multilevel regression analysis to quantify the influence of psychiatric disorders on major surgery outcomes and care resource use. RESULTS The total number of hospital stays included in the study was 5569, of which 250 were patients with psychiatric disorders. Compared with those without psychiatric disorders, those with schizophrenia had a significantly higher risk of complications, and those with neurotic disorder tended to have fewer complications. Total cost was significantly higher for those with schizophrenia and mood disorder and significantly lower in those with neurotic disorder. Lengths of stay were significantly longer for those with schizophrenia and mood disorder but not for those with neurotic disorder. Post-surgical mortality was equivalent among those with any psychiatric disorder and among those without a psychiatric disorder. CONCLUSION The study revealed that surgical outcomes and care resource use are differentiated by psychiatric disorders.
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Affiliation(s)
- Toshiki Maeda
- Department of Healthcare Administration and Management, Graduate School of Healthcare Sciences, Kyushu University, Fukuoka 812-8581, Japan.
| | - Akira Babazono
- Department of Healthcare Administration and Management, Graduate School of Healthcare Sciences, Kyushu University, Fukuoka 812-8581, Japan.
| | - Takumi Nishi
- Department of Healthcare Administration and Management, Graduate School of Healthcare Sciences, Kyushu University, Fukuoka 812-8581, Japan.
| | - Kazumitsu Tamaki
- Division of Internal Medicine, Okinawa Chubu Hospital, 281 Miyazato, Uruma, Okinawa 904-2293, Japan.
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Mather B, Roche M, Duffield C. Disparities in treatment of people with mental disorder in non-psychiatric hospitals: a review of the literature. Arch Psychiatr Nurs 2014; 28:80-6. [PMID: 24673780 DOI: 10.1016/j.apnu.2013.10.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 10/26/2013] [Accepted: 10/29/2013] [Indexed: 11/29/2022]
Abstract
People with mental disorder experience a heavy burden of physical ill-health. This, alongside structural health-system changes, means more people with mental disorder are being cared for in non-psychiatric hospitals. This article reports on 32 studies that have investigated the care and outcomes of people with comorbid mental and physical health problems in non-psychiatric hospitals. Prevalence of mental disorder ranged between 4%-46%, and rates of psychiatric referral was 2%-10%. The receipt of invasive cardiac procedures was markedly reduced for those with mental disorder. Likelihood of experiencing an adverse event, post-operative complication or increased length of stay was also elevated for those with mental disorder.
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Lancaster CA, Flynn HA, Johnson TRB, Marcus SM, Davis MM. Peripartum length of stay for women with depressive symptoms during pregnancy. J Womens Health (Larchmt) 2012; 19:31-7. [PMID: 20088656 DOI: 10.1089/jwh.2009.1383] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Approximately 1 in 10 women suffers from depression during pregnancy. Little is known about whether antepartum depression affects a mother's length of stay at delivery. We aimed to compare peripartum length of stay in women with and without depressive symptoms during pregnancy. METHODS This study involved secondary data analysis of a larger study exploring antepartum depression. Each subject completed the Center for Epidemiological Studies Depression Scale (CES-D). We used bivariate analyses to compare patient characteristics of women with and without an elevated CES-D, and we used a multivariate Poisson regression to evaluate predictors of length of stay. RESULTS The study sample included 867 pregnant women. Overall, 18% of study subjects scored >or=16 on the CES-D. In bivariate analyses, a longer stay was associated with an elevated CES-D and minority race, antepartum complications, cesarean delivery, prematurity, multiple gestation, and neonatal length of stay. In the final multivariate model adjusting for sociodemographic, antepartum, and obstetric factors, an elevated CES-D was associated with a significantly longer peripartum stay (0.26 days, CI 0.04-0.48). CONCLUSIONS Depressive symptoms during pregnancy predict an increase in peripartum length of stay.
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Affiliation(s)
- Christie A Lancaster
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan 48109-5604, USA.
