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1.
BMC Palliat Care ; 20(1): 11, 2021 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-33435954

RESUMO

BACKGROUND: Palliative care day services provide a safe environment for people with palliative care needs, enabling them to access a range of services while acting as a respite services for family caregivers. Viewed as marginal services, they are often under resourced and under researched. The aim of this study was to understand how palliative day care services contribute to client care from the perspective of management and hospice multidisciplinary teams. METHODS: A descriptive qualitative study, using six focus groups conducted with staff at three United Kingdom hospices in England, Scotland and Northern Ireland. Thirty-five participants were recruited, including management and staff. Discussions were transcribed and analysed thematically. RESULTS: Four key themes emerged: (1) variations of care, beyond heterogeneity of patients; (2) unclear referrals and inconsistent patient population; (3) recognising strengths and challenges and (4) an uncertain future. A major focus of group discussions was the model of care and the benefits of the service, however the importance of demonstrating services' effectiveness and value for money was highlighted. CONCLUSIONS: Management and hospice staff believed day-services to be a helpful introduction to palliative care, providing both social and medical support. Economic pressures and patient demand were influencing them to move from a social model to a hybrid model. Further research is needed to understand the effectiveness of the service.


Assuntos
Hospital Dia , Pessoal de Saúde , Hospitais para Doentes Terminais , Cuidados Paliativos , Cuidados Intermitentes , Pessoal Técnico de Saúde , Cuidadores , Assistência à Saúde , Grupos Focais , Acesso aos Serviços de Saúde , Humanos , Enfermeiras Administradoras , Enfermeiras e Enfermeiros , Pesquisa Qualitativa , Encaminhamento e Consulta , Reino Unido
2.
BMC Palliat Care ; 20(1): 12, 2021 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-33435952

RESUMO

BACKGROUND: Huntington's disease (HD) has a poor prognosis. Decision-making capacity and communication ability may become lost as the disease progresses. Therefore, HD patients are encouraged to engage in advance care planning (ACP). To improve ACP for HD patients, there is a need to better understand how these patients face their poor prognosis. AIM: To gain insight into the views of HD patients who receive outpatient care regarding their future and the way they deal with the poor prognosis of their disease. METHODS: A qualitative study using semi-structured interviews with 12 patients with HD (7 outpatient clinic, 3 day care, 2 assisted living facility). Audio-recorded interviews were transcribed verbatim. Through reading and re-reading interviews, writing memos and discussions in the research team, strategies were identified. RESULTS: Three strategies emerged for facing a future with HD. Participants saw the future: 1) as a period that you have to prepare for; 2) as a period that you would rather not think about; 3) as a period that you do not have to worry about yet. Participants could adopt more than one strategy at a time. Even though participants realized that they would deteriorate and would need more care in the future, they tried to keep this knowledge 'at a distance', with the motivation of keeping daily life as manageable as possible. CONCLUSIONS: Official ACP guidelines recommend discussing goals and preferences for future treatment and care, but patients tend to want to live in the present. Further research is needed to elucidate the best approach to deal with this discrepancy.


Assuntos
Planejamento Antecipado de Cuidados , Atitude Frente a Saúde , Objetivos , Doença de Huntington , Adulto , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial , Moradias Assistidas , Hospital Dia , Eutanásia Ativa Voluntária , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Países Baixos , Casas de Saúde , Pesquisa Qualitativa
3.
Arch Gerontol Geriatr ; 93: 104310, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33316639

RESUMO

BACKGROUND: Persons with dementia (PwD) are at greater risk for various adverse health outcomes, and the best care model remains to be determined. This study aimed to compare the physical and neurocognitive performance of PwD in the Program of All-inclusive Care for the Elderly (PACE) and residential dementia care units. METHODS: This was a case-control study comparing outcomes between care recipients of PACE services (PC group) and residential dementia care (RC group). Demographic characteristics, underlying diseases, physical function, cognitive function, mood status, and behavioral and psychotic symptoms of dementia (BPSDs) were assessed every 3-6 months in both groups, while frailty status and Timed Up-and-Go Test (TUGT) performance were assessed every 6 months in the PC group only. RESULTS: Overall, 96 participants (PC group: 25, RC group: 71; mean age: 86.4 ± 6.8 years) were enrolled with the median follow-up period of 43.6 weeks. Lower incidence of hospital admissions was noted in the PC group (0.52 ± 1.12 vs 1.38 ± 2.49 admissions/1,000 person-days, p=0.023), even though the PC group had higher multimorbidity and more severe BPSDs. During the study period, the PC group showed a significant improvement in body mass index, less physical dependence, better cognitive performance and reduced depressive mood. In addition, the PC group showed improvement in frailty, leisure hour activities, and TUGT results. However, participants in the PC group were more likely to experience BPSD deterioration (ß coeff.: 0.193, 95% CI: 0.121- 0.265). CONCLUSION: The PACE services significantly reduced unexpected hospital admissions of PwD, facilitated the maintenance of physical independence, and improved cognitive performance and mood status. Further randomized controlled studies are needed to determine the most appropriate care model for PwD.


