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1.
Fortschr Neurol Psychiatr ; 88(1): 24-32, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-30731483

RESUMO

Modern psychiatry needs to implement novel mental health care systems in order to address recent developments in diagnostics and treatment of psychiatric patients. In this context, it is necessary to take into account recent ethical and certain legal aspects which explicitly seek to reduce coercive treatment. The so-called "track-unit" is a promising strategy in order to achieve these goals. The "track-unit" seeks to enhance and improve patients' autonomy, setting-overlapping team continuity, compliance and adherence to treatment as well as to reduce time of patients in hospital as inpatients by more flexible intervention. Although there are many interfaces between normal wards and the "track-unit", implementation into daily routine should be done gradually. The first part of this paper will focus on required changes taking as an example the Department of Psychiatry and Psychotherapy at the Central Institute of Mental Health in Mannheim. In the second part, we will describe corresponding helpful constructional measures. In part three, we will discuss the socio-economic aspects and benefits of "track-units". In conclusion, the implementation of "track-units" in a German psychiatric department is a personnel and economic endeavor to improve the link and coordination between diagnostics and treatment throughout all stages of mental illness.


Assuntos
Transtornos Mentais/terapia , Psiquiatria/métodos , Coerção , Humanos , Transtornos Mentais/diagnóstico , Transtornos Mentais/economia , Saúde Mental , Psiquiatria/economia , Psiquiatria/ética , Psicoterapia
2.
Health Serv Res ; 54(6): 1316-1325, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31598965

RESUMO

OBJECTIVE: To investigate whether continuity of care in family practice reduces unplanned hospital use for people with serious mental illness (SMI). DATA SOURCES: Linked administrative data on family practice and hospital utilization by people with SMI in England, 2007-2014. STUDY DESIGN: This observational cohort study used discrete-time survival analysis to investigate the relationship between continuity of care in family practice and unplanned hospital use: emergency department (ED) presentations, and unplanned admissions for SMI and ambulatory care-sensitive conditions (ACSC). The analysis distinguishes between relational continuity and management/ informational continuity (as captured by care plans) and accounts for unobserved confounding by examining deviation from long-term averages. DATA COLLECTION/EXTRACTION METHODS: Individual-level family practice administrative data linked to hospital administrative data. PRINCIPAL FINDINGS: Higher relational continuity was associated with 8-11 percent lower risk of ED presentation and 23-27 percent lower risk of ACSC admissions. Care plans were associated with 29 percent lower risk of ED presentation, 39 percent lower risk of SMI admissions, and 32 percent lower risk of ACSC admissions. CONCLUSIONS: Family practice continuity of care can reduce unplanned hospital use for physical and mental health of people with SMI.


Assuntos
Continuidade da Assistência ao Paciente/organização & administração , Medicina de Família e Comunidade/organização & administração , Hospitalização/estatística & dados numéricos , Transtornos Mentais/economia , Transtornos Mentais/terapia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Inglaterra , Medicina de Família e Comunidade/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
3.
Psychiatriki ; 30(2): 97-107, 2019.
Artigo em Grego Moderno | MEDLINE | ID: mdl-31425138

