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1.
Medicine (Baltimore) ; 98(52): e18399, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876712

RESUMO

Integration of psychiatric care at the Primary Health Care (PHC) could be an important strategy towards addressing the shortages of in-patient mental health care services in South Africa. This study describes the profiles of admitted psychiatric patients at the East London Mental Health Unit (ELMHU) of the Eastern Cape from January 2016 to December 2016.In this retrospective cross-sectional study, an audit of medical records of all psychiatric in-patients managed at the ELMHU during the study period was undertaken. Simple descriptive and inferential statistics were used to describe the profiles and examine the associations with the common psychiatric conditions.Of the participants with complete data (n = 186), the majority were males (n = 108); single (72.6%) and had secondary education (45.7%). The majority of in-patients were psychotic (38%), violent (31%), manic (16%) or suicidal (9.2%) at the time of admission. Patients who were 35 years and above, resided in urban areas, and presented with suicidal and depressive symptoms were more likely to be admitted voluntarily. Schizophrenia (31.6%), cannabis-related psychiatric disorders (31.6%), bipolar Type-1 disorder (21.9%) and alcohol related disorders (15.5%) were the main reasons for admission. There was a significant association between demographic characteristics and the common psychiatric disorders of the patients.Schizophrenia, bipolar 1 disorder, cannabis-related disorders and alcohol-related disorders are the predominant disorders leading to in- patient mental health care services being utilized in the study setting. Findings might inform training of health care workers at the PHCs with a view to integrating mental health care services in the Eastern Cape.


Assuntos
Transtornos Mentais/epidemiologia , Adolescente , Adulto , Fatores Etários , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Unidade Hospitalar de Psiquiatria/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , África do Sul , Adulto Jovem
2.
Med Care ; 57(11): 913-920, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31609847

RESUMO

OBJECTIVE: There is limited knowledge about how general hospitals and Veterans Health Administration (VHA) hospitals fare relative to each other on a broad range of inpatient psychiatry-specific patient safety outcomes.This research compares data from 2 large-scale epidemiological studies of adverse events (AEs) and medical errors (MEs) in inpatient psychiatric units, one in VHA hospitals and the other in community-based general hospitals. METHOD: Retrospective medical record reviews assessed the prevalence of AEs and MEs in a sample of 4371 discharges from 14 community-based general hospitals (derived from 69,081 discharges at 85 hospitals) and a sample of 8005 discharges from 40 VHA hospitals (derived from 92,103 discharges at 105 medical centers). Rates of AEs and MEs across hospital systems were calculated, controlling for relevant patient and hospital characteristics. RESULTS: The overall rate of AEs and MEs in inpatient psychiatric units of VHA hospitals was 7.11 and 1.49 per 100 patient discharges; at community-based acute care hospitals, these rates were 13.48 and 3.01 per 100 patient discharges. The adjusted odds ratio of a patient experiencing an AE and a ME at community-based hospitals as compared with VHA hospitals was 2.11 and 2.08, respectively. CONCLUSION: Although chart reviews may not document the complete nature and outcomes of care, even after controlling for differences in patient and hospital characteristics, psychiatric inpatients at community-based hospitals were twice as likely to experience AEs or MEs as inpatients at VHA hospitals. While community-based hospitals may lag behind VHA hospitals, both hospital systems should continue to pursue evidence-based improvements in patient safety. Future research aimed at changing hospital practices should draw on established strategies for bridging the gap from research to practice in order to improve the quality of care for this vulnerable patient population.


Assuntos
Hospitais Comunitários/estatística & dados numéricos , Hospitais Gerais/estatística & dados numéricos , Hospitais de Veteranos/estatística & dados numéricos , Pacientes Internados/psicologia , Erros Médicos/estatística & dados numéricos , Unidade Hospitalar de Psiquiatria/estatística & dados numéricos , Adolescente , Adulto , Feminino , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Erros Médicos/psicologia , Pessoa de Meia-Idade , Alta do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Adulto Jovem
3.
Australas Psychiatry ; 27(5): 465-468, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31282178

RESUMO

OBJECTIVE: The effects of limited English and interpreter use on clinical outcomes in mental health are poorly understood. This paper describes an exploratory study examining those effects across three adult inpatient psychiatric units, predicting it would lead to increased length of stay. METHODS: Forty-seven patients with limited English proficiency (LEP) were retrospectively identified and compared with 47 patients with proficient English. Length of stay, number of consultant reviews and discharge diagnosis were recorded and compared. RESULTS: An increased length of stay for those with LEP was not statistically significant (p=0.155). The LEP group did undergo more consultant reviews (p=0.036), however, and attracted different discharge diagnoses, with no primary discharge diagnoses of personality disorder made (p=0.018). CONCLUSIONS: This study provides evidence of significant effects of limited English on both service burden and outcome.