Assuntos
Demência , Fragilidade , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Hospital Dia , Demência/epidemiologia , Demência/terapia , Hospitalização , Humanos
4.
Soins Psychiatr ; 41(328): 19-22, 2020.
Artigo em Francês | MEDLINE | ID: mdl-33039086

RESUMO

The act of 5 July 2011 pertaining to the rights and the protection of persons under psychiatric care presents the possibility for compulsory care, without the need for full hospitalisation. Patients can be cared for through partial hospitalisation (day hospital and part-time therapeutic clinic) or in a medical-psychological centre. Treatments and all care are detailed in a care programme. This programme is sent, like all certificates, to the regional health agency and the prefecture in the case of psychiatric care by decision of the State representative, or to the hospital director for psychiatric care at the request of a third party. We propose two clinical vignettes.


Assuntos
Assistência Ambulatorial , Transtornos Mentais/terapia , Hospital Dia , Humanos , Direitos do Paciente/legislação & jurisprudência
5.
Artigo em Inglês | MEDLINE | ID: mdl-33063479

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic prevented a group-based partial hospitalization program (PHP) from running in-person care due to social distancing guidelines. However, the crisis also simultaneously increased stress on families while decreasing their desire to hospitalize youth for a nonmedical issue. Hence, the need for a PHP remained high. Health care organizations worked diligently to create a secure telehealth platform (tele-PHP) to be delivered to patients in their home environments. This article describes the development and implementation of child and adolescent tele-PHPs in response to the COVID-19 pandemic. These new programs were started in mid-March 2020, and changes were implemented over the next 3 to 4 weeks. Overall, patients and families have been receptive to behavioral health services delivered through telemedicine. While tele-PHPs are the most plausible solution to continue behavioral health care for these patients, some challenges were observed during this process. Besides procedural and technological challenges associated with creating a virtual setup, other difficulties include variable patient engagement, specific treatment-related challenges, and system-related changes. These challenges are addressed through psychoeducation, provision of online measures to assess treatment outcomes, and efforts to optimize parent engagement prior to treatment initiation for better treatment adherence. Initial experiences during a time of crisis suggest that tele-PHP services can be a viable long-term treatment option in the future during both a disaster and routine times to improve access for those who otherwise cannot take advantage of such services. Long-term effectiveness of these interventions still needs to be explored.


Assuntos
Infecções por Coronavirus , Hospital Dia/métodos , Pandemias , Participação do Paciente , Pneumonia Viral , Telemedicina/métodos , Adolescente , Psiquiatria do Adolescente , Betacoronavirus , Criança , Psiquiatria Infantil , Humanos , Pais
6.
Niger J Clin Pract ; 23(6): 754-758, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32525107

RESUMO

Background: To evaluate the extent of recall of consent information by daycare prostate biopsy patients in our low-literacy setting. And to evaluate the role of a 3rd party check on patient's recall of consent information. Subjects and Methods: As part of our standard of care, a formal informed consent session for day care prostate biopsy takes place 3 days prior to the procedure. For this study, before leaving the outpatient clinic the same day, the patient acknowledged before a third-party that his concerns were or were not satisfactorily addressed. The extent of recall of consent information was assessed on the morning of the procedure using a researcher-administered questionnaire. Consecutive patients participated in this cross-sectional study for day care prostate biopsy at a tertiary hospital in southeast Nigeria from February to November 2015 after obtaining due consent. Results: The recall of the risks associated with the planned procedure was poorer than the recall of the nature of the disease condition or the nature of the planned procedure. However, it was observed that aggregate recall was significantly poorer among patients who negatively attested to a satisfying consent session (OR 0.125; P < 0.0005). Conclusion: The use of a third-party in determining patient satisfaction after a consent session may be a better indicator of patient comprehension and subsequent recall of consent information, especially in low-literacy settings. Using a third-party, in this manner, may assist in checking paternalism inherent in the patient-doctor relationship.


