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1.
Psychiatr Serv ; 71(4): 412-413, 2020 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-32233770
2.
Psychiatr Serv ; : appips201900301, 2020 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-31931683

RESUMO

OBJECTIVE: The aim of this study was to investigate racial-ethnic differences in use of mental health services and antipsychotic medication in the year following the recent onset of a psychotic disorder and to examine the role of household income as a proxy for socioeconomic status. METHODS: Deidentified administrative claims data from the OptumLabs Data Warehouse were used to identify 8,021 commercially insured individuals ages 14 through 30 with a recent-onset psychotic disorder (January 1, 2011, through December 31, 2015). The authors compared mental health service use among African-American (11.5%), Hispanic (11.0%), and non-Hispanic white (77.4%) individuals during the year following an index diagnosis and adjusted these analyses for household income. RESULTS: The probability of any use of outpatient mental health services was lower among African-American (67.4%±1.4%) and Hispanic individuals (66.5%±1.5%) compared with non-Hispanic white patients (72.3%±0.6%; p<0.05 for each comparison). Among those who used services, African-American and Hispanic individuals had fewer mean outpatient mental health visits per year compared with non-Hispanic whites (9.7±0.7 and 10.2±0.7 versus 14.3±0.5, respectively, p<0.001 for each comparison). These racial-ethnic differences in service use remained after adjustment for household income. CONCLUSIONS: Among young, commercially insured individuals using outpatient services following an index diagnosis of psychotic disorder, African Americans and Hispanics received less intensive outpatient mental health care than their non-Hispanic white counterparts. Amid the upsurge of early intervention programs, special attention should be paid to increasing access to mental health services for racial-ethnic minority groups.

4.
Psychiatr Serv ; 71(1): 75-78, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31590622

RESUMO

OBJECTIVE: This study examined whether communication between inpatient and outpatient mental health providers during patients' inpatient stays was associated with whether patients attended postdischarge appointments. METHODS: Psychiatric inpatient medical records of 189 Medicaid recipients at two hospitals were reviewed to document whether inpatient staff had communicated with current or prior outpatient providers. Medicaid claims provided demographic, clinical, and outpatient attendance data. Associations between provider communications and follow-up care for patients who had or had not received outpatient mental health care within the 30 days prior to admission were evaluated. RESULTS: Inpatient staff communicated with outpatient providers for 118 (62%) patients. For patients who had not received outpatient care within 30 days of admission, compared with those who had, communication was associated with increased odds of attending timely outpatient appointments (odds ratio=2.73, 95% confidence interval=1.09-6.84). CONCLUSIONS: Communication with outpatient providers may be especially important for patients who were not engaged in outpatient care prior to admission.

5.
Schizophr Bull ; 46(1): 91-97, 2020 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-31292650

RESUMO

OBJECTIVE: To investigate patterns of mental health service and antipsychotic use following a first-episode schizophrenia (FES) and to examine the role of the treatment setting in which individuals are first diagnosed. METHOD: Analysis of de-identified administrative claims data from the OptumLabs Data Warehouse was used to identify 1450 privately insured youth and young adults aged 14 through 30 with FES from January 1, 2011 through December 31, 2015. Regression analysis was used to estimate the use of mental health services during the year following FES, by type of service and by site of index diagnosis. RESULTS: In the year following FES, 79.7% of youth received outpatient mental health services and 35.8% filled a prescription for antipsychotic medication. Among service users, mean outpatient visits were 15.9 and mean antipsychotic fills were 8.3. Youth who received an index diagnosis of FES in an inpatient setting were more likely to fill an antipsychotic medication than youth with FES in other settings. Youth who received an index diagnosis of FES during a specialty mental health outpatient visit had greater use of outpatient mental health than youth who received their diagnosis during a primary care visit. CONCLUSIONS: Despite evidence-based guidelines supporting outpatient psychosocial care and antipsychotic treatment for FES, one-fifth of this cohort did not use outpatient services and the majority did not fill any prescriptions for antipsychotic medications during the year following FES. Our findings provide renewed urgency to ongoing efforts to accelerate early identification and care coordination for youth with FES.