RESUMO

During previous financial crises as well as the recent global financial crisis, a strong impact of the crisis on the population mental health in many countries has been observed. Similarly, in Greece, a series of epidemiological studies pointed out the consequences of the economic crisis on the population mental health. However, there is limited data available, both in Greece and worldwide, regarding the impact of the economic crisis from the perspective of mental health services. The goal of the present study was to examine possible changes on the community mental health during the first years of the Greek financial crisis, as they are reflected on the operation of a community mental health unit with a specific catchment area within Athens (Byron and Kessariani). The demographic, social and clinical characteristics of adult users who were admitted for the first time at ByronKessariani Mental Health Community Center during the years 2008-2013 were analysed. The impact of the financial crisis on the workload of the center was also assessed during the same period. The sample of the study consisted of 1865 adult users and the data was collected with the use of an ad hoc structured questionnaire as well as from the users' case files. No significant differentiation on the number of clients admitted to the center per year after the beginning of the financial crisis was found. However, it is possible that an upper limit has been reached on the center's capacity to admit new clients, i.e. a ceiling effect, as it is shown from the increased number of provided sessions per year as well as from the increase in the mean waiting time for the intake of new patients during the same period. A constant increase in the number of women among the new clients of ByronKessariani Mental Health Community Center was found, but no significant differentiations were detected during the study period. Moreover, the study showed an upward trend in aggressive behavior as a reason for admission, a significant and continuous increase in the rate of unemployed individuals among the new clients, as well as a statistically significant increase in the number of referrals for psychotherapy during the study period. There was also an increase in the number of patients who had psychiatric history, even though they were admitted to Byron-Kessariani Mental Health Community Center for the first time. No significant differentiations were found in the remaining users' demographic and clinical characteristics assessed. Our study showed that during the crisis community mental health services are under pressure due to the increased needs of patients, especially the needs for psychotherapeutic intervention and psychological support. The increased unemployment rates affect the influx of new patients as well as the therapeutic management of many users. Reinforcement of the community mental health service network is an important strategy against the consequences of the crisis on the population mental health.


Assuntos
Centros Comunitários de Saúde Mental/estatística & dados numéricos , Recessão Econômica/estatística & dados numéricos , Adulto , Agressão , Centros Comunitários de Saúde Mental/organização & administração , Serviços Comunitários de Saúde Mental , Feminino , Grécia/epidemiologia , Humanos , Masculino , Transtornos Mentais/economia , Transtornos Mentais/psicologia , Saúde Mental , Pessoa de Meia-Idade , Psicoterapia/estatística & dados numéricos , Fatores Socioeconômicos , Desemprego/psicologia , Desemprego/estatística & dados numéricos
4.
Artigo em Inglês | MEDLINE | ID: mdl-31454958

RESUMO

This study analyzes the dynamic interaction of an individual's physical and mental health using the German Socio-Economic Panel and the Cross-National Equivalent File of Germany. Its main objective is to find a way to reduce people's health expenditure by examining the magnitude of the interdependence between physical and mental health. For the analysis, this study develops a dynamic correlated random effects model. We create two aggregate health measures (aggregate physical health and aggregate mental health) with four submeasures each, which provides a better understanding of changes in an individual's health status by capturing additional information that cannot be analyzed at the aggregate level. There is clear evidence that the persistence of a mental health condition is less than that of a physical health condition. Moreover, the impact of previous mental health on current physical health is greater than that of previous physical health on current mental health. This suggests that individuals can reduce their expenditures on physical health problems by focusing on the treatment of mental problems when they first arise. Finally, the Government's attention and support toward mental health care would lead to a reduction in health expenditures and eventually improve the sustainability of the nation's health system.


Assuntos
Gastos em Saúde/estatística & dados numéricos , Nível de Saúde , Transtornos Mentais/economia , Transtornos Mentais/terapia , Serviços de Saúde Mental/economia , Alemanha , Humanos , Serviços de Saúde Mental/estatística & dados numéricos
5.
Inquiry ; 56: 46958019871815, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31455121

RESUMO

This study examined income-based disparities in financial burdens from out-of-pocket (OOP) medical spending among individuals with multiple chronic physical and behavioral conditions, before and after the Affordable Care Act's (ACA) implementation in 2014. Using the 2012-2015 Medical Expenditure Panel Survey data, we studied changes in financial burdens experienced by nonelderly U.S. populations. Financial burdens were measured by (1) high financial burden, defined as total OOP medical spending exceeding 10% of annual household income; (2) health care cost-sharing ratio, defined as self-paid payments as a percent of total health care payments, excluding individual contributions to premiums; and (3) the total OOP costs spent on health care utilization. The findings indicated reductions in the proportion of those who experienced a high financial burden, as well as reductions in the OOP costs for some individuals. However, individuals with incomes below 138% federal poverty level (FPL) and those with incomes between 251% and 400% FPL who had multiple physical and/or behavioral chronic conditions experienced large increases in high financial burden after the ACA, relative to those with incomes greater than 400% FPL. While the ACA was associated with relieved medical financial burdens for some individuals, the worsening high financial burden for moderate-income individuals with chronic physical and behavioral conditions is a concern. Policymakers should revisit the cost subsidies for these individuals, with a particular focus on those with chronic conditions.