Assuntos
Compreensão , Hospital Dia/estatística & dados numéricos , Consentimento Livre e Esclarecido , Rememoração Mental , Satisfação do Paciente , Próstata/patologia , Idoso , Idoso de 80 Anos ou mais , Biópsia , Estudos Transversais , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria , Relações Médico-Paciente , Consentimento do Representante Legal
7.
Inf. psiquiátr ; (240): 53-59, abr.-jun. 2020.
Artigo em Espanhol | IBECS | ID: ibc-194758

RESUMO

Propuesta de trabajo de equipo en el Hospital de Día de Adultos (HDA) bajo el paradigma de la trandisciplinariedad. Desde el reconocimiento de la interdependencia entre profesionales de las diferentes disciplinas, trabajar hacia generar espacios de construcción de los casos donde el protagonismo revierta en los pacientes. La propuesta sería concebir el caso como eje, motor y vector; el grupo como vida y el equipo como red de apoyo


This is a proposal of teamwork at Day Hospital using the paradigm of trandisciplinarity. From the recognition of the interdependence between professionals of different disciplines, the aim is to work towards creating spaces for the construction of cases where protagonism return to the patients. The proposal is to conceive the case as axis, motor and vector, the group as life and the team as support network


Assuntos
Humanos , Hospital Dia/organização & administração , Comunicação Interdisciplinar , Hospital Dia/normas , Relações Interprofissionais , Saúde Mental
8.
BMC Health Serv Res ; 20(1): 476, 2020 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-32460778

RESUMO

BACKGROUND: Day care is an important service for many people with dementia and their carers. In Ireland, day care services for people with dementia are delivered by a mix of dementia-specific day care centres as well as generic day care centres that cater for people with dementia to various degrees. In this paper we examine the geographic distribution of day care services for people with dementia relative to potential need. METHODS: Using a national survey of day care centres, we estimate the current availability of day care services for people with dementia in the country. We use geographic information systems (GIS) to map day care provision at regional and sub-regional levels and compare this to the estimated number of people with dementia in local areas. RESULTS: There is significant variation across the country in the existing capacity of day care centres to cater for people with dementia. The number of places per 100 persons with dementia in the community varies from 14.2 to 21.3 across Community Health Organisation areas. We also show that 18% of people with dementia do not live within 15kms of their nearest day care centre. CONCLUSION: Currently, day care centres, in many parts of the country, have limited capacity to provide a service for people with dementia who live in their catchment area. As the number of people with dementia increases, investment in day care centres should be targeted to areas where need is greatest. Our GIS approach provides valuable evidence that can help inform decisions on future resource allocation and service provision in relation to day care.


Assuntos
Hospital Dia , Demência , Acesso aos Serviços de Saúde , Área de Atuação Profissional , Área Programática de Saúde , Sistemas de Informação Geográfica , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Irlanda , Alocação de Recursos , Inquéritos e Questionários
9.
Schmerz ; 34(5): 421-430, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-32451747

RESUMO

The direct comparison of day care pain patients with patients from other treatment sectors with respect to sociodemographic, pain-related and psychological characteristics has not yet been the subject of systematic analyses. The project core documentation and quality assurance in pain therapy (KEDOQ-pain) of the German Pain Society (Deutsche Schmerzgesellschaft e.V.) makes this comparison possible. This second analysis of the available KEDOQ data was intended to show how patients receiving day care treatment can be characterized using the core data set and whether and to what extent they differ from patients receiving outpatient or inpatient treatment. This is a continuation of the first publication, which showed remarkably small differences between outpatients and inpatients but did not include day care patients.The KEDOQ-pain data from 25 centers with a total of 8953 patients were evaluated. Patients had completed the German pain questionnaire (DSF) between January 2012 and March 2017 and received day care (n = 1264), outpatient (n = 4082) or inpatient (n = 3607) pain therapy treatment. Sociodemographic, pain-related and psychometric data of the DSF reported by patients were evaluated as well as physician information on the pain chronification stage and pain localization. The evaluation was descriptive and compared groups using univariate and multivariate procedures.Day care treated patients were significantly younger, had a higher level of education, were more frequently employed, reported higher impairment values and showed a higher severity index according to von Korff than inpatients and outpatients treated for pain. In addition, they described a shorter pain duration as well as worse habitual well-being (Marburg questionnaire on habitual well-being, MFHW). These predictors explained roughly half of the variance in the prediction of the day care treatment setting. The comparison of outpatients and inpatients showed significant group differences for some variables; however, the effects were very small.The evaluations suggest that pain therapy day care facilities treat a special group of pain patients that significantly differ from patients in other treatment sectors. Cautious conclusions are drawn regarding the systematic allocation of patients to care appropriate to their treatment needs.