6.
J Ment Health Policy Econ ; 22(3): 95-108, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31811753

RESUMO

BACKGROUND: Psychosis onset commonly occurs at ages 16-30 when individuals are typically developing their education, employment and career trajectories. Coordinated specialty care (CSC) programs provide access to team-based early invention services for psychosis, including supported education and employment (SEE) services. AIMS OF STUDY: We examine factors associated with the use of SEE services and whether use of SEE services (for supported education, supported employment, or both) is associated with education and employment participation within New York's CSC program, OnTrackNY. METHODS: Participants (n=779) enrolled in OnTrackNY from October 2013-September 2017. Assessments were collected by clinical staff at admission, quarterly, and at discharge. Logistic regression models were specified to identify factors associated with the probability of use of SEE specialist services during the first year of program participation, using generalized estimating equations with an autoregressive covariance structure to account for within-subject correlations over time. Logistic models were also used to predict whether use of SEE services in the prior quarter predict the probability of work and school participation in the subsequent quarter, respectively; these were analyzed cross-sectionally for each time period. Models controlled for other factors associated with work/school outcomes for young people with early psychosis. RESULTS: Participants who were younger, and who had lower rates of work/school participation had greater odds of SEE service use. Use of SEE services for education support in the first quarter among clients under age 23 is significantly associated with school enrollment in the second quarter and this continued through the first year. Use of SEE services for employment support in the first quarter is significantly associated with employment in the second quarter, but significant associations for employment were not found at later periods of participation. Use of SEE services for both education and employment support was inconsistently associated with subsequent school enrollment or employment in the subsequent quarter. Results were upheld when limiting the sample to those not receiving other SEE services. DISCUSSION: Rates of school and work participation increased over the duration of OnTrackNY participation. Clients with lower work/school participation were more likely to use SEE services. Supported education services are associated with greater school participation during the first year for clients under age 23. However, this association is only significant in the first quarter for supported employment services, and is inconsistent when examining those who used both simultaneously. It is possible that we may find significant associations for employment as the program continues. It is also possible that clients may end supported employment services after obtaining employment, while those in school may require ongoing services (e.g. to renew educational accommodations). Additionally, it is possible that OnTrackNY's supported education model, designed to adhere to Individual Placenment and Support (IPS) principles, may be helping clients stay in school. However, as this is an observational study with no control condition, we cannot say that OnTrackNY, or SEE services participation, caused the observed outcomes. IMPLICATIONS FOR FURTHER RESEARCH: Future research should continue to develop the evidence base for supported education services.


Assuntos
Pessoas com Deficiência/psicologia , Intervenção Médica Precoce/métodos , Educação Especial/métodos , Readaptação ao Emprego/métodos , Transtornos Psicóticos/reabilitação , Adolescente , Adulto , Serviços Comunitários de Saúde Mental , Readaptação ao Emprego/estatística & dados numéricos , Hospitalização , Humanos , New York , Desenvolvimento de Programas , Transtornos Psicóticos/complicações , Transtornos Psicóticos/psicologia , Transtornos Psicóticos/terapia , Adulto Jovem
7.
Psychiatr Serv ; 70(12): 1168-1171, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31500545

RESUMO

The number of people with opioid use disorder and the number of overdose deaths in the United States have increased dramatically over the past 20 years. U.S. Congress passed the SUPPORT for Patients and Communities Act, which was signed into law in 2018, authorizing almost $8 billion to address the crisis. As experts in the treatment of central nervous systems disorders, psychiatrists can play a leading role in expanding treatment for people with opioid use disorder and in advocating for policy changes to support community treatment for this group.

8.
Psychiatr Serv ; 70(12): 1110-1115, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31480927

RESUMO

OBJECTIVE: The importance of building a strong treatment alliance is widely accepted and uncontroversial. Quantitative research suggests that coercive experiences during psychiatric treatment negatively affect the treatment alliance, but reveals little about how this happens or how patients navigate treatment relationships while experiencing coercion during psychiatric treatment. METHODS: Fifty psychiatric inpatients were interviewed at two hospitals. Patients were asked open-ended questions about the relationship between the treatment alliance and a set of coercive treatment experiences (court-mandated treatment, involuntary hospitalization, locked facilities) and whether such hospital experiences affected the patients' plans for future adherence. Interviews were audio-recorded, transcribed, and qualitatively analyzed. RESULTS: Many participants reported events where coercion made it difficult to form a treatment alliance. An imbalance of power, lack of control, and insufficient participation in treatment planning were described as experiences that interfered with the treatment alliance. Other participants felt the treatment alliance was maintained despite coercive experiences and spoke of good communication with the psychiatrist, understanding the rationale behind interventions, and feeling the psychiatrist was trying to keep the patient's best interests in mind. CONCLUSIONS: Coercive experiences remain undesirable and are frequently detrimental to the treatment alliance. Nevertheless, patients and clinicians should continue to seek a strong treatment alliance even when treatment plans include coercive elements. Efforts to improve communication, to explain the rationale for treatment plans, and to show that clinicians are trying to act in the patient's best interests may help to preserve a therapeutic alliance.