Assuntos
Tempo de Internação/estatística & dados numéricos , Transtornos Mentais/diagnóstico , Transtornos Mentais/terapia , Unidade Hospitalar de Psiquiatria/estatística & dados numéricos , Tradução , Adulto , Feminino , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Alta do Paciente/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Estudos Retrospectivos
4.
Nervenarzt ; 90(7): 709-714, 2019 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-31165210

RESUMO

BACKGROUND: An open-door policy may help to reduce conflicts, aggression and containment measures in inpatient psychiatric care. OBJECTIVE: A complex intervention was performed including opening the doors of an acute psychiatric ward. The aim was to deescalate conflicts and reduce containment measures. METHODS: Along with opening of the doors, several other measures were taken including intensive training of staff in deescalating techniques and nonviolent communication, review and liberalization of rules of the ward, opening of a time-out room and access to a secure garden. RESULTS: The open-door policy proved to be feasible and was permanently established. Thereafter, incidents involving aggression decreased but containment measures did not. Overall, the staff appreciated the new concept but considered the opening of the doors to be of minor importance. CONCLUSION: The opening of a closed psychiatric ward should be understood as part of a complex, autonomy focused intervention. Other aspects such as sufficient numbers of well-trained staff and structural architectural features of the ward are possibly more important than opening of the doors.


Assuntos
Serviços de Saúde Mental , Unidade Hospitalar de Psiquiatria , Agressão , Humanos , Serviços de Saúde Mental/estatística & dados numéricos , Unidade Hospitalar de Psiquiatria/estatística & dados numéricos , Psiquiatria/métodos , Psiquiatria/normas
5.
Int J Ment Health Nurs ; 28(5): 1078-1089, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31169358

RESUMO

Violent incidents in acute inpatient units for children and adolescents are a major and persistent problem. The demographic, clinical, and modifiable (environmental-organizational) risk factors that affect inpatient violence in an Acute Child and Adolescent Psychiatric Unit were investigated via a retrospective study. Data were collected from nursing and medical reports and the unit's census and included 100 days per year for 16 years. Incidents of violence and assault types were recorded, and variables such as the diagnostic category of assailants, total number of patients, and staffing factors during the incident were examined. Of the 2390 violent incidents recorded, 50% were attributed to cases of physical violence towards another patient, 17% to physical violence towards nursing staff, 19% to physical violence towards self and 14% to destruction of property. According to the final multivariable model, for each additional patient in the unit, the risk of a violent event increased by 9.51%; for each additional offender patient, the risk increased by 14.06%; the number of assistant nurses was associated with a 25.03% increased risk; and, after 2006, the risk increased by 68.99%. The most significant factor associated with a 59.98% decreased risk was the total number of nursing staff. All variables significantly and independently contributed to the model. Acute inpatient psychiatric units with a small number of hospitalized patients, adequate, well-trained and specialized nursing staff, and the hospitalization of different types of patients in separate wards or units are expected to facilitate a reduction in the frequency of violent incidents.


Assuntos
Unidade Hospitalar de Psiquiatria , Violência/estatística & dados numéricos , Adolescente , Criança , Feminino , Humanos , Masculino , Unidade Hospitalar de Psiquiatria/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Violência/psicologia , Adulto Jovem
6.
Artigo em Inglês | MEDLINE | ID: mdl-30934957

RESUMO

Environmental variables can regulate behavior in healthy subjects. Recently, some authors investigated the role of meteorological variables in bipolar patients with an impact on both the onset and course of bipolar disorder (BD). The aim of this study was to investigate the impact of meteorological variables and other indexes in bipolar hospitalized patients. We examined all patients admitted to the Psychiatric Inpatient Unit of San Luigi Gonzaga Hospital, Orbassano (Turin, Italy) from September 2013 to August 2015, collecting several socio-demographic and clinical characteristics. Seven hundred and thirty patients were included. Compared to the day of admission of control individuals, patients with BD were admitted on a day that presented higher minimum, medium, and maximum temperature, higher maximum humidity, higher solar radiation, and higher hours of sunshine. After logistic regression analysis, admissions to the emergency psychiatric ward due to a primary diagnosis of BD were associated with maximum temperature and solar radiation. The current study provides a novel perspective on the question surrounding seasonal mood patterns in patients with BD. A greater awareness of all possible precipitating factors is needed to inform self-management and psycho-educational programs as well as to improve resilience regarding affective recurrences in the clinical practice.