Assuntos
Hospital Dia , Pacientes Ambulatoriais , Manejo da Dor , Alemanha , Humanos , Pacientes Internados , Dor
10.
Anticancer Res ; 40(4): 2179-2183, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32234912

RESUMO

BACKGROUND: In 2011, a guidance was issued by the National Health Service (NHS) Improvement a model on how mastectomy could be offered in the day-case setting. The goal of this guidance was to reduce inpatient bed days and cost to the NHS, and demonstrate that it can be performed within an acceptable safety profile. The aim of this study was to assess whether patients find the day-case pathway for mastectomy an acceptable management model. We compared complication rates between the day-case and inpatient delivery model. PATIENTS AND METHODS: This study was a retrospective analysis of patients' experience undergoing day-case (n=26) and inpatient mastectomy (n=60). The primary outcome measure was based on a telephone interview using a validated, standardised questionnaire. RESULTS: No statistically significant difference in the satisfaction levels between the two groups (raw scores 6.76 day-case vs. 6.15 inpatient, p=0.37) was demonstrated. We found no statistically significant difference between the two groups when specifically analysing whether patients found the first night harder as a day-case or inpatient (3.192 vs. 2.80, p=0.59, range 0-10). Our overall complications were 11.4% (day-case) and 18.3% (inpatients). Rates were comparable between the two groups and equivalent to published rates in the literature. CONCLUSION: There was no statistically significant difference in satisfaction scores between patients who had a mastectomy as an inpatient versus those who had their operation as a day-case procedure. In addition, there were no significant differences in the complication rates between the two groups. We conclude then that it is feasible and safe to offer day-case mastectomy, with no loss in patient satisfaction.


Assuntos
Neoplasias da Mama/cirurgia , Pacientes Internados/estatística & dados numéricos , Mastectomia/métodos , Satisfação do Paciente/estatística & dados numéricos , Inquéritos e Questionários , Adulto , Idoso , Idoso de 80 Anos ou mais , Hospital Dia/estatística & dados numéricos , Feminino , Humanos , Mastectomia/estatística & dados numéricos , Pessoa de Meia-Idade , Estudos Retrospectivos , Medicina Estatal/estatística & dados numéricos
11.
Cas Lek Cesk ; 159(1): 22-25, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32290669

RESUMO

Due to population aging in developed countries, it has become necessary to prepare a functional health care plan for the elderly. One of the possibilities to improve postoperative outcomes and recovery in elderly patients is to perform common surgical procedures in the regime of one-day surgery. We compared elderly patients who underwent surgery in a large university hospital with elderly patients who underwent surgery in a facility dedicated to one-day surgery. The homogeneity and clinical outcomes of the two groups were statistically analyzed. Complications were assessed according to the Clavien-Dindo classification. There were no statistically significant differences in demographic data and pre-operative risk assessment (ASA). The one-day surgery group had fewer complications and a shorter average hospital stay. Advanced age is not the only criterion for assessing the biological state of the patient and therefore does not always necessitate surgical care in a university hospital setting with a high volume of acute and complicated cases. Many elderly patients will benefit from a more individualized approach and healthcare facilities that specialize solely in elective procedures. When indicating elderly patients for one-day surgery, their health status is more important than their calendar age.