Assuntos
Doença Crônica/economia , Família , Gastos em Saúde/estatística & dados numéricos , Cobertura do Seguro/economia , Seguro Saúde/economia , Pobreza/estatística & dados numéricos , Fatores Socioeconômicos , Adulto , Custo Compartilhado de Seguro , Feminino , Humanos , Masculino , Transtornos Mentais/economia , Pessoa de Meia-Idade , Patient Protection and Affordable Care Act/economia , Inquéritos e Questionários , Estados Unidos , Adulto Jovem
6.
J Ment Health Policy Econ ; 22(2): 43-59, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31319375

RESUMO

BACKGROUND: Insurance benefit features play a role in determining access to specialty mental health care. Previous research, primarily examining the effects of copayments, coinsurance, and deductibles in a fee-for-service setting, has concluded that specialty mental health use is highly sensitive to changes in financial requirements. Less is known about the effects of other benefit features and the effects of all of these features in a managed care environment. AIMS OF THE STUDY: Determine whether increased generosity of three types of benefit features was associated with increases in specialty mental health use and expenditures in a managed care setting. Secondary analyses investigated whether these associations varied by income level. METHODS: A first-differences design used linked claims, enrollment, and benefit data for 1,242,949 non-elderly adults (aged 18-64) with employer-sponsored insurance, before (2009) and after (2011) national behavioral health parity implementation. The data were provided by a large national managed behavioral health organization. Benefit design features included combined cost sharing from copayment and coinsurance, deductibles, the presence of annual use limits, cost sharing penalties associated with services used without getting required prior-authorization, and provider network. Outcomes included visits/days, total expenditures and patient out-of-pocket expenditures for individual psychotherapy and inpatient use, with separate values for in-network and out-of-network (OON) service use. Ordinary least squares regression was performed on change scores (2011 minus 2009 values) of all outcomes to implement the first-differences study design and normalize distributions of otherwise heavily skewed (towards zero) variables. Regressions stratified by higher income (>=USD75,000) and net worth (>=USD100,000) and lower income/net worth were also conducted. RESULTS: For in-network individual psychotherapy, larger increases in cost sharing from copayment and coinsurance were modestly associated with larger decreases in use and total expenditures (beta_visits=--0.00008, p-value=0.030; beta_total expenditures=USD--0.00629, p-value=0.011), and elimination of treatment limits was associated with larger increases in use (beta=0.09637, p-value=0.002) and total expenditures (beta=USD6.57506, p-value=0.001). These results were observed among all enrollees of plans that covered in-network and out-of-network plans and among a sub-set of these enrollees who did not change plans between 2009 and 2011. Benefit features had fewer associations with inpatient care and OON services. DISCUSSION: Elimination of limits was associated with small average increases in in-network individual psychotherapy utilization and expenditures. Cost sharing sensitivities of individual psychotherapy visits to financial requirements reported here were small, and resembled previous findings based in a managed care setting, which were smaller than findings based on the fee-for-service settings. Cost sharing may not pose a practical barrier to specialty behavioral health for non-elderly adults with employer-sponsored managed care plans. However, the influence of cost sharing may vary by specific healthcare needs, something that should be explored in further research.


Assuntos
Custo Compartilhado de Seguro , Dedutíveis e Cosseguros , Benefícios do Seguro , Programas de Assistência Gerenciada/organização & administração , Transtornos Mentais/economia , Serviços de Saúde Mental/economia , Saúde Mental , Adolescente , Adulto , Idoso , Gastos em Saúde , Humanos , Programas de Assistência Gerenciada/economia , Pessoa de Meia-Idade , Estados Unidos , Adulto Jovem
7.
World Neurosurg ; 129: e718-e725, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31181363

