Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Outpatient Treatment. Show all posts
Showing posts with label Outpatient Treatment. Show all posts

Friday, November 11, 2016

Psychiatric patients wait the longest in emergency rooms

By Amy Ellis Nutt
The Washington Post
Originally published October 18, 2016

Here is an excerpt:

Many studies over the past decade have shown that ER overcrowding results in higher mortality rates of ER patients, higher costs and higher stress levels for medical professionals.

That overcrowding won’t end anytime soon, Parker said, unless access to outpatient treatment centers expands. But in the latest survey, more than half of the ER physicians said mental health resources in their communities had declined in the past year.

The paradox at the heart of the problem is almost beyond comprehension, in Lippert’s view.

“Nowhere else in medicine,” she said, “do we have our most severely ill patients staying the longest.”

The article is here.

Sunday, January 12, 2014

E.R. Costs for Mentally Ill Soar, and Hospitals Seek Better Way

By Julie Creswell
The New York Times
Originally published December 25, 2013

Here is an excerpt:

Today, North Carolina has only eight beds in state psychiatric hospitals per 100,000 people, the lowest ratio in the country.(North Carolina, like other states, has added beds in local community facilities but, even then, its total beds are down a quarter since 2001.)

Uninsured patients rarely receive individual therapy, only group sessions. And it can take up to three months to see a psychiatrist.

“Now, we are seeing some of the most acute, the most aggressive and the most chronic mental health patients, and we’re holding them longer,” said Janice Frohman, the director of WakeMed’s emergency department.

The effects of the upheaval in care of the mentally ill is playing out vividly at WakeMed. A private, nonprofit organization with 884 beds, WakeMed is struggling to find a way to meet the needs of increasing numbers of mentally ill patients while also controlling costs.

The entire article is here.

Saturday, June 2, 2012

Outpatient Care of Young People After Emergency Treatment of Deliberate Self-Harm

By Dennis Thompson
MedicineNet.com
Originally published on May 25, 2012


Doctors have long known that some kids suffering severe emotional turmoil find relief in physical pain -- cutting or burning or sticking themselves with pins to achieve a form of release.

But researchers now are questioning whether enough is being done to reach out to these young people and help them before they do themselves irreparable damage.

One study this year found that six of every 10 adolescents who went to an emergency room for treatment after harming themselves were released without receiving a mental health assessment or any follow-up mental health care. The findings were reported in the February issue of the Journal of the American Academy of Child & Adolescent Psychiatry.

Here is a link to the summary of this article.

The original research is below.

by Jeffrey Bridge, Steven Marcus, and Mark Olfson

Journal of the American Academy of Child & Adolescent Psychiatry
Volume 51, Issue 2 , Pages 213-222.e1, February 2012

Objective

Little is known about the mental health care received by young people after an episode of deliberate self-harm. This study examined predictors of emergency department (ED) discharge, mental health assessments in the ED, and follow-up outpatient mental health care for Medicaid-covered youth with deliberate self-harm.

Method

A retrospective longitudinal cohort analysis was conducted of national 2006 Medicaid claims data supplemented with the Area Resource File and a Substance Abuse and Mental Health Services Administration Medicaid policy survey of state policy characteristics focusing on ED treatment episodes by youth 10 to 19 years old for deliberate self-harm (n = 3,241). Rates and adjusted risk ratios (ARR) of discharge to the community, mental health assessments in the ED, and outpatient visits during the 30 days after the ED visit were assessed.

Results

Most patients (72.9%) were discharged to the community. Discharge was inversely related to recent psychiatric hospitalization (ARR 0.75, 99% confidence interval [CI] 0.63–0.90). Thirty-nine percent of discharged patients received a mental health assessment in the ED and a roughly similar percentage (43.0%) received follow-up outpatient mental health care. Follow-up mental health care was directly related to recent outpatient (ARR 2.58, 99% CI 2.27–2.94) and inpatient (ARR 1.33, 99% CI 1.14–1.56) mental health care and inversely related to Hispanic ethnicity (ARR 0.78, 99% CI 0.64–0.95) and residence in a county with medium-to-high poverty rates (ARR 0.84, 99% CI 0.73–0.97).

Conclusions

A substantial proportion of young Medicaid beneficiaries who present to EDs with deliberate self-harm are discharged to the community and do not receive emergency mental health assessments or follow-up outpatient mental health care.

Friday, August 5, 2011

Prescription pain medication addiction prevalent among chronic pain patients

News Release

A new study by Geisinger Health System researchers finds a high prevalence of prescription pain medication addiction among chronic pain patients. In addition, researchers found that the American Psychiatric Association’s (APA) new definition of addiction, which was expected to reduce the number of people considered addicts who take these medicines, actually resulted in the same percentage of people meeting the criteria of addiction.

Published in the Journal of Addictive Diseases, the study found that 35 percent of patients undergoing long-term pain therapy with opioids like morphine, OxyContin, Percocet and Vicodin, meet the criteria for addiction.

“Most patients will not know if they carry the genetic risk factors for addiction,” said study lead Joseph Boscarino, senior investigator II, Geisinger Health System. “Improper or illegal use of prescription pain medication can become a lifelong problem with serious repercussions for users and their families.”
Boscarino added that “genetic predisposition to addiction further exacerbates the risks associated with misuse of prescription pain medication.”

Using electronic health records, a random sample of outpatients undergoing long-term opioid therapy for non-cancer pain was identified and 705 participants completed telephone interviews from August 2007 through November 2008.

When comparing the APA’s newly revised criteria for addiction with the old criteria, researchers were surprised to find the prevalence of and risk factors for addiction to be virtually the same. It was determined that different symptoms now qualify the same patients for inclusion who would have been excluded under the previous classification system.

The study states that pain medication addiction often happens in people under 65, with a history of opioid abuse, withdrawal symptoms and substance abuse treatment. Risk factors for severe pain medication addiction also include a history of anti-social personality disorder.

“Ultimately, we hope our research will aid the development of newer classes of medications that don’t negatively impact the brain and therefore avoid addiction entirely,” Boscarino said.

Researchers from New York University also contributed to the study.