9.
Psychiatr Serv ; 70(10): 860-866, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31310186

RESUMO

OBJECTIVE: Involving family in the care of inpatients with serious mental illness is known to be beneficial. This study examined frequencies of involvement by family in the care and discharge planning for 179 psychiatric inpatients. METHODS: Involvement by family in care and discharge planning was assessed from randomly selected medical records of inpatients with Medicaid and severe mental illness at two New York hospitals from 2012 to 2013. "Family" also included anyone close to the patient who provided support. Medicaid claims were reviewed for patient demographic and clinical characteristics and for postdischarge outpatient attendance data. Multiple regression models were used to test whether involvement by family was associated with comprehensive discharge planning (contacting outpatient providers, scheduling follow-up appointments, and forwarding a discharge summary to a provider) and initiation of outpatient treatment. RESULTS: Inpatient staff contacted a family member for 134 (75%) patients. Sixty-seven (37%) patients received comprehensive discharge planning, and 96 (53%) and 139 (78%) attended an outpatient appointment within 7 and 30 days of discharge, respectively. Inpatient staff contacting family, communicating about the patient's health and/or mental health, and communicating about the discharge plan were significantly associated with entry into follow-up care by 7 and 30 days postdischarge. Family phone calls and/or visits with patients, attendance at family therapy sessions, and communication with inpatient staff about services available to families were significantly associated with patients receiving comprehensive discharge planning. When analyses controlled for demographic and clinical factors, having any involvement between family members and inpatient staff was significantly associated with patients' attending an outpatient appointment by 7 days (odds ratio [OR]=2.79, 95% confidence interval [CI]=1.28-6.08) or 30 days (OR=3.07, 95% CI=1.29-7.32) after discharge. CONCLUSIONS: The association of family involvement with comprehensive discharge planning and prompt entry into outpatient care underscores the importance of family contact and communication with staff during inpatient hospitalizations.

10.
Psychiatr Serv ; 70(9): 793-800, 2019 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-31109264

RESUMO

OBJECTIVE: Individuals with serious mental illness experience excess mortality related to general medical comorbidities. Reverse-integrated and reverse-colocated models of care have been proposed as a system-level solution. Such models integrate primary care services within behavioral health settings. Further understanding of consumer perspectives on these models is needed to ensure that models adequately engage consumers on the basis of their expressed needs. This qualitative study examined the perspectives of English- and Spanish-speaking individuals with serious mental illness on their current experience with the management of their medical care and on a hypothetical reverse-colocated care model. METHODS: Semistructured interviews were conducted in a purposive sample of 30 individuals with serious mental illness recruited from two outpatient mental health clinics affiliated with a comprehensive community-based program. The interview assessed the participant's current experience with the management of their health care, followed by a vignette describing a reverse--colocated care model and questions to elicit the participant's reaction to the vignette. An inductive thematic analysis was employed. RESULTS: Consumers expressed positive views of the potential for working with trusted staff, increased communication, and access to care through reverse colocation. Reflections on current health management experience were notable for an emphasis on self-efficacy and receipt of support for self-management strategies from mental health clinicians. CONCLUSIONS: Study findings add to prior literature indicating support for assistance with management of general medical health in the mental health setting among individuals with serious mental illness. Key themes similar to those in previous studies generate hypotheses for further evaluation.