Assuntos
Hospital Dia , Procedimentos Cirúrgicos Minimamente Invasivos , Idoso , Humanos , Tempo de Internação , Complicações Pós-Operatórias
12.
Artigo em Inglês | MEDLINE | ID: mdl-32244980

RESUMO

Adult day care (ADC) provides various services for meeting clients' needs. Based on the mini-Delphi method with 46 ADC staff and the discussions with eight ADC administrators, this study developed and finalized a comprehensive logic model to represent the elements of ADC. For the three basic structures of a logic model-inputs/activities, outputs, and outcomes-the model contained seven core categories and 23 sub-categories. The ADC inputs/activities consisted of two core categories: "Place to stay" and "Intervention from staff". These inputs/activities caused two kinds of outputs: "Clients' experiences" and "Families' experiences". "Accumulating experiences" with repeated ADC visits was established as the link between the ADC outputs and outcomes, which were "Clients' change" and "Families' change". ADC centers provide various experiences for their clients and their caregivers, ranging from the fulfillment of needs for fundamental care to psychiatric care and self-actualization. Improving various model-related inputs/interventions can produce better experiences and outcomes. The model can guide ADC administrators, policymakers, and researchers in the evaluation of a heterogeneous ADC service program that is community-based, thereby ensuring optimal care for clients with an efficient use of resources.


Assuntos
Centros-Dia de Assistência à Saúde para Adultos , Cuidadores , Hospital Dia , Adulto , Humanos , Japão , Lógica , Modelos Teóricos
14.
Actas esp. psiquiatr ; 48(2): 64-74, mar.-abr. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-191906

RESUMO

INTRODUCCIÓN: La terapia basada en la mentalización (TBM), una psicoterapia manualizada de orientación psico-dinámica y en la teoría del desarrollo, ha demostrado efectividad en estudios controlados en pacientes con trastornos mentales graves no psicóticos. Aunque la TBM se utiliza en el tratamiento de los trastornos del espectro esquizofrénico (TEE), hasta la fecha no se han realizado estudios prospectivos para evaluar los resultados y los efectos adversos. La terapia de grupo breve basada en la mentalización (B-TGBM) es un programa de 12 semanas basado en las técnicas de mentalización explícita de la TBM. El estudio se realizó en un hospital de día (HD) y el objetivo principal fue examinar la viabilidad de la B-TGBM en pacientes con TEE. MÉTODO: Estudio abierto para evaluar la seguridad de la B-TGBM en 72 pacientes que cumplían criterios DSM-IV de esquizofrenia, trastorno esquizofreniforme, trastorno esquizoafectivo o trastorno psicótico no especificado. Todos los pacientes realizaron B-TGBM y terapia psicológica integrada (IPT). Consecuentemente, un objetivo secundario fue compa-rar la aceptación y la eficacia subjetiva de estas dos terapias. RESULTADOS: Las reacciones adversas fueron escasas y la más común de las registradas, malestar durante la sesión de grupo, se consideró leve en la mayoría de los casos. Comparada con la IPT, la B-TGBM presentó puntuaciones significativamente superiores en cuatro de los parámetros de eficacia subjetiva. CONCLUSIÓN: La B-TGBM en HD es viable y segura en pacientes con TEE y la mayoría de los pacientes en este estudio la consideraron beneficiosa. Se necesitan estudios controla-dos para determinar la efectividad de la B-TGBM


BACKGROUND: Mentalization-based therapy (MBT), a manualized psychodynamically and developmentally orient-ed psychotherapy, has been proven effective in controlled studies in non-psychotic patients with severe mental disorders. Although MBT is currently being used to treat schizo-phrenia spectrum disorders (SSD), to date no prospective studies have evaluated outcomes and treatment-related adverse effects. Brief mentalization-based group psychotherapy (B-MBGT) is a 12-week program based on the explicit mentalizing techniques of MBT. The study was conducted at a day hospital (DH) and the main objective was to examine the feasibility of B-MBGT to treat patients with SSD. Method. Open study to assess the safety of B-MBGT in 72 patients who met DSM-IV criteria for schizophrenia, schizophreniform disorder, schizoaffective disorder, or unspecified psychotic disorder. All patients underwent both B-MBGT and Integrated Psychological Therapy (IPT). Consequently, a secondary aim was to compare these two therapies in terms of acceptance and subjective efficacy. RESULTS: Adverse reactions were scarce and the most common of the reported ones, discomfort during the group treatment session, was considered mild in most cases. Compared to IPT, B-MBGT yielded significant higher scores on four subjective efficacy parameters. CONCLUSION: B-MBGT in DH is both feasible and safe in SSD patients and most patients in this study considered B-MBGT to be beneficial. Controlled studies are needed to determine the effectiveness of B-MBGT