RESUMO

OBJECTIVE: The present study examined the differences in outcomes of cervical spinal surgery for patients with and without a major psychiatric comorbidity using the Healthcare Cost and Utilization Project National Inpatient Sample database. METHODS: Data were queried from the Healthcare Cost and Utilization Project National Inpatient Sample database from 2013 to 2014 for hospitalizations with a major psychiatric comorbidity and a diagnosis of cervical spondylotic myelopathy treated by an appropriate surgical procedure. The included psychiatric comorbidities were schizophrenia, episodic mood disorders (bipolar I and II disorders), delusional disorders, and psychoses not otherwise specified. Univariate and multivariate regression analyses were performed to determine the differences in outcomes between patients with and without a major psychiatric comorbidity. RESULTS: A total of 18,335 hospitalizations met the inclusion criteria, of which 648 (3.5%) included a major psychiatric comorbidity. Multivariate regression analysis demonstrated that psychiatric comorbidity was an independent predictor of non-home discharge (odds ratio [OR], 1.81; 95% confidence interval [CI], 1.43-2.30; P < 0.0001) and a longer hospital stay (+0.52 day; 95% CI, 0.43-0.61; P < 0.0001) but was not an independent predictor of overall complications (OR, 0.79; 95% CI, 0.58-1.07; P = 0.13) or total hospital charges ($1992; 95% CI, -$917-$4902; P = 0.18). CONCLUSIONS: Psychiatric comorbidity was associated with an increased risk of non-home discharge and a longer length of stay for patients undergoing surgical intervention for cervical myelopathy. However, we did not find an associated increased risk of in-hospital mortality, complications, or total hospital charges. Psychiatric comorbidity should not be weighed against patients who require surgical treatment for cervical spondylotic myelopathy, and special attention should be given to postoperative care and discharge planning for this unique patient population.


Assuntos
Vértebras Cervicais/cirurgia , Transtornos Mentais/complicações , Espondilose/complicações , Idoso , Bases de Dados Factuais , Feminino , Preços Hospitalares , Humanos , Tempo de Internação/economia , Masculino , Transtornos Mentais/economia , Pessoa de Meia-Idade , Fatores de Risco , Espondilose/economia , Espondilose/cirurgia , Resultado do Tratamento
8.
Dermatology ; 235(4): 276-286, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31163441

RESUMO

BACKGROUND: Psoriasis is associated with psychosocial distress. Little is known about the relationship between psoriasis and mental health (MH) emergencies. OBJECTIVE: To examine the associations of psoriasis and MH hospitalizations in the USA. METHODS: Data from the 2002-2012 National Inpatient Sample were analyzed, including an approximately 20% sample of all US hospitalizations (n = 87,053,155 children and adults). RESULTS: Hospitalization for MH disorders occurred more commonly in those with psoriasis compared to those without psoriasis (4.04 vs. 2.21%). In multivariable logistic regression models, psoriasis was associated with higher odds of admission for any MH disorder overall (adjusted odds ratio [95% confidence interval]: 2.32 [2.24-2.41]), as well as 9 of the 15 MH-specific disorders examined. Associated MH disorders included: anxiety, schizophrenia, personality disorder, depression, substance use disorders, history of MH disorder, alcohol-related disorders, adjustment disorders, and cognitive disorders. Children with versus those without psoriasis were also more likely to have a primary hospitalization for any MH disorder (2.82 [2.24-3.56]). Psoriasis inpatients were also more likely to have a primary hospitalization for any MH disorder compared to those with alopecia areata (1.99 [1.45-2.74]) or hidradenitis suppurativa (3.97 [3.49-4.52]). Psoriasis patients hospitalized with any MH disorder had higher mean [95% confidence interval] cost of inpatient care (USD 11,004 [10,846-11,241] vs. 9,547 [8,730-10,364]; p < 0.0001) compared to those without psoriasis, with USD 1,610,860 excess costs annually, with the majority of the costs coming from depression and mood disorders. CONCLUSIONS: Children and adults with psoriasis had increased hospitalization for multiple MH disorders, which were associated with a considerable financial burden.