Assuntos
Transtorno Bipolar/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Unidade Hospitalar de Psiquiatria/estatística & dados numéricos , Luz Solar , Temperatura Ambiente , Adulto , Transtorno Bipolar/psicologia , Feminino , Humanos , Umidade , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Energia Solar
7.
Int J Ment Health Nurs ; 28(4): 909-921, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30931546

RESUMO

Reducing and/or eliminating the use of coercive measures in psychiatric services is a priority worldwide. Chemical restraint is one such measure, yet to date has been poorly defined and poorly investigated. The aim of this study was to examine chemical restraint use in 12 adult acute inpatient psychiatric units in Adelaide, South Australia. Methods involved the analysis of all reported chemical restraint events occurring over a 12-month period analysed using a descriptive quantitative design. There were 166 chemical restraint events involving 110 consumers. The highest prevalence rate in an individual unit was 28.78 events per 1000 occupied bed days, with the lowest being 0.12 events per 1000 occupied bed days. More males (n = 69, 57.5%) were involved in chemical restraint than females. Schizophrenia, schizotypal, and delusional disorders were the predominant diagnoses among consumers who were chemically restrained. The most events occurred during three time blocks: 14.00-14.59 pm, 16.00-16.59 pm, and 21.00-21.59 pm. The two most common medications used were olanzapine and clonazepam. The study presents a general picture of the practice of chemical restraint in Adelaide and identifies areas of concern in relation to the need for monitoring of side effects and completion of systematic processes of documentation regarding chemical restraint events. Findings highlight the need for sustained focus on reducing the need for chemical restraint and exploring less restrictive measures with those most likely to receive medication against their will.


Assuntos
Sedação Consciente/estatística & dados numéricos , Unidade Hospitalar de Psiquiatria/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Antipsicóticos/uso terapêutico , Benzodiazepinas/uso terapêutico , Sedação Consciente/métodos , Feminino , Humanos , Hipnóticos e Sedativos/uso terapêutico , Incidência , Masculino , Transtornos Mentais/terapia , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Sexuais , Austrália do Sul , Adulto Jovem
8.
Trends Psychiatry Psychother ; 41(1): 27-35, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30994784

RESUMO

INTRODUCTION: User satisfaction assessment in mental health services is an important indicator of treatment quality. The objective of this study was to evaluate treatment satisfaction in a sample of inpatients with mental disorders and the associations between levels of satisfaction and clinical/sociodemographic variables. METHODS: This exploratory study investigated 227 psychiatric inpatients who answered the Patient Satisfaction with Mental Health Services Scale (SATIS-BR) and the Perception of Change Scale (EMP). SATIS scores were analyzed according to associations with clinical and sociodemographic data. Pearson correlations were used to correlate SATIS scores with other variables. RESULTS: We found a high degree of satisfaction with care at the psychiatric inpatient unit assessed. In general, patients rated maximum satisfaction for most items. The highest satisfaction scores were associated with patients receiving treatment through the Brazilian Unified Health System (SUS) and with less education. SATIS showed a moderate positive correlation with EMP. The worst evaluated dimension was physical facilities and comfort of the ward. CONCLUSION: Patients treated via SUS may be more satisfied than patients with private health insurance when treated in the same facility. The evaluation of treatment satisfaction can be used to reorganize services at psychiatric inpatient units.


