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Reid N, Mason J, Kurdyak P, Nisenbaum R, de Oliveira C, Hwang S, Stergiopoulos V. Evaluating the Impact of a Critical Time Intervention Adaptation on Health Care Utilization among Homeless Adults with Mental Health Needs in a Large Urban Center. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:57-66. [PMID: 33611924 PMCID: PMC8811242 DOI: 10.1177/0706743721996114] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study evaluated the impact of a critical time intervention (CTI) adaptation on health care utilization outcomes among adults experiencing homelessness and mental health needs in a large urban center. METHODS Provincial population-based administrative data from Ontario, Canada, were used in a pre-post design for a cohort of 197 individuals who received the intervention between January 2013 and May 2014 and were matched to a cohort of adults experiencing homelessness who did not receive the intervention over the same time period. Changes in health care utilization outcomes in the year pre- and postintervention were evaluated using generalized estimating equations, and post hoc analyses evaluated differences between groups. RESULTS Pre-post analyses revealed statistically significant changes in health care utilization patterns among intervention recipients, including reduced inpatient service use and increased outpatient service use in the year following the intervention compared to the year prior. However, the matched cohort analysis found nonsignificant differences in health service use changes between a subgroup of intervention recipients and their matched counterparts. CONCLUSIONS An adapted CTI model was associated with changes in health care utilization among people experiencing homelessness and mental health needs. However, changes were not different from those observed in a matched cohort. Rigorous study designs with adequate samples are needed to examine the effectiveness of CTI and local adaptations in diverse health care contexts.
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Affiliation(s)
- Nadine Reid
- 7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Joyce Mason
- 7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Mental Health and Addictions Research Program, ICES, Toronto, Ontario, Canada
| | - Paul Kurdyak
- Mental Health and Addictions Research Program, ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Rosane Nisenbaum
- Li Ka Shing Knowledge Institute, 10071St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Claire de Oliveira
- Mental Health and Addictions Research Program, ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Centre for Health Economics, Hull York Medical School, University of York, York, UK
| | - Stephen Hwang
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, 10071St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Populations and Public Health Research Program, ICES, Toronto, Ontario, Canada
| | - Vicky Stergiopoulos
- 7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, 10071St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
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2
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Boora N, Surood S, Coulombe J, Poudel S, Agyapong VIO. Improving community care for patients discharged from hospital through zone-wide implementation of a seamless care transition policy. Int J Qual Health Care 2021; 33:6272219. [PMID: 33963413 PMCID: PMC8161518 DOI: 10.1093/intqhc/mzab079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 04/15/2021] [Accepted: 05/06/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Several studies within the psychiatry literature have illustrated the importance of discharge planning and execution, as well as accessibility of outpatient follow-up post-discharge. We report the results of implementing a new seamless care transition policy to expedite post-discharge follow-up in the community Addiction and Mental Health (AMH) program in the Edmonton Zone, Alberta, Canada. The policy involved a distribution mechanism for assessment by a mental health therapist (MHT) within 7 days of discharge as well as a dedicated roster of community psychiatrists to accept newly discharged patients. OBJECTIVE Our aim was to assess the feasibility of this novel policy and to assess its effect on our outcome measures of wait time to first outpatient MHT assessment and re-admission rate to hospital. METHODS Our study involved a retrospective clinical audit with total sampling design and a comparison of data 1 year before (2015/2016 fiscal year) and 1 year after (2017/2018 fiscal year) the implementation of the seamless care policy within the Edmonton Zone. Extracted data were analyzed with simple descriptive statistics and presented as percentages, mean and median. RESULTS Overall, with the enactment of this policy, follow-up volumes ultimately increased, while wait times for initial assessment decreased on average for patients discharged from the hospital. In the 2015/2016 fiscal year, MHT completed 128 assessments of post-discharge patients who were new to the community AMH program compared to 298 completed new assessments for the 2017/2018 fiscal year. The corresponding wait times for the new MHT assessments were 12.7 days (median of 12 days) and 7.8 days (median of 6 days), respectively. Similarly, psychiatrists completed only 59 assessments of post-discharge patients who were new to AMH compared to 133 new psychiatric assessments for the 2017/2018 fiscal year. The corresponding wait times for the new psychiatric assessments were 15.3 days (median of 14 days) and 8.8 days (median of 7 days), respectively. We correspondingly found a slight decline in readmission rates after the implementation of our model in the subsequent fiscal year. CONCLUSION We envision that this policy will set a precedent with regard to streamlining post-discharge follow-up care for admitted inpatients, ultimately improving mental health outcomes for patients.