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18
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Physician Staffing for the Practice of Psychosomatic Medicine in General Hospitals: A Pilot Study. PSYCHOSOMATICS 2010. [DOI: 10.1016/s0033-3182(10)70746-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Holden L, Scuffham P, Hilton M, Vecchio N, Whiteford H. Psychological distress is associated with a range of high-priority health conditions affecting working Australians. Aust N Z J Public Health 2010; 34:304-10. [PMID: 20618274 DOI: 10.1111/j.1753-6405.2010.00531.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Psychological distress is growing in prevalence in Australia. Comorbid psychological distress and/or depressive symptoms are often associated with poorer health, higher healthcare utilisation and decreased adherence to medical treatments. METHODS The Australian Work Outcomes Research Cost-benefit (WORC) study cross-sectional screening dataset was used to explore the association between psychological distress and a range of health conditions in a sample of approximately 78,000 working Australians. The study uses the World Health Organization Health and Productivity Questionnaire (HPQ), to identify self-reported health status. Within the HPQ is the Kessler 6 (K6), a six-item scale of psychological distress which strongly discriminates between those with and without a mental disorder. Potential confounders of age, sex, marital status, number of children, education level and annual income were included in multivariate logistic regression models. RESULTS Psychological distress was significantly associated with all investigated health conditions in both crude and adjusted estimates. The conditions with the strongest adjusted association were, in order from highest: drug and alcohol problems, fatigue, migraine, CVD, COPD, injury and obesity. CONCLUSIONS Psychological distress is strongly associated with all 14 health conditions or risk factors investigated in this study. Comorbid psychological distress is a growing public health issue affecting Australian workers.
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Affiliation(s)
- Libby Holden
- School of Medicine, Griffith University, University Drive, Meadowbrook, QLD 4131.
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de Moraes VY, Jorge MR, Faloppa F, Belloti JC. Anxiety and depression in Brazilian orthopaedics inpatients: a cross sectional study with a clinical sample comparison. J Clin Psychol Med Settings 2010; 17:31-7. [PMID: 20111986 DOI: 10.1007/s10880-009-9184-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
There are few studies on the development of anxiety and depression in orthopaedics and trauma (O&T) inpatients. We designed a cross-sectional study aimed at comparing the prevalence of depression and anxiety in 100 O&T inpatients and 100 clinical inpatients in the same hospital. O&T patients were divided into subgroups: trauma and non-trauma (arthroplasty, tumour, and infection sub grouping). We measured anxiety and depression by the Hospital Anxiety and Depression Scale and co-morbidities by the Charlson age-adjusted comorbidity index (CCI). For the trauma subgroup, AO/OTA fracture classification and Gustillo and Anderson grade of open fractures classification was applied. The prevalence of anxiety and depression was 35% and 28%, respectively for the clinical sample, and 44% and 33% for the O&T sample. Compared with the clinical sample, anxiety scores were higher in the O&T sample (p = .047), and in arthroplasty (p = .020) and trauma subgroups (p = .031). In the O&T sample, high CCI scores were associated with high anxiety scores (p = .033).
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Affiliation(s)
- Vinícius Ynoe de Moraes
- Department of Orthopaedics and Traumatology, Federal University of São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brazil.
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Ververs TF, van Wensen K, Freund MW, van der Heide M, Visser GHA, Schobben AFAM, de Jong-van den Berg LTW, Egberts ACG. Association between antidepressant drug use during pregnancy and child healthcare utilisation. BJOG 2009; 116:1568-77. [DOI: 10.1111/j.1471-0528.2009.02292.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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de Jonge P, Bel Hadj F, Boffa D, Zdrojewski C, Dorogi Y, So A, Ruiz J, Stiefel F. Prevention of Major Depression in Complex Medically Ill Patients: Preliminary Results From a Randomized, Controlled Trial. PSYCHOSOMATICS 2009; 50:227-33. [DOI: 10.1176/appi.psy.50.3.227] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Johnston ML, Cowman S. An examination of the services provided by Psychiatric Consultation Liaison Nurses in a general hospital. J Psychiatr Ment Health Nurs 2008; 15:500-7. [PMID: 18638211 DOI: 10.1111/j.1365-2850.2008.01264.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The political, professional and economic context in which mental health care is delivered has witnessed significant changes in recent times. The movement of psychiatric patients from institutions to community settings has seen the emphasis of the loci of care delivery shifting with increasing numbers presenting to general hospitals. The speciality of the Psychiatric Consultation Liaison Nurse (PCLN) has emerged as a bridge between mental health and general hospital services. A descriptive, non-experimental research approach was employed to establish patient profiles and to provide an overview of the depth of service provision. This design was selected as the most appropriate because of the limited information on the PCLN in an Irish setting and secondly, as the study was limited to one rural geographical location. A questionnaire was utilized to collate the details of patients who had received a mental health assessment. The findings presented here are the profiles of patients assessed by the PCLN during the 3-month study period. The results add further credence to the existing evaluative studies in presenting the characteristics of patients within the Irish context and further contribute to the unique body of evidence that defines the mental health nurse in an advancing role.
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Affiliation(s)
- M L Johnston
- Faculty of Nursing & Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland.