Assuntos
Pacientes Internados/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Transtornos Mentais/terapia , Serviços de Saúde Mental/estatística & dados numéricos , Satisfação do Paciente , Unidade Hospitalar de Psiquiatria/estatística & dados numéricos , Adulto , Brasil , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
9.
Nord J Psychiatry ; 73(3): 169-177, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30848979

RESUMO

OBJECTIVE: To investigate whether patients with dual diagnosis have a higher risk of being mechanical restraint compared to patients with only psychiatric diagnoses. METHODS: Data on all patients admitted to a psychiatric ward from 2010-2014 in the Capital Region of Denmark was linked with information from the register of coercive measures. Patients were based on diagnosis divided into six groups. The three main patient groups were: only psychiatric diagnosis defined as all ICD-10 F-diagnosis except F10-F19, dual diagnosis (co-occurrence of diagnoses of harmful use or dependency and psychiatric diagnoses) and only other substance use diagnosis (i.e. other than harmful use or dependency). The risk of mechanical restraint was investigated by analyzing all first-time admissions in the period using Cox-proportional hazard models. RESULTS: In the crude rates patients with dual diagnosis were more often mechanically restrained compared to patients with only psychiatric diagnoses or only other substance use diagnoses. However, this was attenuated when the characteristics of patients were accounted for. Patients with only other substance related diagnoses had the highest risk of being mechanically restrained. CONCLUSION: When preventing mechanical restraint, the focus should be on actual use of substances or withdrawal effects and not on the dual diagnoses patients in them-self.


Assuntos
Transtornos Mentais/complicações , Restrição Física/estatística & dados numéricos , Adolescente , Adulto , Idoso , Dinamarca , Diagnóstico Duplo (Psiquiatria) , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Classificação Internacional de Doenças , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Unidade Hospitalar de Psiquiatria/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/complicações , Adulto Jovem
10.
Int J Ment Health Nurs ; 28(4): 845-856, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30887624

RESUMO

International efforts to minimize coercive practices include the US Six Core Strategies© (6CS). This innovative approach has limited evidence of its effectiveness, with few robustly designed studies, and has not been formally implemented or evaluated in the UK. An adapted version of the 6CS, which we called 'REsTRAIN Yourself' (RY), was devised to suit the UK context and evaluated using mixed methods. RY aimed to reduce the use of physical restraint in mental health inpatient ward settings through training and practice development with whole teams, directly in the ward settings where change was to be implemented and barriers to change overcome. In this paper, we present qualitative findings that report on staff perspectives of the impact and value of RY following its implementation. Thirty-six staff participated in semi-structured interviews with data subject to thematic analysis. Eight themes are reported that highlight perceived improvements in every domain of the 6CS after RY had been introduced. Staff reported more positively on their relationships with service users and felt their attitudes towards the use of coercive practices such as restraint were changed; the service as a whole shifted in terms of restraint awareness and reduction; and new policies, procedures, and language were introduced despite certain barriers. These findings need to be appreciated in a context wherein substantial reductions in the use of physical restraint were proven possible, largely due to building upon empathic and relational alternatives. However, yet more could be achieved with greater resourcing of inpatient care.


Assuntos
Unidade Hospitalar de Psiquiatria/estatística & dados numéricos , Restrição Física/estatística & dados numéricos , Atitude do Pessoal de Saúde , Empatia , Humanos , Liderança , Inovação Organizacional , Unidade Hospitalar de Psiquiatria/organização & administração , Restrição Física/psicologia , Reino Unido
12.
Int J Ment Health Nurs ; 28(1): 199-208, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30010239

RESUMO

The Health of the Nation Outcomes Scales (HoNOS) provides an overview of a person's behaviour, impairment, clinical symptoms, and social functioning. This study investigated the profile of people who had been secluded in New Zealand's adult mental health inpatient services using 12 individual HoNOS ratings. Routinely collected clinical data were extracted from the Programme for the Integration of Mental Health Data (PRIMHD). This is the national data set for mental health and addiction services. A logistic regression model was fitted to the data which adjusted for age, sex, ethnicity, bed nights, compulsory treatment, and district health board. After adjustment, three HoNOS items significantly predicted the risk of seclusion: overactive, aggressive, disruptive, or agitated behaviour (adjusted OR = 4.82, 95% CI [3.88, 5.97], P < 0.001); problem drinking or drug-taking (adjusted OR = 1.51, 95% CI [1.25, 1.82], P < 0.001); and problems with hallucinations and delusions (adjusted OR = 1.33, 95% CI [1.09, 1.63], P = 0.006). In addition, two HoNOS items were protective for seclusion: nonaccidental self-injury (adjusted OR = 0.65, 95% CI [0.51, 0.83], P < 0.001) and depressed mood (adjusted OR = 0.58, 95% CI [0.47, 0.72], P < 0.001). Thus, responding effectively to agitation and/or aggression, substance use, and psychosis plays an important role in reducing the use of seclusion. Mental health nurses and other workers can reduce seclusion through early assessment, effective communication, de-escalation techniques, reduction tools, trauma-informed care, and consulting with consumers and whanau.