11.
Psychiatr Serv ; 70(5): 425-427, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30914002

RESUMO

As coordinated specialty care for first-episode psychosis is implemented nationally, questions arise regarding financial sustainability. To address this, New York State undertook a time study in which 13 coordinated specialty care sites reported all activities provided to 75 randomly selected Medicaid clients with first-episode psychosis over a 2-week period. The average estimated cost was $1,375 per client per month, yet under optimal billing conditions, estimated revenues were only $662 per client per month, or 48% of the costs. These results underscore the need for continued subsidies and novel payment schemes for coordinated specialty care.

12.
J Nerv Ment Dis ; 207(3): 157-161, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30768542

RESUMO

Despite widespread use, how clinicians use the DSM in psychiatric practice is not well understood. Recognizing public and professional attitudes toward the DSM are integral to future DSM development, to assess a commonly held assumption such as that the DSM is used primarily for coding, and to assess its clinical utility. A convenience sample of Psychiatric Times readers was surveyed to assess the DSM's use in clinical practice. A total of 394 behavioral health care practitioners fully completed the online survey. Results suggest that the DSM, beyond administrative and billing use, is used for communication with health care providers, for teaching diagnoses to trainees, and, importantly, as an educational tool to inform patients and caregivers alike.


Assuntos
Atitude do Pessoal de Saúde , Manual Diagnóstico e Estatístico de Transtornos Mentais , Pessoal de Saúde/estatística & dados numéricos , Serviços de Saúde Mental/estatística & dados numéricos , Adulto , Comunicação , Técnica Delfos , Feminino , Humanos , Reembolso de Seguro de Saúde , Relações Interprofissionais , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Inquéritos e Questionários , Materiais de Ensino
13.
Psychiatr Serv ; 70(3): 247-249, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30630399

RESUMO

The New York State Medicaid program is pursuing reforms that would shift reimbursement from fee-for-service to value-based models. Behavioral health populations and services are key to these reforms, but important gaps exist in the breadth and relevance of available quality measures for the behavioral health field. This column describes how the state addressed these gaps by using both inter- and intra-agency collaborations. As part of this effort, the state convened a panel of consultants, including academics, providers, and consumers, to develop a behavioral health quality measurement agenda. Panel recommendations and ongoing partnerships are described as a model for states considering similar value-based reform initiatives.

14.
Fam Pract ; 36(2): 125-131, 2019 03 20.
Artigo em Inglês | MEDLINE | ID: mdl-29860527

RESUMO

BACKGROUND: Complicated grief, a syndrome of persistent grief diagnosed >6 months following the loss of someone close is expected to be included in the 11th revision of the International Classification of Diseases as a new diagnosis called prolonged grief disorder. Complicated grief is associated with impaired functioning and health comorbidity and does not respond to treatments for depression. Individuals may seek help in primary care where providers need to be familiar with the syndrome. OBJECTIVE: This study examines the acceptability, feasibility and outcome of a screening programme for complicated grief among diverse adults receiving behavioural health services in integrated primary care. METHODS: Behavioural health providers (n = 14) administered the Brief Grief Questionnaire and the Inventory of Complicated Grief during routine assessment and completed an acceptability survey. Descriptive statistics described rates of complicated grief symptoms and sample demographics, health and service use. RESULTS: Most providers (71%) reported the Brief Grief Questionnaire to be a moderate to very useful assessment instrument and the Inventory of Complicated Grief moderate to very useful for developing a treatment plan (57%). Of the 2425 patients screened, 1015 reported a loss over 6 months ago. Of these 1015, 28% (n = 282) screened positive on the Brief Grief Questionnaire and 22% (n = 228) endorsed symptoms of complicated grief (Inventory of Complicated Grief score ≥25), considered at high risk for needing clinical care. CONCLUSIONS: A screening programme for identifying complicated grief was acceptable to providers, feasible to implement and useful in identifying complicated grief in integrated primary care clinics.


