RESUMO
BACKGROUND: Based on the data of an analysis of costs of psychopharmacological treatment by the Austrian Rechnungshof in 2011, which also revealed remarkable differences between Salzburg and Carinthia (federal states of Austria), a panel of experts discussed the potential causes. A consequence was the following prospective study, which took place at the department of psychiatry and psychotherapy in Klagenfurt/Carinthia. METHODS: The aim in this mirror design study was to analize the data of psychopharmacologic treatment, epidemiological data of the treated patients (N = 230) and utilization of healthcare ressources such as contacts to psychiatrists or practicioners after discharge. RESULTS: We could show a high adherence concerning the redeem of the prescriptions, a low proportion of generics, and a very low rate of contacts to psychiatrists contrasting contacts to practitioners. CONCLUSIONS: Beneath that in the sense of descriptive epidemiology the data help to characterize adherence behavior after discharge and details of in- and outdoor treatment.
Assuntos
Transtornos Mentais/tratamento farmacológico , Cooperação do Paciente/psicologia , Alta do Paciente , Unidade Hospitalar de Psiquiatria , Psicoterapia , Psicotrópicos/uso terapêutico , Adulto , Áustria , Custos e Análise de Custo , Feminino , Humanos , Assistência de Longa Duração/economia , Assistência de Longa Duração/estatística & dados numéricos , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/economia , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/estatística & dados numéricos , Alta do Paciente/economia , Estudos Prospectivos , Unidade Hospitalar de Psiquiatria/economia , Psicoterapia/economia , Psicotrópicos/economia , Encaminhamento e Consulta/economia , Encaminhamento e Consulta/estatística & dados numéricos , Revisão da Utilização de Recursos de Saúde/economiaRESUMO
Objective The study looked at the impact that the switch from a reimbursement system with hospital per diem charges to a regional budget had on treatment. Methods Routine data from two clinics over a period of ten years were evaluated. Results Treatment took place in day clinics and on an outpatient basis to an increased extent after the change. Conclusion The change in reimbursement system was the cause of the change in treatment. Since similar effects can also be expected when switching from the new reimbursement system for psychiatry and psychosomatic medicine to a regional budget system, regional budgets are a reasonable alternative.
Assuntos
Assistência Ambulatorial/economia , Orçamentos/tendências , Hospital Dia/economia , Preços Hospitalares/tendências , Transtornos Mentais/economia , Unidade Hospitalar de Psiquiatria/economia , Mecanismo de Reembolso/economia , Adulto , Assistência Ambulatorial/tendências , Redução de Custos/tendências , Hospital Dia/tendências , Feminino , Previsões , Alemanha , Humanos , Tempo de Internação/economia , Tempo de Internação/tendências , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/terapia , Pessoa de Meia-Idade , Unidade Hospitalar de Psiquiatria/tendências , Regionalização da Saúde/tendências , Mecanismo de Reembolso/tendênciasRESUMO
OBJECTIVE: The aim of this study was to review how the effectiveness of consultation liaison psychiatry (CLP) services has been measured and to evaluate the strength of the evidence for effectiveness. METHODS: Systematic review of medical databases using broad search terms as well as expert opinion was sought. The literature search was restricted to studies of general, whole-of-hospital inpatient CLP services. RESULTS: Forty articles were found and grouped into five measurements of effectiveness: cost effectiveness including length of stay, concordance, staff and patient feedback, and follow-up outcome studies. All measurements contributed to the evaluation of CLP services, but no one measure in isolation could adequately cover the multifaceted roles of CLP. Concordance was the only measurement with an established, consistent approach for evaluation. Cost effectiveness and follow-up outcome studies were the only measures with levels of evidence above four, however the three follow-up outcome studies reported conflicting results. Subjective evidence derived from patient and staff feedback is important but presently lacking due to methodological problems. The effectiveness of CLP services was demonstrated by cost-effectiveness, earlier referrals to CLP predicting shorter length of stay, and concordance with some management recommendations. CONCLUSION: There is evidence that some CLP services are cost-effective and reduce length of stay when involved early and that referrers follow certain recommendations. However, many studies had disparate results and were methodologically flawed. Future research should focus on standardising patient and staff feedback, and short-term patient outcomes.