Assuntos
Isolamento de Pacientes/psicologia , Unidade Hospitalar de Psiquiatria/estatística & dados numéricos , Adolescente , Adulto , Feminino , Humanos , Pacientes Internados/psicologia , Pacientes Internados/estatística & dados numéricos , Masculino , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Isolamento de Pacientes/estatística & dados numéricos , Resultado do Tratamento , Adulto Jovem
13.
Int J Ment Health Nurs ; 28(1): 209-225, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30019798

RESUMO

Seclusion and restraint continue to be used across psychiatric inpatient and emergency settings, despite calls for elimination and demonstrated efficacy of reduction initiatives. This study investigated nurses' perceptions regarding reducing and eliminating the use of these containment methods with psychiatric consumers. Nurses (n = 512) across Australia completed an online survey examining their views on the possibility of elimination of seclusion, physical restraint, and mechanical restraint as well as perceptions of these practices and factors influencing their use. Nurses reported working in units where physical restraint, seclusion, and, to a lesser extent, mechanical restraint were used. These were viewed as necessary last resort methods to maintain staff and consumer safety, and nurses tended to disagree that containment methods could be eliminated from practice. Seclusion was considered significantly more favourably than mechanical restraint with the elimination of mechanical restraint seen as more of a possibility than seclusion or physical restraint. Respondents accepted that use of these methods was deleterious to relationships with consumers. They also felt that containment use was a function of a lack of resources. Factors perceived to reduce the likelihood of seclusion/restraint included empathy and rapport between staff and consumers and utilizing trauma-informed care principles. Nurses were faced with threatening situations and felt only moderately safe at work, but believed they were able to use their clinical skills to maintain safety. The study suggests that initiatives at multiple levels are needed to help nurses to maintain safety and move towards realizing directives to reduce and, where possible, eliminate restraint use.


Assuntos
Atitude do Pessoal de Saúde , Serviço Hospitalar de Emergência , Isolamento de Pacientes , Unidade Hospitalar de Psiquiatria , Enfermagem Psiquiátrica , Restrição Física , Adulto , Idoso , Austrália , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Transtornos Mentais/terapia , Pessoa de Meia-Idade , Isolamento de Pacientes/organização & administração , Isolamento de Pacientes/estatística & dados numéricos , Unidade Hospitalar de Psiquiatria/organização & administração , Unidade Hospitalar de Psiquiatria/estatística & dados numéricos , Enfermagem Psiquiátrica/estatística & dados numéricos , Restrição Física/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
14.
Encephale ; 45(2): 139-146, 2019 Apr.
Artigo em Francês | MEDLINE | ID: mdl-30126611

RESUMO

OBJECTIVES: The UHSA (UHSA) are French psychiatric units for inmates which admit detainees suffering from a psychiatric disorder requiring full-time hospital care. Non-psychiatric pathologies are overrepresented in patients with psychiatric disorders but also in detainees. As a result, patients hospitalized in UHSA are largely exposed to non-psychiatric conditions, and exploring the organization of general medical care for these patients appears very relevant. The aim of this study is to review the general medical care in all French UHSA. METHODS: A descriptive study was carried out through a survey of the nine facilities. RESULTS: All UHSA benefit from the intervention of a general practitioner. The physical clinical examination, the biological assessment and the electrocardiogram are systematically performed at the patient's admission in 7, 5 and 9 establishments, respectively. However, the offer of general medical care in UHSA seems disparate and sometimes insufficient. Specialized consultations are regularly requested during hospitalizations, but no establishment benefits from a telemedicine system or specialized consultations on site. The extraction of the patient to the general hospital is therefore systematic when such a consultation is needed. But the number of penitentiary escorts per day is limited. In 6 UHSA, medical extractions are thus regularly canceled by the penitentiary administration, sometimes without a medical opinion. Finally, the patient's regular physician is only contacted in 3 UHSA during hospitalizations. CONCLUSION: Based on these results, ways of improving the organization of general medical care in UHSA are proposed through four main axes: the structure and general organization; the general medical care; the link with the healthcare partners and the articulation with the penitentiary administration.