Assuntos
Prestação Integrada de Cuidados de Saúde/métodos , Pesar , Programas de Rastreamento , Atenção Primária à Saúde , Adulto , Estudos de Viabilidade , Feminino , Humanos , Masculino , Inquéritos e Questionários , Fatores de Tempo
15.
Clin Schizophr Relat Psychoses ; 12(4): 152-167, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-27454213

RESUMO

Approximately 60% of individuals with schizophrenia do not take their antipsychotic medications as prescribed, and nonadherence is associated with exacerbation of psychotic symptoms, increased hospital and emergency room use, and increased healthcare costs. Behavioral-tailoring strategies that incorporate medication taking into the daily routine and use environmental supports have shown promise as adherence-enhancing interventions. Informed by the Information-Motivation-Behavioral (IMB) Skills Model and using the iterative process of user-centered design, we collaborated with individuals with schizophrenia and psychiatrists to develop an interactive smartphone application and web-based clinician interface, MedActive, for improving adherence to oral antipsychotic treatment. MedActive facilitates the active involvement of individuals with schizophrenia in managing their antipsychotic medication regimen by providing automated reminders for medication administration and tailored motivational feedback to encourage adherence, and by displaying user-friendly results of daily ecological momentary assessments (EMAs) of medication adherence, positive psychotic symptoms, and medication side effects for individuals and their psychiatrists. In a 2-week open trial completed by 7 individuals with schizophrenia and their psychiatrists, MedActive was determined to be both feasible and acceptable, with patient participants responding to 80% of all scheduled EMAs and providing positive evaluations of their use of the application. Psychiatrist participants were interested in viewing the information provided on the MedActive clinician interface, but cited practical barriers to regularly accessing it and integrating into their daily practice.


Assuntos
Antipsicóticos , Transtornos Psicóticos , Esquizofrenia , Smartphone , Adolescente , Adulto , Idoso , Antipsicóticos/uso terapêutico , Humanos , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Projetos Piloto , Transtornos Psicóticos/tratamento farmacológico , Adulto Jovem
17.
Front Public Health ; 6: 113, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29868533

RESUMO

Background: Implementation science lacks a systematic approach to the development of learning strategies for online training in evidence-based practices (EBPs) that takes the context of real-world practice into account. The field of instructional design offers ecologically valid and systematic processes to develop learning strategies for workforce development and performance support. Objective: This report describes the application of an instructional design framework-Analyze, Design, Develop, Implement, and Evaluate (ADDIE) model-in the development and evaluation of e-learning modules as one strategy among a multifaceted approach to the implementation of individual placement and support (IPS), a model of supported employment for community behavioral health treatment programs, in New York State. Methods: We applied quantitative and qualitative methods to develop and evaluate three IPS e-learning modules. Throughout the ADDIE process, we conducted formative and summative evaluations and identified determinants of implementation using the Consolidated Framework for Implementation Research (CFIR). Formative evaluations consisted of qualitative feedback received from recipients and providers during early pilot work. The summative evaluation consisted of levels 1 and 2 (reaction to the training, self-reported knowledge, and practice change) quantitative and qualitative data and was guided by the Kirkpatrick model for training evaluation. Results: Formative evaluation with key stakeholders identified a range of learning needs that informed the development of a pilot training program in IPS. Feedback on this pilot training program informed the design document of three e-learning modules on IPS: Introduction to IPS, IPS Job development, and Using the IPS Employment Resource Book. Each module was developed iteratively and provided an assessment of learning needs that informed successive modules. All modules were disseminated and evaluated through a learning management system. Summative evaluation revealed that learners rated the modules positively, and self-report of knowledge acquisition was high (mean range: 4.4-4.6 out of 5). About half of learners indicated that they would change their practice after watching the modules (range: 48-51%). All learners who completed the level 1 evaluation demonstrated 80% or better mastery of knowledge on the level 2 evaluation embedded in each module. The CFIR was used to identify implementation barriers and facilitators among the evaluation data which facilitated planning for subsequent implementation support activities in the IPS initiative. Conclusion: Instructional design approaches such as ADDIE may offer implementation scientists and practitioners a flexible and systematic approach for the development of e-learning modules as a single component or one strategy in a multifaceted approach for training in EBPs.