Assuntos
Hospitalização/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Psoríase/epidemiologia , Psoríase/psicologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Efeitos Psicossociais da Doença , Emergências/economia , Emergências/epidemiologia , Feminino , Hospitalização/economia , Humanos , Lactente , Recém-Nascido , Masculino , Transtornos Mentais/economia , Pessoa de Meia-Idade , Psoríase/economia , Estados Unidos/epidemiologia , Adulto Jovem
9.
Z Kinder Jugendpsychiatr Psychother ; 47(4): 345-358, 2019 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-31099287

RESUMO

Various socioeconomic factors as predictors of internalizing and externalizing disorders in children and adolescents Abstract. Objective: Socioeconomic status (SES) is an important risk factor for psychiatric disorders in children and adolescents. Various SES parameters are included in research efforts. This paper investigates the predictive value of different individual SES measures and the combination thereof regarding internalizing and externalizing disorders in children and adolescents. Method: We used data from N = 381 8- to 14-year-olds who had been recruited in child and adolescent psychiatric facilities and in the general population. Based on a diagnostic parent interview (K-SADS-PL), we divided the sample into internalizing and externalizing groups and a healthy control group. The SES data of both parents were collected. Education, occupational status, and income were integrated as single factors as well as combined factor to form the SES index. Additionally, we assessed unemployment. Results: Using multivariate analyses, we controlled for age and sex. All single factors turned out to be significant risk factors for internalizing and externalizing disorders. Occupational status was the most important single factor. The explained variance for the SES index was as high as for occupational status. Unemployment was not predictive when examined simultaneously with the SES index. Conclusion: Future studies should integrate the SES as risk factor and use the SES index or occupational status as single factor. The integration of unemployment is not necessarily needed.


Assuntos
Transtornos Mentais/epidemiologia , Transtornos Mentais/etiologia , Fatores Socioeconômicos , Adolescente , Criança , Humanos , Transtornos Mentais/economia , Transtornos Mentais/psicologia , Pais/psicologia , Fatores de Risco
11.
Asian J Psychiatr ; 42: 42-47, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30951932

RESUMO

Mental health problems are common in Lebanon, and so are psychiatric emergencies. In order to show the characteristics of psychiatric emergencies in Lebanon along with their dispositional determinants, we conducted this retrospective, single-center, chart-review study of patients who presented to the Emergency Department between July 1, 2016 until December 31, 2016 and required an official psychiatrist consultation. Our sample included 195 patients of all age groups. The most common diagnosis was depression (75 patients) followed by anxiety (61 patients). 107 patients (54.8%) required admission for adequate treatment; however only 72 (67.3%) of those were actually admitted, and the rest (32.7%) left the hospital against medical advice. Increased hospital admission was associated with being a female (OR = 3.042), having family history of psychiatric disease (OR = 2.040) and having suicidal ideations (OR = 12.949). In a country that has inadequate health coverage, financial coverage can also be a determining factor in whether or not patients get the admission they need.


Assuntos
Suscetibilidade a Doenças/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Transtornos Mentais , Admissão do Paciente/estatística & dados numéricos , Ideação Suicida , Adolescente , Adulto , Transtornos de Ansiedade/economia , Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/terapia , Transtorno Depressivo/economia , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/terapia , Suscetibilidade a Doenças/terapia , Serviço Hospitalar de Emergência/economia , Feminino , Hospitais Universitários/estatística & dados numéricos , Humanos , Cobertura do Seguro/economia , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/economia , Seguro Saúde/estatística & dados numéricos , Líbano/epidemiologia , Masculino , Transtornos Mentais/economia , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Pessoa de Meia-Idade , Admissão do Paciente/economia , Estudos Retrospectivos , Adulto Jovem
15.
Int J Radiat Oncol Biol Phys ; 104(4): 748-755, 2019 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-30904707

