Cost of care: a study of patients hospitalized for treatment of psychotic illness

An analysis of financial hardship faced by patients with First Episode Psychosis, and their families, in an Indian setting

BACKGROUND

The economic burden of psychotic disorders is not well documented in LMICs like India, due to several bottlenecks present in Indian healthcare system like lack of adequate resources, low budget for mental health services and inequity in accessibility of treatment. Hence, a large proportion of health expenditure is paid out of pocket by the households.

OBJECTIVE

To evaluate the direct and indirect costs incurred by patients with First Episode Psychosis and their families in a North Indian setting.

METHOD

Direct and Indirect costs were estimated for 87 patients diagnosed at AIIMS, New Delhi with first-episode psychosis (nonaffective) in the first- and sixth month following diagnosis, and the six months before diagnosis, using a bespoke questionnaire. Indirect costs were valued using the Human Capital Approach.

RESULTS

Mean total costs in month one were INR 7991 ($107.5). Indirect costs were 78.3% of this total. Productivity losses was a major component of the indirect cost. Transportation was a key component of direct costs. Costs fell substantially at six months (INR 2732, Indirect Costs 61%). Respondents incurred substantial costs pre-diagnosis, related to formal and informal care seeking and loss of income.

CONCLUSION

Families suffered substantial productivity loss. Care models and financial protection that address this could substantially reduce the financial burden of mental illness. Measures to address disruption to work and education during FEP are likely to have significant long-term benefits. Families also suffered prolonged income loss pre-diagnosis, highlighting the benefits of early and effective diagnosis.

Drug use pattern for emergency psychiatric conditions in a tertiary care hospital: A prospective observational study

Purpose:

Psychiatric emergencies (PEs) are defined as acute disturbances of thought, mood, behavior, or social relationships requiring immediate interventions. The common emergency psychiatrics are attempted suicide, severe anxiety, schizophrenia, acute psychosis, substance abuse, acute panic attacks, drug toxicities, and extrapyramidal reactions. Emergency physicians in the general hospital may face the challenge of assessing and managing patients in PEs. This study was conducted to evaluate the clinical pattern and drug use pattern for PEs at a tertiary care hospital.

Materials and Methods:

This was a cross-sectional, observational study where patients presenting to emergency medical services of a tertiary care hospital were recruited after approval from Institutional Ethics Committee and written informed consent. Demographic details, diagnosis, medication details, cost of the treatment, and adherence to guidelines in the management of emergency psychiatric conditions were assessed using a validated questionnaire. Descriptive statistics was applied to analyze the data.

Results:

In 110 patients, a total number of drugs prescribed were 463 (mean: 4.21 drugs/prescription). The most commonly used psychotropic drug in emergency setting was found to be risperidone (19.39%), followed by lorazepam (13.60%) and clonazepam (4.28%). The most common diagnoses were substance abuse (32.72%) and schizophrenia (21.81%). About 74.5% of the physicians prescribed drugs abiding by the standard guidelines. The average total cost incurred by patients was about Rs. 366.

Conclusion:

The most commonly used drugs in emergency treatment found in this study are risperidone, followed by lorazepam and haloperidol.

Retrospective assessment of the reporting of adverse drug reactions in a Malaysian clinical training center: A short communication

Objectives:

This study aimed to assess the completeness and quality of adverse drug reaction (ADR) reports that were submitted to the Pharmacovigilance Unit (PVU) in clinical training center (CTC), Faculty of Medicine, UiTM Sungai Buloh Campus.

Materials and Methods:

A retrospective study was conducted using all ADR reports that were submitted to the PVU in CTC from December 31, 2000, to December 31, 2018. The completeness was assessed by reviewing all the required elements to be filled in the ADR reports. The quality was assessed by investigating the required information in the ADR reporting form. Descriptive statistics have been used to present the findings.

Key Findings:

In a total of 31 reports that were submitted to the PVU in CTC, 98.9% of patient's information and 100% of ADR descriptions were completed. Suspected drug information and the reporter's details were completed by 52.2% and 79.6%, respectively. Of 58.0% of the information about seriousness recorded, 38.9% (n = 7) is mild, 44.4% (n = 8) is moderate, and 16.7% (n = 3) is severe. Among all the suspected medicines, drug class of antibiotics (32.4%, n = 12) is the most reported suspected drugs that caused ADR, followed by opioid analgesic (8.1%, n = 3) and nonsteroidal anti-inflammatory drugs (8.1%, n = 3).

Conclusion:

Further efforts and relevant interventions should be considered to increase the reporting frequency and to enhance the completeness and the quality of the ADR reports in the study setting.

Innovative Leadership Initiatives to Reduce the Cost of Healthcare

EXECUTIVE SUMMARY

This study involved an examination of the literature with the goal of establishing innovative leadership initiatives to reduce healthcare costs. To achieve this objective, the author used a qualitative research design based on grounded theory to identify the key drivers of high healthcare costs and examine ways to manage them. The study outcomes show that the key drivers were unnecessary diagnostic procedures such as imaging tests, large numbers of specialty referrals, and hospitalization. The author observed that adoption of patient-centered care results in a significant reduction in hospitalization, unnecessary procedures, and specialty visits. The findings also indicate that an emphasis on primary care reduces hospitalization, unnecessary procedures, and visits to specialists. Further, organizational restructuring had a significant impact on reducing unnecessary diagnostic procedures. The study outcomes suggest that healthcare leaders should promote the active participation of patients in care delivery. Leaders also should develop strategies that enhance primary care as a means of reducing hospitalization and the need for specialty referrals. Finally, the study proposes that leaders should focus on organizational restructuring as a means of limiting unnecessary diagnostic procedures.

Rural-urban differences in accessing mental health treatment in patients with psychosis

BACKGROUND

Delay in accessing psychiatric treatment has considerable influence on the outcome of psychoses. Systematic studies examining the source of the delay are lacking in India. In this article, we examine rural-urban differences regarding delay in accessing psychiatric care in patients with psychosis, an issue which was hitherto not studied.

AIMS

To evaluate the rural-urban differences in treatment seeking among patients with psychosis.

METHODS

Patients with psychotic disorders who presented to the outpatient department of an academic psychiatric institute for the first time ( n = 551) were interviewed using a semi-structured interview tool to assess the date of onset of illness.

RESULTS

Families in urban areas had significantly higher level of education and greater income than their rural counterparts. However, there was no difference in urban and rural patients in the duration of untreated illness (DUI). There was no correlation between average years of education of the family members and DUI (spearman's rho = -0.01; p = .77).

CONCLUSIONS

Despite the proximity to psychiatric centers, better education and greater income, patients in urban areas do not access psychiatric care earlier than patients in rural areas. So, mere presence of services would not make patients access them early.