18.
Behav Ther ; 49(4): 631-641, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29937263

RESUMO

Cognitive-behavioral therapy (CBT), consisting of exposure and response prevention (EX/RP), is both efficacious and preferred by patients with obsessive-compulsive disorder (OCD), yet few receive this treatment in practice. This study describes the implementation of an Internet-based CBT program (ICBT) developed in Sweden in individuals seeking OCD treatment in New York. After translating and adapting the Swedish ICBT for OCD, we conducted an open trial with 40 adults with OCD. Using the RE-AIM implementation science framework, we assessed the acceptability, feasibility, and effectiveness of ICBT. The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was the primary outcome measure. Of 40 enrolled, 28 participants completed the 10-week ICBT. In the intent-to-treat sample (N = 40), Y-BOCS scores decreased significantly over time (F = 28.12, df = 2, 49, p < . 001). Depressive severity (F = 5.87, df = 2, 48, p < . 001), and quality of life (F = 12.34, df = 2, 48, p < . 001) also improved. Sensitivity analyses among treatment completers (N = 28) confirmed the intent-to-treat results, with a large effect size for Y-BOCS change (Cohen's d = 1.38). ICBT took less time to implement than face-to face EX/RP and participants were very to mostly satisfied with ICBT. On a par with results in Sweden, the adapted ICBT program reduced OCD and depressive symptoms and improved quality of life among individuals with moderate to severe OCD. Given its acceptability and feasibility, ICBT deserves further study as a way to increase access to CBT for OCD in the United States.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Internet , Transtorno Obsessivo-Compulsivo/psicologia , Transtorno Obsessivo-Compulsivo/terapia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Terapia Assistida por Computador/métodos , Adulto , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , New York/epidemiologia , Transtorno Obsessivo-Compulsivo/epidemiologia , Projetos Piloto , Qualidade de Vida/psicologia , Resultado do Tratamento
19.
Psychiatr Serv ; 69(5): 609-612, 2018 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-29656706

RESUMO

OBJECTIVE: A growing body of literature demonstrates that high-fidelity implementation of the individual placement and support (IPS) model of supported employment increases the chances of achieving desired outcomes. This study examined the relationship between IPS fidelity, as self-reported by program sites, and employment outcomes and determined whether this relationship was maintained over time. METHODS: A total of 78 outpatient programs in New York State provided data on self-reported IPS fidelity and employment outcomes. Pearson correlations were used to determine the relationship between fidelity scores and competitive employment rates. A mixed-effects model examined the relationship between repeated fidelity and employment measures over time. RESULTS: A significant positive relationship was found between better self-reported IPS fidelity and greater employment. The relationship between IPS fidelity and employment was sustained over time (up to one year). CONCLUSIONS: Higher-fidelity implementation of the IPS model, as self-assessed by program sites, was associated with higher employment rates, which were sustained over time.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Readaptação ao Emprego/estatística & dados numéricos , Prática Clínica Baseada em Evidências/estatística & dados numéricos , Transtornos Mentais/reabilitação , Serviços de Saúde Mental/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Adulto , Humanos , Ciência da Implementação , New York
20.
Psychiatr Serv ; 69(7): 777-783, 2018 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-29606074

RESUMO

OBJECTIVE: Violent and aggressive behaviors are common among psychiatric inpatients. Hospital security officers are sometimes used to address such behaviors. Research on the role of security in inpatient units is scant. This study examined when security is utilized and what happens when officers arrive. METHODS: The authors reviewed the security logbook and the medical records for all patients discharged from an inpatient psychiatry unit over a six-month period. Authors recorded when security calls happened, what behaviors triggered security calls, what outcomes occurred, and whether any patient characteristics were associated with security calls. RESULTS: A total of 272 unique patients were included. A total of 49 patients (18%) generated security calls (N=157 calls). Security calls were most common in the first week of hospitalization (N=45 calls), and roughly half of the patients (N=25 patients) had only one call. The most common inciting behavior was "threats to persons" (N=34 calls), and the most common intervention was intramuscular antipsychotic injection (N=49 calls). The patient variables associated with security calls were having more than one prior hospitalization (odds ratio [OR]=4.56, p=.001, 95% confidence interval [CI]=1.80-11.57), involuntary hospitalization (OR=5.09, p<.001, CI=2.28-11.33), and going to court for any reason (OR=5.80, p=.004, CI=1.75-19.15). CONCLUSIONS: Security officers were often called for threats of violence and occasionally called for actual violence. Patient variables associated with security calls are common among inpatients, and thus clinicians should stay attuned to patients' moment-to-moment care needs.


Assuntos
Agressão , Pacientes Internados/estatística & dados numéricos , Transtornos Mentais/psicologia , Medidas de Segurança , Violência/prevenção & controle , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , New York , Unidade Hospitalar de Psiquiatria , Restrição Física , Gestão da Segurança/organização & administração , Adulto Jovem
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