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Affiliation(s)
- Naveenjyote Boora
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, 8440 112 St NW, Edmonton AB T6G 2B7, Canada
| | - Shireen Surood
- Alberta Health Services, Addiction and Mental Health, 9942 - 108 Street, Edmonton AB T5K 2J5, Canada
| | - Jeff Coulombe
- Alberta Health Services, Addiction and Mental Health, 9942 - 108 Street, Edmonton AB T5K 2J5, Canada
| | - Surya Poudel
- Alberta Health Services, Addiction and Mental Health, 9942 - 108 Street, Edmonton AB T5K 2J5, Canada
| | - Vincent I O Agyapong
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, 8440 112 St NW, Edmonton AB T6G 2B7, Canada.,Alberta Health Services, Addiction and Mental Health, 9942 - 108 Street, Edmonton AB T5K 2J5, Canada
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3
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Akram F, Rosales M, Chaudhuri S, Mansouripour SM, Sharif U, Maqsood A, Wadhawan A, Mohyuddin F, Mukhtar F. Predictors of civil and forensic inpatient psychiatric readmissions at a Public Mental Health Hospital. Psychiatry Res 2020; 293:113447. [PMID: 32977046 DOI: 10.1016/j.psychres.2020.113447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 09/07/2020] [Indexed: 11/26/2022]
Abstract
Inpatient psychiatric readmissions are increasingly prevalent and associated with worse prognostic outcomes and high economic costs, regardless of the medicolegal ramifications that necessitate them. Unlike most general medical readmissions, psychiatric readmissions are commonly warranted for both medical and legal purposes. However, studies focusing on analyzing the predictors of inpatient psychiatric readmission and their relationship to civil versus forensic readmission are limited. The purpose of this study was to examine the predictors of psychiatric readmission among civil and forensic patients admitted to a psychiatric hospital. In this retrospective chart review, we extrapolated data from medical records of 741 patients admitted from 2012 to 2017 with follow up until 2019. Analyses involved chi-square tests for comparing the distribution of demographic and clinical variables between forensic and civil readmission, and Cox regression to determine predictors of time to first readmission. Our results show that race, diagnosis, restraint/seclusion, type of admission, and disposition are significantly associated with an increased risk of psychiatric readmission. This study has important implications for healthcare providers and policy makers in revising mental health policies and improving systems-based practices for the mental health system. Future efforts in improving community psychiatric services and enhancing inpatient therapeutic environment may reduce psychiatric readmissions.
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Affiliation(s)
- Faisal Akram
- Saint Elizabeths Hospital, DC Department of Behavioral Health, Washington, DC, United States; Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Marianela Rosales
- Department of Psychiatry, Temple University, Philadelphia, PA, United States
| | - Sanjay Chaudhuri
- Department of Psychiatry, Penn State University, Hershey, PA, United States
| | - Seyed M Mansouripour
- Saint Elizabeths Hospital, DC Department of Behavioral Health, Washington, DC, United States
| | - Usman Sharif
- Department of Psychiatry, Berkshire Medical Center, Pittsfield, MA, United States
| | - Anum Maqsood
- Department of Internal Medicine, Howard University Hospital, Washington DC, United States
| | - Abhishek Wadhawan
- Saint Elizabeths Hospital, DC Department of Behavioral Health, Washington, DC, United States
| | - Farooq Mohyuddin
- Saint Elizabeths Hospital, DC Department of Behavioral Health, Washington, DC, United States
| | - Fahad Mukhtar
- Saint Elizabeths Hospital, DC Department of Behavioral Health, Washington, DC, United States.
