Emergency Departments as Care Providers for Patients with Cardiac Ambulatory Care Sensitive and Mental Health Conditions: Qualitative Interview and Focus Group Study with Patients and Physicians

Prevalence and management of depressive symptoms in coronary heart disease patients and relationship with cardiovascular prognosis: a prospective cohort study

AIMS

Depressive symptoms are comorbid with coronary heart disease (CHD). There is a controversial debate about whether screening and intervention for depressive symptoms could improve cardiovascular prognosis. This study characterizes the prevalence, characteristics, cardiovascular prognosis and management need of depressive symptoms among CHD patients.

METHODS

CHD patients were recruited between November 18, 2020 and November 26, 2021. Depressive symptoms were evaluated with the Patient Health Questionnaire (PHQ-9). During the 12-month follow-up, cardiovascular disease (CVD) was the endpoint. Time-to-event data were estimated by Kaplan-Meier curves and Cox models.

RESULTS

Of 582 patients (25% women), 21.0% had mild depressive symptoms, and 7.5% had moderate-to-severe depressive symptoms during hospitalization. Mild and moderate-to-severe depressive symptoms were risk factor-adjusted predictors of the primary composite endpoints (adjusted HR = 2.20; 95%CI 1.19-4.03, and adjusted HR = 2.70; 95%CI 1.23-5.59, respectively). Platelet count and low-density lipoprotein were higher in mild depressive symptoms compared to no depressive symptoms.

CONCLUSION

Depressive symptoms are prevalent in CHD patients. Mild and moderate-to-severe depressive symptoms are associated with higher risk of further CVD in CHD patients. Platelet function and behavioral mechanisms may contribute to this association.

TRIAL REGISTRATION

This research was registered at https://www.chictr.org.cn . Full data of first registration is 11/09/2020. The registration number is ChiCTR2000038139.

Patients pathways before and after treatments in emergency departments: A retrospective analysis of secondary data in Germany

Increasing emergency department (ED) utilization induces considerable pressure on ED staff and organization in Germany. Reasons for certain ED attendances are seen partly in insufficient continuity of care outside of hospitals. To explore the health care patterns before and after an ED attendance in Germany, we used claims data from nine statutory health insurance funds, covering around 25 % of statutory health insurees (1). We descriptively analyzed ED attendances for adult patients in 2016 according to their sociodemographic characteristics and diagnoses (2). Based on the ED attendance as initial event, we investigated health care provider utilization 180 days before and after the respective ED treatment and are presented by means of Sankey diagrams. In total, 4,757,536 ED cases of 3,164,343 insured individuals were analyzed. Back pain was the most frequent diagnosis in outpatient ED cases (5.0 %), and 80.2 % of the patients visited primary care physicians or specialists 180 days before and 78.8 % 180 days after ED treatment. Among inpatient cases, heart failure (4.6 %) was the leading diagnosis and 74.6 % used primary care physicians or specialists 180 days before and 65.1 % 180 days after ED treatment. The ED re-attendance slightly increased for back pain (4.9 % to 7.9 %) and decreased for heart failure (13.4 % to 12.6 %).

Analysis of the Effect of the Communication Ability of Nurses in Outpatient Infusion Room on the Treatment Experience of Patients and Their Families

Objective

To observe the effect of nursing communication ability in outpatient infusion room on the treatment experience of outpatients and their families and analyze whether improving nurses' communication skills can reduce the incidence of doctor-patient disputes.

Methods

According to the results of the communication ability survey, the outpatient nurses in our hospital are divided into groups A (score < 65), B (65 ≤ score < 80), C (80 ≤ score < 95), and D (score ≥ 95). Taking outpatients and their families in our hospital from September 2019 to December 2020 as the research objects, they were divided into corresponding groups according to the nurses who served them. Finally, there were 73 cases in group A, 85 in group B, 92 in group C, and 65 in group D. The mental toughness scale (Connor-Davidson Resilience Scale Chinese (CD-RISC)) scores and Herth Hope Index (HHI) scores of the four groups of patients were compared, and the correlation between nurse communication scores and CD-RISC scores and HHI scores was analyzed. The incidence of negative events (patient-nurse disputes, complaints, etc.) and the results of nursing satisfaction surveys during the visits of the four study groups were also counted.

Results

The four groups of CD-RISC and HHI total scores were ranked from highest to lowest as groups D, C, B, and A, respectively (P < 0.05). There was a positive correlation between the resilience dimension scores of the family members' CD-RISC and the toughness, strength, optimism dimension scores of the HHI and the nurses' communication dimension scores (r = 0.191-0.472, P < 0.05). Besides, the incidence of negative events was higher in group A than in the other three groups, while the satisfaction with care was lower than in the other three groups (P < 0.05).

Conclusion

Improving nurses' communication skills in infusion room nursing quality management can improve the mental toughness and hope level of patients' accompanying family members, which is conducive to controlling their emotions and avoiding the occurrence of dispute incidents.