Assuntos
Hospitais Gerais/organização & administração , Unidade Hospitalar de Psiquiatria/organização & administração , Encaminhamento e Consulta , Análise Custo-Benefício , Feminino , Humanos , Avaliação de Resultados em Cuidados de Saúde , Unidade Hospitalar de Psiquiatria/economiaRESUMO
AIMS: This research examined factors related to the average length of hospital stay (LOS) and average direct medical costs (DMC) for 2291 psychogeriatric inpatients (aged 65 and over) admitted for the first time to a psychiatric ward in 2002. METHODS: Hospitalization claim data of these inpatients were traced for the subsequent 6 years (2002-2007) from the dataset of Taiwan's National Health Insurance program. Analysis was carried out using the t-test, χ(2) -test and zero truncated Tobit regression. RESULTS: Mean LOS and mean DMC were significantly different according to sex, psychiatric diagnosis, institution type, ownership type, and number of hospitalizations, but age was the exception. Both LOS and DMC exhibited downward U-shape for the number of hospitalizations. Factors significantly associated with longer LOS and higher DMC were: male sex; schizophrenic and delusional disorders (compared with dementia); and public institution (compared with private hospital). Compared with dementia, organic mental and anxiety disorders had significantly shorter LOS, and affective disorders had shorter LOS but higher DMC. Community and psychiatric hospitals (compared with general hospital) significantly influenced LOS but not DMC. CONCLUSION: Our results can be used as a reference for providers and policymakers to improve psychiatric care efficiency and carry out National Health Insurance financial reform for psychogeriatric inpatients.
Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitalização/economia , Tempo de Internação/estatística & dados numéricos , Transtornos Mentais/economia , Idoso , Idoso de 80 Anos ou mais , Demência/economia , Feminino , Hospitais Privados/economia , Hospitais Privados/estatística & dados numéricos , Hospitais Psiquiátricos/economia , Hospitais Psiquiátricos/estatística & dados numéricos , Hospitais Públicos/economia , Humanos , Tempo de Internação/economia , Modelos Lineares , Estudos Longitudinais , Masculino , Transtornos do Humor/economia , Programas Nacionais de Saúde , Unidade Hospitalar de Psiquiatria/economia , Unidade Hospitalar de Psiquiatria/estatística & dados numéricos , TaiwanRESUMO
There is a growing body of evidence on the impact of the environment on health and well-being. This study focuses on the impact of visual artworks on the well-being of psychiatric patients in a multi-purpose lounge of an acute care psychiatric unit. Well-being was measured by the rate of pro re nata (PRN) medication issued by nurses in response to visible signs of patient anxiety and agitation. Nurses were interviewed to get qualitative feedback on the patient response. Findings revealed that the ratio of PRN/patient census was significantly lower on the days when a realistic nature photograph was displayed, compared to the control condition (no art) and abstract art. Nurses reported that some patients displayed agitated behaviour in response to the abstract image. This study makes a case for the impact of visual art on mental well-being. The research findings were also translated into the time and money invested on PRN incidents, and annual cost savings of almost $US30,000 a year was projected. This research makes a case that simple environmental interventions like visual art can save the hospital costs of medication, and staff and pharmacy time, by providing a visual distraction that can alleviate anxiety and agitation in patients.