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4
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Stergiopoulos V, Gozdzik A, Nisenbaum R, Durbin J, Hwang SW, O'Campo P, Tepper J, Wasylenki D. Bridging Hospital and Community Care for Homeless Adults with Mental Health Needs: Outcomes of a Brief Interdisciplinary Intervention. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:774-784. [PMID: 29716396 PMCID: PMC6299183 DOI: 10.1177/0706743718772539] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study examines health and service use outcomes and associated factors among homeless adults participating in a brief interdisciplinary intervention following discharge from hospital. METHOD Using a pre-post cohort design, 223 homeless adults with mental health needs were enrolled in the Coordinated Access to Care for the Homeless (CATCH) program, a 4- to 6-month interdisciplinary intervention offering case management, peer support, access to primary psychiatric care, and supplementary community services. Study participants were interviewed at program entry and at 3- and 6-month follow-up visits and assessed for health status, acute care service use, housing outcomes, mental health, substance use, quality of life, and their working alliance with service providers. Linear mixed models and generalized estimating equations were performed to examine outcomes longitudinally. Additional post hoc analyses evaluated differences between CATCH participants and a comparison group of homeless adults experiencing mental illness who received usual services over the same period. RESULTS In the pre-post analyses, CATCH participants had statistically significant improvements in mental and physical health status and reductions in mental health symptoms, substance misuse, and the number of hospital admissions. The strength of the working alliance between participants and their case manager was associated with reduced health care use and mental health symptoms. Post hoc analyses suggest that CATCH may be associated with statistically significant improvements in mental health symptoms in the study population. CONCLUSIONS A brief interdisciplinary intervention may be a promising approach to improving health outcomes among homeless adults with unmet health needs. Further rigorous research is needed into the effectiveness of brief interventions following discharge from hospital.
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Affiliation(s)
- Vicky Stergiopoulos
- 1 Centre for Addiction and Mental Health, Toronto, Ontario.,2 Department of Psychiatry, University of Toronto, Toronto, Ontario.,3 Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario
| | - Agnes Gozdzik
- 3 Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario
| | - Rosane Nisenbaum
- 3 Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario.,4 Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
| | - Janet Durbin
- 1 Centre for Addiction and Mental Health, Toronto, Ontario.,5 University of Toronto, Toronto, Ontario
| | - Stephen W Hwang
- 3 Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario.,6 Faculty of Medicine, University of Toronto, Toronto, Ontario.,7 Division of General Internal Medicine, University of Toronto, Toronto, Ontario
| | - Patricia O'Campo
- 3 Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario.,4 Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
| | | | - Don Wasylenki
- 2 Department of Psychiatry, University of Toronto, Toronto, Ontario.,9 St. Michael's Hospital, Toronto, Ontario
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5
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Smith MW, Stocks C, Santora PB. Hospital readmission rates and emergency department visits for mental health and substance abuse conditions. Community Ment Health J 2015; 51:190-7. [PMID: 25563483 DOI: 10.1007/s10597-014-9784-x] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 11/24/2014] [Indexed: 11/30/2022]
Abstract
Community hospital stays in 12 states during 2008-2009 were analyzed to determine predictors of 12-month hospital readmission and emergency department (EDs) revisits among persons with a mental health or substance abuse diagnosis. Probabilities of hospital readmission and of ED revisits were modeled as functions of patient demographics, insurance type, number of prior-year hospital stays, diagnoses and other characteristics of the initial stay, and hospital characteristics. Alcohol or drug dependence, dementias, psychotic disorders, autism, impulse control disorders, and personality disorders were most strongly associated with future inpatient admission or ED revisits within 12 months of initial encounter. Insurance type, including uninsured status, were highly significant (p<.01) predictors of both readmission and ED revisits.