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Cohen LJ, Allen JC. Estimating the potential savings with vagus nerve stimulation for treatment-resistant depression: a payer perspective. Curr Med Res Opin 2008; 24:2203-17. [PMID: 18786301 DOI: 10.1185/03007990802229050] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To provide a formula estimating potential reductions in healthcare utilization costs with adjunctive vagus nerve stimulation (VNS Therapy) in treatment-resistant depression (TRD). METHODS This payer-perspective formula incorporates costs of treatment as usual for TRD patients from a published analysis of the MarketScan private payer claims database and the 2004 Medicare 5% standard analytic file. Estimated remission and response rates are from the published VNS pilot and pivotal studies. Costs were converted to 2008 US dollars per the US Bureau of Labor Statistics medical care costs, consumer price index. Device and implantation costs were calculated at $28,336. RESULTS From the MarketScan and pooled outcomes data (VNS pilot and pivotal studies), potential per patient savings (hospitalization directly and indirectly related to depression) was $2974 at 5 years of device life, $23,539 at 8 years (moderate cost reduction scenario); $12,914 at 5 years, $40,935 at 8 years (optimistic scenario). Corresponding break-even device life was 4.57 and 3.62 years, respectively. From the Medicare file and pooled outcomes, potential per patient savings (inpatient and outpatient directly and indirectly related to depression) was $8358 at 5 years of device life, $32,385 at 8 years (moderate scenario); $19,837 at 5 years, $52,473 at 8 years (optimistic scenario). Corresponding break-even device life was 3.96 and 3.18 years, respectively. CONCLUSIONS The formula allows an evaluation of expected reductions in healthcare costs as a function of input cost variables, efficacy rates, and benefit scenarios. Cited costs differ relative to care settings, diagnostic principles, and procedural volume. This formula can help assess moderate-to-longer-term economic benefits of VNS for a particular institution. Results suggested that potential reductions in healthcare costs with VNS for TRD may be substantial. Break-even device life for the scenarios presented ranges between 2.3 and 5.7 years.
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Affiliation(s)
- Lawrence J Cohen
- Washington State University College of Pharmacy, Spokane, WA 99210-1495, USA.
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Stiefel F, Zdrojewski C, Bel Hadj F, Boffa D, Dorogi Y, So A, Ruiz J, de Jonge P. Effects of a multifaceted psychiatric intervention targeted for the complex medically ill: a randomized controlled trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2008; 77:247-56. [PMID: 18443391 DOI: 10.1159/000129658] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND This study evaluated a multifaceted psychiatric intervention targeted at the complex medically ill identified by means of the INTERMED, an instrument to assess case complexity. METHODS Of 885 rheumatology inpatients and diabetes outpatients who were assessed for eligibility, 247 were identified as complex (INTERMED score >20) and randomized to the intervention (n = 125, 84 rheumatology and 41 diabetes patients) or care as usual (n = 122, 78 rheumatology and 44 diabetes patients). For the majority of the cases the multifaceted intervention consisted of an intervention conducted by a psychiatric liaison nurse and/or of referral to a liaison psychiatrist, followed by advice to the treating physician or organization of a multidisciplinary case conference. Baseline and follow-up at months 3, 6, 9 and 12 measured prevalence of major depression (Mini-International Neuropsychiatric Interview), depressive symptoms (Center for Epidemiological Studies Depression Rating Scale), physical and mental health (SF-36), quality of life (EuroQol), health care utilization and HbA(1c) levels (diabetic patients). RESULTS Prevalence of major depression was reduced from 61% (T0) to 28% (T4) in the intervention group and remained stable in care as usual (57% at T0 to 50% at T4). Compared to care as usual, significant improvement over time was observed in the intervention group with regard to depressive symptoms (F = 11.9; p = 0.001), perception of physical (F = 5.7; p = 0.018) and mental health (F = 3.9; p = 0.047) and quality of life (F = 21.8; p < 0.001). Effects tended to be stronger in diabetes patients, in patients with baseline major depression and in patients with moderate INTERMED scores. Finally, hospital admissions occurred less often in the intervention group, reaching statistical significance for the period between 6 and 9 months of follow-up (p = 0.02). CONCLUSIONS The results suggest that a psychiatric intervention targeted for complex medical patients can improve health outcomes.
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Affiliation(s)
- F Stiefel
- Service de Psychiatrie de Liaison, University Hospital of Lausanne, Lausanne, Switzerland.