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Psicoterapia de Grupo/métodos , Esquizofrenia/terapia , Teoria da Mente , Resultado do Tratamento , Fatores Socioeconômicos , Estudos de Viabilidade , Estudos Prospectivos , Hospital Dia
15.
Psychiatr Prax ; 47(5): 235-241, 2020 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-32198734

RESUMO

OBJECTIVE: Approximately 80 % of patients in psychiatric treatment are significant impaired in participation work and are excluded from the labor market. METHOD: Survey of 176 patients in day hospital and inpatient psychiatric treatment regarding work-related participation impairments, need for support in competitive employment, education or study and actually received support. RESULTS: Data of 90 patients were available. 63 % of patients indicated a need for support in work-related participation, 53 % of them would participate in a job coaching. 49 % of the patients were addressed on the topic of work. Regardless of the need for support, only 1/5 of patients received concrete help. There is a strong need for support for young adults (77 %) and first-admission patients (73 %). CONCLUSION: There is a high but unmet need for support in managing work-related participation impairment. Routine needs assessment and the implementation of evidence-based methods could improve work-related inclusion.


Assuntos
Hospital Dia , Pacientes Internados , Participação do Paciente , Alemanha , Hospitalização , Humanos , Adulto Jovem
16.
JAMA Netw Open ; 3(3): e200347, 2020 03 02.
Artigo em Inglês | MEDLINE | ID: mdl-32125428

RESUMO

Importance: A shift in the setting of care delivery for children with a new diagnosis of type 1 diabetes led to a reorganization of treatment. Objective: To determine whether a new diagnosis of pediatric diabetes can be successfully managed in a day hospital model. Design, Setting, and Participants: This quality improvement study used retrospectively collected data on pediatric patients with a new diagnosis of diabetes who completed an inpatient program for education and insulin titration prospectively compared with patients completing a diabetes day hospital program. Baseline data were collected over 12 months (January-December 2015) and intervention data collected over 14 months (March 2016-May 2017). The study was conducted at a single institution and judged as a nonhuman participant project. The referral local base included a 100-mile radius. Patient inclusion was a new diagnosis of diabetes, age 5 years or older, and no biochemical evidence of diabetic ketoacidosis. Ninety-six patients completed the day hospital program and 192 patients completed an inpatient program. Exposures: All patients received 2 consecutive days of insulin titration and education in either a day hospital or inpatient setting. Main Outcomes and Measures: Primary outcomes included the mean length of stay, patient charge, and insurance denial/reimbursement rates. The hypothesis was that a day hospital program would be associated with a reduced length of stay, which would directly affect patient charges and insurance denials. Results: Among the 96 day hospital patients, the mean (SD) age was 12.2 (4.7) years (range 5-20.3), with no patients experiencing diabetic ketoacidosis or hypernatremia. Among the 192 inpatient patients, the mean (SD) age was 9.4 (4.7) years (range, 1.6-20.1). The mean (SD) length of stay reduction in the day hospital was 46 (14.1) to 14 (5.1) hours. The mean day hospital patient charge was $2800, compared with a mean (SD) baseline carge of $24 103 ($9401). Within the first year, there was a cumulative reduction in patient charges of more than $2.1 million. Conclusions and Relevance: This study's findings suggest that a diabetes day hospital setting was associated with reductions in length of stay and patient charges, with an increase in insurance reimbursements and a decrease in insurance denials. This study demonstrates an effective way to streamline new-onset diabetes education, which may reduce length of stay and patient charges. Reimbursement rates for patients with a new diagnosis of diabetes increased from 52% to 72% and reimbursement denial rates decreased from 80% to 0%.


Assuntos
Hospital Dia/métodos , Assistência à Saúde/métodos , Diabetes Mellitus Tipo 1/tratamento farmacológico , Preços Hospitalares , Hospitalização/estatística & dados numéricos , Hipoglicemiantes/administração & dosagem , Insulina/administração & dosagem , Educação de Pacientes como Assunto/métodos , Adolescente , Criança , Pré-Escolar , Análise Custo-Benefício , Hospital Dia/economia , Assistência à Saúde/economia , Feminino , Hospitalização/economia , Humanos , Lactente , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Estudos Prospectivos , Melhoria de Qualidade , Mecanismo de Reembolso , Estudos Retrospectivos , Adulto Jovem
17.
Bull Cancer ; 107(2): 181-190, 2020 Feb.
Artigo em Francês | MEDLINE | ID: mdl-32005357