RESUMO

PURPOSE: The impact of psychiatric comorbidities on the cost of cancer care in radiation oncology practices is not well studied. We assessed the acute and 24-month follow-up costs for patients with and without pre-existing psychiatric comorbidities undergoing radiation therapy. METHODS AND MATERIALS: Patients with cancer undergoing radiation therapy at our institution from 2009 to 2014 were denoted as having pre-existing psychiatric conditions (Psych group) if they had associated billing codes for any of the 422 International Classification of Diseases, 9th revision psychiatric conditions during the 12 months before their cancer diagnosis. The Elixhauser comorbidity index was calculated, excluding psychiatric categories. Medicare reimbursement was assigned to professional services, and Medicare departmental cost-to-charge ratios were applied to service line hospital charges and adjusted for inflation to create 2017 standardized costs. Acute (0-6 month) and follow-up (6-24 month) costs were subcategorized into clinic, emergency department, hospital inpatient, and outpatient costs. RESULTS: Among 1275 patients, 126 (9.9%) had at least 1 pre-existing psychiatric diagnosis. On univariate analysis, both acute and long-term costs were higher in the Psych group. The largest significant differences in costs were follow-up hospital inpatient costs ($5861 higher; 95% confidence interval [CI], $687-$11,035; P = .002), follow-up hospital outpatient costs ($2086 higher; 95% CI, -$142 to $4,314; P = .040), and follow-up emergency department costs ($396 higher; 95% CI, $149-$643; P < .001). Age, race, sex, and treatment modalities were comparable, but the Psych group patients had more median comorbidities (2 vs 1) and had more respiratory cancer diagnoses than the nonpsychiatric group (31% vs 17%). On multivariate analysis adjusted for age, sex, cancer diagnosis, and comorbidities, global follow-up costs remained 150% higher in the Psych group (P < .001). Acute costs were similar after adjustment (P = .63). CONCLUSIONS: Psychiatric comorbidities independently predict elevated healthcare costs in patients treated for cancer. Radiation oncology payment models should consider adjustments to account for psychiatric comorbidities because addressing these may mitigate cost differential.


Assuntos
Assistência ao Convalescente/economia , Custos de Cuidados de Saúde , Transtornos Mentais/economia , Neoplasias/radioterapia , Cobertura de Condição Pré-Existente/economia , Idoso , Análise de Variância , Comorbidade , Intervalos de Confiança , Custos e Análise de Custo , Feminino , Custos Hospitalares , Humanos , Estimativa de Kaplan-Meier , Masculino , Medicare/economia , Transtornos Mentais/classificação , Transtornos Mentais/mortalidade , Neoplasias/economia , Neoplasias/mortalidade , Cobertura de Condição Pré-Existente/classificação , Taxa de Sobrevida , Estados Unidos
17.
PLoS One ; 14(2): e0212208, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30785954

RESUMO

Supported employment is a treatment whereby those with severe mental illness (or other disabilities) receive aid searching for competitive employment and mental health (or other) treatments concurrently. The most popular implementation of supported employment is individual placement and support (IPS). We conducted meta-analytic analyses of the randomized controlled trials of IPS. We found that subjects in IPS, compared to usual treatment conditions, had better vocational outcomes (obtained any competitive employment: RR = 1.63, 95%CI = [1.46, 1.82]; job tenure: d = 0.55, 95%CI = [0.33, 0.79]; job length: d = 0.46, 95%CI = [0.35, 0.57]; income: d = 0.48, 95%CI = [0.36, 0.59]) Non-vocational outcomes estimates, while favoring IPS, included the null (quality of life: d = 0.30, 95%CI = [-0.07, 0.67]; global functioning: d = 0.09, 95%CI = [-0.09, 0.27]; mental health: d = 0.03, 95%CI = [-0.15, 0.21]). Analysis of the expected proportion of studies with a true effect on non-vocational outcomes with d>0.2 showed some reason to expect a possible improvement for quality of life for at least some settings (Prop = 0.57, 95%CI = [0.30, 0.84]).