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Greenberg-Dotan S, Reuveni H, Simon-Tuval T, Oksenberg A, Tarasiuk A. Gender differences in morbidity and health care utilization among adult obstructive sleep apnea patients. Sleep 2008; 30:1173-80. [PMID: 17910389 PMCID: PMC1978412 DOI: 10.1093/sleep/30.9.1173] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVE To explore gender differences in morbidity and total health care utilization 5 years prior to diagnosis of obstructive sleep apnea (OSA). DESIGN Case-control study; patients were recruited between January 2001 and April 2003. SETTING Two university-affiliated sleep laboratories. PATIENTS 289 women (22-81 years) with OSA were matched with 289 men with OSA for age, body mass index (BMI), and apnea-hypopnea index (AHI). All OSA patients were matched 1:1 with healthy controls by age, geographic area, and primary physician. MEASUREMENTS AND RESULTS Women with OSA compared to men with OSA have lower perceived health status and Functional Outcomes of Sleep Questionnaire score (54.5% vs. 28.4%, P <0.05 and 67.5+/-21.4 vs. 76+/-20.1, P <0.05, respectively). Compared to men with OSA, women with OSA have higher risk of hypothyroidism (OR 4.7; 95% CI, 2.3-10) and arthropathy (OR 1.6, 95% CI, 1.1-2.2) and lower risk for CVD (OR 0.7; 95% CI, 0.5-0.91). Compared to controls, both women and men with OSA had 1.8 times higher 5-year total costs (P <0.0001). Compared to men with OSA, expenditures for women with OSA are 1.3 times higher (P <0.0001). The multiple logistic regression (adjusting for BMI, AHI) revealed that age (OR 1.04; 95% CI, 1.01-1.07), antipsychotic and anxiolytic drugs (OR 2.3; 95% CI, 1.2-4.4), and asthma (OR 2.4; 95% CI, 1.1-5.6) are independent determinants for "most costly" OSA women. CONCLUSION Compared to men with similar OSA severity, women are heavier users of health care resources. Low FOSQ score and poor perceived health status in addition to overuse of psychoactive drugs are associated with high health care utilization among women with OSA.
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Affiliation(s)
- Sari Greenberg-Dotan
- Sleep-Wake Disorders Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, IsraelM
| | - Haim Reuveni
- Sleep-Wake Disorders Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, IsraelM
| | - Tzahit Simon-Tuval
- Sleep-Wake Disorders Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, IsraelM
| | - Arie Oksenberg
- Sleep Disorders Unit, Loewenstein Hospital-Rehabilitation Center, Ra'anana, Israel
| | - Ariel Tarasiuk
- Sleep-Wake Disorders Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, IsraelM
- Address correspondence to: Ariel Tarasiuk, PhD,
Sleep-Wake Disorders Unit, Soroka University Medical Center, PO Box 151, Beer-Sheva, 84105 Israel+972-8-640-3049+972-8-640-3886
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Guo Y, Young BL, Hainley S, Palmer JL, Bruera E. Evaluation and Pharmacologic Management of Symptoms in Cancer Patients Undergoing Acute Rehabilitation in a Comprehensive Cancer Center. Arch Phys Med Rehabil 2007; 88:891-5. [PMID: 17601470 DOI: 10.1016/j.apmr.2007.03.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To identify cancer patients' symptoms at admission and on discharge from an acute rehabilitation unit, to document the discharge medications used for symptom management, and to assess how symptoms affect lengths of stay (LOS). DESIGN Retrospective chart review. SETTING Acute inpatient rehabilitation unit within a tertiary cancer center. PARTICIPANTS Ninety-six patients (49 men, 47 women) were admitted to an acute inpatient rehabilitation unit. The median age was 64 years (range, 26-87y). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Edmonton Symptom Assessment Scale (ESAS) scores at admission and on discharge. RESULTS The most intense symptom (mean ESAS visual analog scale score +/- standard deviation) on admission was poor appetite (3.7+/-3.3), followed by fatigue (3.4+/-2.6). Similar results were found for the 63 patients with ESAS scores available at both time points. On discharge, poor appetite (2.2+/-2.4) was still the most intense symptom reported, again followed by fatigue (2.2+/-2.1). There were significant improvements in anxiety (P=.001), constipation (P=.001), fatigue (P=.002), pain (P=.003), appetite (P=.004), sense of well-being (P=.01), and insomnia (P=.04). Seventy percent (65/93) of patients received discharge prescriptions for symptom control, with analgesics being the most frequently prescribed. The poor appetite and depression admission scores correlated positively with hospital LOS (P<.001, P=.05, respectively). CONCLUSIONS Assessment of symptoms revealed significant symptom burdens in cancer patients undergoing rehabilitation. Pharmacologic interventions for management of symptoms were frequently needed.