RESUMO

The Paul Strauss Center day-care accompaniment department ("SSAJ") is an oncologic supportive day-care, also an alternative to conventional hospitalization. In order to follow the SSAJ department's activity, in the "ambulatory turnover" context, we compared the 2008 and 2016 four first months activity. In 2016, there was an average of 4.96 patients per day versus 5.62 in 2008 (P<0.001); average day incoming of 653€ per stay in 2016 versus 775€ in 2008 (P<0.001). In 2016, there was an average 63.9 % of imagery done versus 27.7 % in 2008 (P<0.001). The 2016 average patient following period was of 84.7 days versus 67.6 days in 2008 (P=0.019). Average time between first day-care visit and death was 161.7 days in 2016 versus 133.5 days in 2008 (P=0.0033). Average day activity is lower in 2016 than 2008, nonetheless number of total stays and inpatients has increased on the four months period. The SSAJ intervenes more precociously in 2016 than 2008. Hospital technical platform is better used, but average per-stay incoming has statistically lowered. The SSAJ limits and prepares complete hospitalizations. Inpatient close reevaluation after a "shorter-willing" stay, home issues anticipation and identification with the home-care team, and worsening prevention gives this activity all its meaning.


Assuntos
Institutos de Câncer/estatística & dados numéricos , Hospital Dia/estatística & dados numéricos , Neoplasias/terapia , Idoso , Antineoplásicos/uso terapêutico , Hospital Dia/economia , Diagnóstico por Imagem/estatística & dados numéricos , França , Humanos , Pessoa de Meia-Idade , Neoplasias/diagnóstico por imagem , Alta do Paciente/estatística & dados numéricos , Transferência de Pacientes/estatística & dados numéricos
18.
Int J Eat Disord ; 53(4): 606-610, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32092177

RESUMO

OBJECTIVE: Improved treatment outcome in family-based treatment (FBT) for anorexia nervosa (AN) is predicted by weight gain occurring early in the course of treatment (i.e., about 4 lbs by week 4). Although prior work suggests that early weight gain in higher levels of care (e.g., partial hospitalization programs [PHP]) predicts weight restoration at discharge, no study has examined the specific rate of gain within FBT-informed PHP programs that best predicts treatment response. METHOD: This study examined rate of weight gain in pounds and percent expected body weight (EBW) that predicts positive outcome in 70 patients (M age = 15.49 years, SD = 2.56) with AN who were enrolled in a family-based PHP. RESULTS: Receiver operator characteristic analyses demonstrated that changes in %EBW during weeks 2-5 were more useful than changes in weight in predicting positive outcome. Gaining at least 8.9 pounds or over 8% of EBW in the first 4 weeks of treatment significantly predicted positive outcome. DISCUSSION: Findings suggest that positive outcome in an FBT-informed PHP is predicted by rapid weight gain in the initial weeks of treatment. Research is needed to identify specific family and patient characteristics that facilitate weight gain and to develop corresponding interventions to improve outcome.


Assuntos
Anorexia Nervosa/terapia , Hospital Dia/métodos , Terapia Familiar/métodos , Ganho de Peso/efeitos da radiação , Adolescente , Feminino , Hospitalização , Humanos , Masculino , Resultado do Tratamento , Ganho de Peso/fisiologia
19.
Actas esp. psiquiatr ; 48(1): 19-27, ene.-feb. 2020. graf
Artigo em Espanhol | IBECS | ID: ibc-188329