Assuntos
Transtornos de Ansiedade/enfermagem , Arteterapia/métodos , Decoração de Interiores e Mobiliário , Unidade Hospitalar de Psiquiatria , Agitação Psicomotora/enfermagem , Meio Social , Adulto , Ansiolíticos/economia , Ansiolíticos/uso terapêutico , Transtornos de Ansiedade/economia , Transtornos de Ansiedade/psicologia , Arteterapia/economia , Análise Custo-Benefício , Uso de Medicamentos/estatística & dados numéricos , Feminino , Grupos Focais , Humanos , Decoração de Interiores e Mobiliário/economia , Pessoa de Meia-Idade , Unidade Hospitalar de Psiquiatria/economia , Agitação Psicomotora/economia , Agitação Psicomotora/psicologia , Tranquilizantes/economia , Tranquilizantes/uso terapêutico , Estados UnidosAssuntos
Eficiência Organizacional/economia , Honorários e Preços/estatística & dados numéricos , Implementação de Plano de Saúde/economia , Transtornos Mentais/economia , Programas Nacionais de Saúde/economia , Admissão e Escalonamento de Pessoal/economia , Política , Unidade Hospitalar de Psiquiatria/economia , Serviços Comunitários de Saúde Mental/economia , Serviços Comunitários de Saúde Mental/legislação & jurisprudência , Análise Custo-Benefício/economia , Análise Custo-Benefício/tendências , Prestação Integrada de Cuidados de Saúde/economia , Prestação Integrada de Cuidados de Saúde/legislação & jurisprudência , Eficiência Organizacional/legislação & jurisprudência , Previsões , Alemanha , Reforma dos Serviços de Saúde/economia , Reforma dos Serviços de Saúde/legislação & jurisprudência , Implementação de Plano de Saúde/legislação & jurisprudência , Custos Hospitalares/estatística & dados numéricos , Hospitais Gerais/economia , Hospitais Gerais/legislação & jurisprudência , Humanos , Corpo Clínico Hospitalar/economia , Corpo Clínico Hospitalar/legislação & jurisprudência , Transtornos Mentais/terapia , Programas Nacionais de Saúde/legislação & jurisprudência , Admissão e Escalonamento de Pessoal/legislação & jurisprudência , Unidade Hospitalar de Psiquiatria/legislação & jurisprudência , Mecanismo de Reembolso/estatística & dados numéricosRESUMO
OBJECTIVE: Current mental health policies emphasise the need for services to be integrated and to develop outcomes-based evaluation systems. An overview of the challenges faced by service managers and clinical academics who develop the appropriate financial, personnel and academic infrastructure for these tasks is presented. METHOD: By drawing on experiences within the St George Service and references to other services, we propose a model for a successful partnership between the academic and management components of a district service. RESULTS: Major logistic impediments to the development of a partnership are identified, although the long-term scientific and service delivery benefits are highlighted. Key areas within both academic practice and managerial approaches requiring transformation are discussed. CONCLUSIONS: A successful long-term partnership between management and an academic department within a district service may provide the opportunity for rapid progress in population-based service evaluation and health outcomes research.
Assuntos
Serviços Comunitários de Saúde Mental/tendências , Prestação Integrada de Cuidados de Saúde/tendências , Programas de Assistência Gerenciada/tendências , Transtornos Mentais/terapia , Avaliação de Processos e Resultados em Cuidados de Saúde/tendências , Equipe de Assistência ao Paciente/tendências , Serviços Comunitários de Saúde Mental/economia , Análise Custo-Benefício/tendências , Prestação Integrada de Cuidados de Saúde/economia , Previsões , Hospitais Comunitários/economia , Hospitais Comunitários/tendências , Humanos , Relações Interprofissionais , Programas de Assistência Gerenciada/economia , Transtornos Mentais/economia , New South Wales , Equipe de Assistência ao Paciente/economia , Unidade Hospitalar de Psiquiatria/economia , Unidade Hospitalar de Psiquiatria/tendênciasRESUMO
This paper describes a combined inpatient and partial hospital program, with a ten-bed short-term inpatient unit and a partial hospital program that can accommodate 24 patients. Inpatients and partial hospital patients are treated together by the same staff in a program located in the partial hospital. The authors highlight features of the program that address the five elements of continuity: place, personnel, program, patient-peers, and plan for treatment. The discussion focuses on the importance of continuity in sustaining a combined unit; potential benefits for patients, families, staff, and trainees; attractiveness to third-party payers; and impediments to fully realizing the potential of the unit.