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Affiliation(s)
- Ying Guo
- Department of Palliative Care and Rehabilitation Medicine, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
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Koopmans GT, Lamers LM. Gender and health care utilization: The role of mental distress and help-seeking propensity. Soc Sci Med 2007; 64:1216-30. [PMID: 17194514 DOI: 10.1016/j.socscimed.2006.11.018] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2005] [Indexed: 10/23/2022]
Abstract
Many studies report higher levels of health care utilization among women. Understanding how gender influences health care utilization is still unresolved. We developed a model that could explain these gender-related differences. The possible pathways assumed by this model that relate gender to utilization, can be summarized as follows: (1) utilization may be influenced by somatic morbidity, mental distress, perceived symptoms, poor subjective health and propensity to use services; (2) women have higher levels of these variables than men (mediating effect); and (3) the direct effects of some of these variables on utililization are moderated by gender, i.e. they are stronger for women than for men (moderating effect). Data were drawn from a community-based sample of adult enrollees of a sickness fund in the Netherlands, who had responded to a mailed health survey (N = 8698). This survey contained questions on somatic morbidity, mental distress and other mediating variables. Health care utilization was measured prospectively, using data extracted from a claims database held by the sickness fund that covers all types of general health services except general practitioner consultations. The model was tested using structural equation modelling. Women reported more somatic morbidity and mental distress than men did, as well as elevated levels of other mediating variables, which might explain-at least partly-gender related differences in utilization. Differences in propensity to use services were not found. The expected moderating effect of gender could not be demonstrated. That is, we did not find gender related differences in the strength of the relations between mental distress, other mediating variables and utilization. Mental distress is related to utilization in a way that is not gender specific, however, because women report higher levels of mental distress (as well as somatic morbidity), this results in a greater utilization of somatic health care services.
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Affiliation(s)
- Gerrit T Koopmans
- Department of Health Policy and Management, Erasmus University Medical Center, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands.
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Koopmans GT, Lamers LM. Is the impact of depressive complaints on the use of general health care services dependent on severity of somatic morbidity? J Psychosom Res 2006; 61:41-50. [PMID: 16813844 DOI: 10.1016/j.jpsychores.2005.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2005] [Revised: 12/12/2005] [Accepted: 12/13/2005] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of this study was to examine the effects of depressive complaints and chronic medical illnesses on prospective somatic health care utilization and the possible heterogeneity of the effect of depressive complaints across levels of medical illness severity. METHODS Data from a community-based sample of adults (n=9428) were used, of whom a health survey and claims data, indicating health care use, were available. Assessments of depressive complaints and somatic illnesses were based on self-report. Binomial regression analyses were used to study the expected relations. RESULTS Depressive complaints and somatic morbidity were both positively related to general health care utilization. Somatic morbidity has an attenuating effect on the impact of depressive complaints: If it becomes more severe, the impact of depressive complaints on utilization is reduced. Depressive complaints are especially related to the use of paramedic services, use of prescription drugs, and consultations of medical specialists. CONCLUSION Depressive complaints predict somatic health care utilization, but somatic morbidity attenuates this relation. Future research on this subject should include interaction effects of depressive complaints and somatic morbidity. Interventions aiming to reduce excess use related to mental distress should be primarily targeted on subjects with mental distress who have no comorbid somatic morbidity.
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Affiliation(s)
- Gerrit T Koopmans
- Department of Health Policy and Management, Erasmus University Medical Center, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands.
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Tew JD. Post-hospitalization transitional care needs of depressed elderly patients: models for improvement. Curr Opin Psychiatry 2005; 18:673-7. [PMID: 16639096 DOI: 10.1097/01.yco.0000186813.01202.ec] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW In the weeks immediately following psychiatric hospital discharge, severely depressed elderly patients are at risk of 'falling through the cracks' in a complex health care system: becoming lost to follow-up, receiving inadequate care, or requiring prompt readmission. The purpose of this review is to highlight recent literature on the comorbid physical health problems and complex care needs of elderly patients hospitalized for depression. This paper will also review recent initiatives to improve the quality of care transitions for elderly patients discharged from medical hospitals that may be adaptable to a severely depressed population. RECENT FINDINGS Due to shorter hospital stays, comorbid physical health problems, and limitations in functional capacity, severely depressed elderly patients discharged from psychiatric hospitals have complex service needs, and numerous barriers to care, immediately following hospital discharge. There is a lack of research specifically addressing the transitional care needs of this population. Improvement interventions assigning transitional care providers to chronically medically ill elderly patients immediately after medical hospital discharge have shown decreased rates of rehospitalization and emergency services utilization, and appear to be cost-effective. SUMMARY Further research is needed to adapt successful transitional care interventions targeting chronically ill elderly patients in medical hospitals to severely depressed elderly patients being discharged from psychiatric hospitals.
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Affiliation(s)
- James D Tew
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.
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