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6
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Olson-Madden JH, Homaifar BY, Hostetter TA, Matarazzo BB, Huggins J, Forster JE, Schneider AL, Nagamoto HT, Corrigan JD, Brenner LA. Validating the Traumatic Brain Injury-4 Screening Measure for Veterans Seeking Mental Health Treatment With Psychiatric Inpatient and Outpatient Service Utilization Data. Arch Phys Med Rehabil 2014; 95:925-9. [DOI: 10.1016/j.apmr.2014.01.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 01/08/2014] [Accepted: 01/10/2014] [Indexed: 11/24/2022]
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7
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Maritz J. Follow-up of Mental Care Users by Nurses in the Primary Care Setting in South Africa. JOURNAL OF PSYCHOLOGY IN AFRICA 2014. [DOI: 10.1080/14330237.2010.10820343] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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8
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Schubart CD, Boks MPM, Breetvelt EJ, van Gastel WA, Groenwold RHH, Ophoff RA, Sommer IEC, Kahn RS. Association between cannabis and psychiatric hospitalization. Acta Psychiatr Scand 2011; 123:368-75. [PMID: 21198455 DOI: 10.1111/j.1600-0447.2010.01640.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the relationship between cannabis use and mental health. METHOD A cross-sectional analysis in a sample of 17 698 individuals with a mean age of 22 years (SD: 4.2). Participants provided information on the amount and initial age of cannabis use and history of psychiatric hospitalizations through a web-based questionnaire. To quantify Δ(9) -tetrahydrocannabinol exposure, we operationalized cannabis use as the amount of money spent on cannabis per week over the last month. The odds ratio of having a history of psychiatric hospitalizations was the primary outcome measure. RESULTS We found a dose-response relationship between the amount of cannabis use and the odds for psychiatric hospitalization. Adjusted odds ratios for hospitalization increased with the amount of cannabis consumed from 1.6 (95% CI: 1.1-2.3) in incidental users to 6.2 (95% CI: 4.3-8.9) in heavy users (>€25/week). Our data suggested that concomitant drug use was an intermediate factor. Exposure to cannabis before the age of 12 years was found to carry a 4.8 (95% CI: 2.9-7.8) times increased odds for past psychiatric hospitalizations. CONCLUSION We conclude that early and heavy uses of cannabis are each and independently associated with poor mental health in its users.
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Affiliation(s)
- C D Schubart
- Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Center, Utrecht, The Netherlands.
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9
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Gianfrancesco F, Rajagopalan K, Goldberg JF, Wang RH. Hospitalization risks in the treatment of bipolar disorder: comparison of antipsychotic medications. Bipolar Disord 2007; 9:252-61. [PMID: 17430300 DOI: 10.1111/j.1399-5618.2007.00394.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study compared the relative risk for hospitalization of patients with bipolar and manic disorders receiving atypical and typical antipsychotics. METHODS This retrospective study was based on administrative claims data extracted from the PharMetrics database during 1999 through 2003. Comparisons were made among atypical antipsychotics (risperidone, olanzapine, quetiapine or ziprasidone), as well as between each of these versus a combined group of the leading typical antipsychotics. Relative risk for hospitalization was estimated with Cox proportional regression, which adjusted for differences in patient characteristics. RESULTS Risperidone and olanzapine demonstrated higher risks for hospitalization than quetiapine [hazard ratio (HR) 1.19, p < 0.05 for both], translating into higher annual mental health inpatient charges of $260 per patient. Risperidone and olanzapine also showed higher estimated risks than ziprasidone, which approached the p < 0.05 threshold. Differences between each of the atypicals and the combined typicals were not significant. Patients with putative rapid cycling had a threefold greater risk for hospitalization than other patients with bipolar disorder. In these patients, comparisons among atypical antipsychotics showed that risperidone had a significantly higher hospitalization risk than olanzapine (HR 3.31, p < 0.05), resulting in higher annual mental health inpatient charges of $4,930 per patient. CONCLUSIONS In the treatment of bipolar and manic disorders, risperidone and olanzapine were associated with a higher risk for hospitalization than quetiapine, and possibly ziprasidone. In the treatment of putative rapid cyclers, olanzapine was associated with a lower risk for hospitalization than risperidone.