RESUMO

INTRODUCCIÓN: La Hospitalización Total (HT) es el tratamiento de elección para adolescentes con Anorexia Nerviosa (AN) moderada-grave. Sin embargo, ésta es costosa y el riesgo de recaída o reingresos es alto. Una alternativa menos costosa es la Hospitalización Parcial (HP), que puede ayudar a evitar recaídas y reingresos porque facilita la transición del hospital al tratamiento comunitario. OBJETIVO: Evaluar la eficacia de un tratamiento intensivo en HP para adolescentes con AN, el programa de HP para Trastornos de la Conducta Alimentaria (TCA) de 11 horas (HP-TCA-11h), respecto a la recuperación ponderal, evitar ingresos y disminuir estancias en HT. MÉTODO: Se realizó un estudio longitudinal y naturalístico que analizó las variables clínicas y socio-demográficas de los pacientes con AN que fueron dados de alta consecutivamente del HP-TCA-11h, durante los años 2015-2016. RESULTADOS: Se realizaron 77 altas. La edad media fue de 14.4 años (DE: 1.62). La estancia media fue de 28.9 días (DE: 18.5). La media del índice de masa corporal aumentó significativamente al alta (17.2 frente a 17.9, p < 0.001) y a los 12 meses de seguimiento (17.9 frente a 19.3, p < 0.001). Veintinueve (70.8%) pacientes tratados en HP-TCA-11h, que vinieron de un recurso menos intensivo, evitaron el ingreso en HT. Catorce (18.2%) requirieron un reingreso en HP-TCA-11h en dos años. La estancia media en HT disminuyó significativamente (de 33 a 24 días, p < 0.043). CONCLUSIÓN: HP-TCA-11h ha demostrado ser un recurso eficaz como alternativa a la HT para adolescentes con AN moderada-grave. Este nuevo modelo tiene implicaciones coste-efectivas ya que es un recurso seguro y menos costoso que la HT


INTRODUCTION: Inpatient Treatment (IT) is the treatment of choice for moderate or severely ill adolescents with An-orexia Nervosa (AN). Nevertheless, it is expensive, and the risk for relapse or readmissions is high. A less costly alterna-tive to IT is Day Patient Treatment (DP), which may also help to avoid relapses and readmissions because facilitates tran-sition from hospital to community treatment. AIM: To assess the effectiveness of the 11-hour DP pro-gram for Eating Disorders (DP-ED-11h), a new intensive DP treatment for adolescents with AN, with respect to weight recovery, avoidance of hospital admission and decrease of Length of Stay (LoS). METHOD: A longitudinal, naturalistic study was carried out analysing clinical and sociodemographic variables from 77 patients with AN who were consecutively discharged from DP-ED-11h, during years 2015-2016. RESULTS: There were 77 discharges. The average age was 14.4 years old (SD: 1.62). The LoS at DP-ED-11h was 28.9 days (SD: 18.5). The mean body mass index increased significantly at discharge (17.2 vs.17.9, p < 0.001) and at 12 months fol-low-up (17.9 vs.19.3, p < 0.001). Twenty nine (70.8%) of the patients treated at DP-ED-11h, who came from a less inten-sive setting, avoided an admission. Fourteen (18.2%) required readmission at DP-ED-11h within two years. The LoS at IT was significantly reduced (from 33 to 24 days, p < 0.043). CONCLUSIONS: DP-ED-11h has shown to be an effective resource as an alternative to IT for adolescents with moder-ate to severe AN. This new model has cost-effectiveness im-plications as it is a safe resource and is less costly than IT


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Assistência Ambulatorial , Anorexia Nervosa/terapia , Hospital Dia , Índice de Gravidade de Doença , Estudos Longitudinais
20.
Eur Eat Disord Rev ; 28(2): 199-210, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31925866

RESUMO

Despite initial data suggesting positive treatment outcomes for adolescent eating disorder day-hospital programmes (DHPs), existing studies have included limited follow-up, small samples, and a focus on restricting-type eating disorders. To address these gaps, we explored naturalistic outcomes for an adolescent eating disorders DHP. Adolescent participants (N = 265) completed measurements at treatment admission, discharge (n = 170), and various lengths of follow-up (n = 126; Mfollow up = 278.87 days). Results from multilevel models indicated significant increases in body weight for the anorexia nervosa group throughout treatment and maintenance of increased body weight from discharge to follow-up. In bulimic spectrum disorders, binge eating and purging significantly decreased from intake to discharge and did not change from discharge to follow-up. Across the entire sample, eating disorder symptoms decreased from intake to discharge and did not change from discharge to follow-up. Further, anxiety and depression decreased over the course of treatment and continued to decrease over the follow-up period. The current investigation represents the first study to explore longitudinal DHP outcomes within adolescent bulimic spectrum eating disorders. Our findings also highlight many challenges inherent in conducting naturalistic research; it is critical that the field continue to develop solutions to the barriers inherent in conducting longitudinal research on eating disorder treatment.


Assuntos
Hospital Dia/métodos , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Adolescente , Feminino , Humanos , Masculino , Resultado do Tratamento
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