Assuntos
Readaptação ao Emprego/economia , Renda , Transtornos Mentais , Saúde Mental/economia , Qualidade de Vida , Feminino , Humanos , Masculino , Transtornos Mentais/economia , Transtornos Mentais/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto
19.
J Med Econ ; 22(5): 491-498, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30810050

RESUMO

BACKGROUND: Residential step-up/step-down services provide transitional care and reintegration into the community for individuals experiencing episodes of subacute mental illness. This study aims to examine psychiatric inpatient admissions, length of stay, and per capita cost of care following the establishment of a step-up/step-down Prevention And Recovery Care (PARC) facility in regional Australia. METHODS: This was a pragmatic before and after study set within a participatory action research methodology. The target sample comprised patients at a PARC facility over 15 months. Six-month individual level data prior to study entry, during, and over 6-months from study exit were examined using patient activity records. Costs were expressed in 2015-2016AU$. RESULTS: An audit included 192 people experiencing 243 episodes of care represented by males (58%), mean age = 39.3 years (SD = 12.7), primarily diagnosed with schizophrenia (48%) or mood disorders (30%). The cost of 1 day in a psychiatric inpatient unit was found to be comparable to an average of 5 treatment days in PARC; the mean cost difference per-bed day (AU$1,167) was associated with fewer and shorter inpatient stays. Reduced use of inpatient facility translated into an opportunity cost of improved patient flow equivalent to AU$12,555 per resident (bootstrapped 95% CI = $5,680-$19,280). More noticeable outcomes were observed among those who stayed in PARC for longer during index admission (rs = 0.16, p = 0.024), who have had more and lengthy inpatient stays (rs = 0.52, p < 0.001 and rs = 0.69, p < 0.001), and those who stepped-down from the hospital (p < 0.001). This information could be proactively used within step-up/step-down services to target care to patients most likely to benefit. Despite early evidence of positive association, the results warrant further investigation using an experimental study design with alongside economic evaluation. CONCLUSION: Efforts should be directed toward the adoption of cost-effective alternatives to psychiatric inpatient facilities that provide comparable or improved patient outcomes.


Assuntos
Serviços Comunitários de Saúde Mental/economia , Hospitalização/economia , Transtornos Mentais/economia , Instituições Residenciais/economia , Adolescente , Adulto , Idoso , Austrália , Feminino , Humanos , Tempo de Internação/economia , Masculino , Pessoa de Meia-Idade , Admissão do Paciente/economia , Adulto Jovem
20.
Clin Exp Dermatol ; 44(7): 766-772, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30706514

RESUMO

BACKGROUND: Little is known about the mental health (MH) hospitalization among patients with acne and rosacea. AIMS: To determine the MH disorders and cost burden associated with acne and rosacea. METHODS: Data were examined from the 2002-2012 US National Inpatient Sample, comprising a sample of ~20% of all US paediatric and adult hospitalizations (n = 87 053 155 admissions). RESULTS: A diagnosis of ≥ 1 MH disorder was much more common among all inpatients with vs. those without a diagnosis of acne (43.7% vs. 20.0%, respectively) and rosacea (35.1% vs. 20.0%, respectively). In multivariable logistic regression models controlling for sex, age, race/ethnicity and insurance status, acne (adjusted OR = 13.02; 95% CI 11.75-14.42) and rosacea (adjusted OR = 1.70; 95% CI 1.56-1.95) were associated with significantly higher odds of a primary admission for an MH disorder (13 and 8, respectively, of 15 MH disorders examined). Both acne and rosacea were associated with higher risk of mood, anxiety, impulse control and personality disorders, and with > $2 million of excess mean annual costs of hospitalization for MH disorders in the USA. CONCLUSION: In this study, inpatients with acne or rosacea had increased odds of comorbid MH disorders. In particular, there was an increased number of hospital admissions secondary to a primary MH disorder with coexistent acne/rosacea. MH comorbidities were associated with considerable excess costs among inpatients with acne or rosacea.


Assuntos
Acne Vulgar/epidemiologia , Tempo de Internação/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Admissão do Paciente/estatística & dados numéricos , Rosácea/epidemiologia , Acne Vulgar/economia , Acne Vulgar/psicologia , Adolescente , Adulto , Criança , Comorbidade , Bases de Dados Factuais , Feminino , Humanos , Tempo de Internação/economia , Masculino , Transtornos Mentais/economia , Pessoa de Meia-Idade , Fatores de Risco , Rosácea/economia , Rosácea/psicologia , Estados Unidos/epidemiologia , Adulto Jovem
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