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10
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Gianfrancesco F, Wang RH, Pesa J, Rajagopalan K. Hospitalisation risks in the treatment of schizophrenia in a Medicaid population: comparison of antipsychotic medications. Int J Clin Pract 2006; 60:1419-24. [PMID: 17073838 DOI: 10.1111/j.1742-1241.2006.01161.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
This study used administrative claims data to compare the relative risks for hospitalisation among patients with schizophrenia within a US Medicaid programme receiving atypical and typical antipsychotics. The newer atypical antipsychotics may be better tolerated among mentally ill patients receiving public assistance (Medicaid) who are less functional than other mentally ill populations. Risperidone, olanzapine, quetiapine and ziprasidone were compared with each other and to typical antipsychotics as a single category. Cox proportional hazard estimates, adjusted for differences in patient characteristics, showed numerically lower risks for each of the atypicals in comparison with the typicals, with that for quetiapine being statistically significant (HR: 0.672, p = 0.0413). There were no statistically significant differences among atypical pairs. This study provides evidence that risk for hospitalisation among Medicaid patients with schizophrenia may be lower with atypical antipsychotics, particularly quetiapine.
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Gianfrancesco F, Rajagopalan K, Wang RH. Hospitalization risks in the treatment of schizophrenia: comparison of antipsychotic medications. J Clin Psychopharmacol 2006; 26:401-4. [PMID: 16855459 DOI: 10.1097/01.jcp.0000231536.79175.cd] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study used administrative claims data to compare the relative risks for hospitalization among commercially insured patients with schizophrenia receiving atypical and typical antipsychotic drugs. Cox proportional hazard regression estimates, adjusted for differences in patient characteristics, suggested that among patients treated with the 4 atypical antipsychotic drugs, only olanzapine had a significantly higher risk for hospitalization than the typical antipsychotic drugs (hazard ratio [HR], 1.81; 95% confidence interval [CI], 1.20-2.75). In addition, risk for hospitalization with olanzapine was significantly higher than that for risperidone (HR, 1.34; 95% CI, 1.03-1.74) and numerically higher than that for quetiapine (HR, 1.40; 95% CI, 0.94-2.07). Overall, olanzapine was associated with a higher risk for hospitalization than the typical antipsychotic drugs and among the atypical antipsychotic drugs, risperidone and, potentially, quetiapine.
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Affiliation(s)
- Frank Gianfrancesco
- Hecon Associates Inc., 9833 Whetstone Drive, Montgomery Village, MD 20886, USA.
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Min MO, Biegel DE, Johnsen JA. Predictors of psychiatric hospitalization for adults with co-occurring substance and mental disorders as compared to adults with mental illness only. Psychiatr Rehabil J 2005; 29:114-21. [PMID: 16268006 DOI: 10.2975/29.2005.114.121] [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] [Indexed: 11/17/2022]
Abstract
Predictors of psychiatric hospitalization, predisposing, enabling and need, of adults with co-occurring mental and substance disorders were compared to predictors for adults with a mental illness only. Research participants were 1613 users of crisis intervention services. Findings using Cox regression show that dually-diagnosed individuals were more likely to be hospitalized. Enabling and need factors were important predictors for both groups. Disruptive behavior was a predictor for dually-diagnosed clients but not for clients with mental illness only. Findings suggest that outpatient mental health services are less well equipped to address a psychiatric crisis when it was accompanied by substance use issues.
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Affiliation(s)
- Meeyoung Oh Min
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH 44106-7164, USA.
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