Assuntos
Medicina Geral , Hospitais Especializados , Transtornos Mentais/terapia , Prisioneiros , Unidade Hospitalar de Psiquiatria , Internação Compulsória de Doente Mental/legislação & jurisprudência , Internação Compulsória de Doente Mental/normas , Internação Compulsória de Doente Mental/estatística & dados numéricos , Psiquiatria Legal/métodos , Psiquiatria Legal/organização & administração , Psiquiatria Legal/normas , Psiquiatria Legal/estatística & dados numéricos , França/epidemiologia , Medicina Geral/organização & administração , Medicina Geral/normas , Medicina Geral/estatística & dados numéricos , Clínicos Gerais/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Unidades Hospitalares/organização & administração , Unidades Hospitalares/normas , Unidades Hospitalares/estatística & dados numéricos , Hospitais Especializados/métodos , Hospitais Especializados/organização & administração , Hospitais Especializados/normas , Hospitais Especializados/estatística & dados numéricos , Humanos , Medicina Interna/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Prisioneiros/psicologia , Prisioneiros/estatística & dados numéricos , Prisões/organização & administração , Prisões/normas , Prisões/estatística & dados numéricos , Unidade Hospitalar de Psiquiatria/organização & administração , Unidade Hospitalar de Psiquiatria/normas , Unidade Hospitalar de Psiquiatria/estatística & dados numéricos , Psiquiatria/estatística & dados numéricos , Estudantes de Medicina/estatística & dados numéricos , Inquéritos e Questionários
15.
J Epidemiol ; 29(7): 264-271, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-30249947

RESUMO

BACKGROUND: Understanding the area-specific resource use of inpatient psychiatric care is essential for the efficient use of the public assistance system. This study aimed to assess the geographical variation in psychiatric admissions and to identify the prefecture-level determinants of psychiatric admissions among recipients of public assistance in Japan. METHODS: We identified all recipients of public assistance who were hospitalized in a psychiatric ward in May 2014, 2015, or 2016 using the Fact-finding Survey on Medical Assistance. The age- and sex-standardized number of psychiatric admissions was calculated for each of the 47 prefectures, using direct and indirect standardization methods. RESULTS: A total of 46,559 psychiatric inpatients were identified in May 2016. The number of psychiatric admissions per 100,000 population was 36.6. We found a 7.1-fold difference between the prefectures with the highest (Nagasaki) and lowest (Nagano) numbers of admissions. The method of decomposing explained variance in the multiple regression model showed that the number of psychiatric beds per 100,000 population and the number of recipients of public assistance per 1,000 population were the most important determinants of the number of psychiatric admissions (R2 = 28% and R2 = 23%, respectively). The sensitivity analyses, using medical cost as the outcome and data from different survey years and subgroups, showed similar findings. CONCLUSIONS: We identified a large geographical variation in the number and total medical cost of psychiatric admissions among recipients of public assistance. Our findings should encourage policy makers to assess the rationale for this variation and consider strategies for reducing it.


Assuntos
Hospitais Psiquiátricos/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Admissão do Paciente/estatística & dados numéricos , Unidade Hospitalar de Psiquiatria/estatística & dados numéricos , Assistência Pública , Características de Residência/estatística & dados numéricos , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Japão/epidemiologia , Tempo de Internação/estatística & dados numéricos , Masculino , Serviços de Saúde Mental , Pessoa de Meia-Idade , Admissão do Paciente/tendências , Vigilância da População
16.
J Epidemiol ; 29(8): 288-294, 2019 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-30224579

RESUMO

BACKGROUND: A better understanding of resource use of new psychiatric admissions is important for healthcare providers and policymakers to improve psychiatric care. This study aims to describe the pattern of new psychiatric admissions and length of stay in Japan. METHODS: A retrospective cohort study was conducted using data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB). All patients newly admitted to psychiatric wards from April 2014 through March 2016 were included and followed up until discharge to the community. RESULTS: Our sample included 605,982 admissions from 1,621 hospitals over 2 years. The average monthly number of admissions was 25,024 in fiscal year 2014 and 25,475 in fiscal year 2015. There was a seasonal trend in the number of admissions, with a peak in summer (in July). The discharge rates within 90 days and 360 days were 64.1% and 85.7%, respectively, and varied by type of hospital fee and by hospital. For example, the range of hospital-level discharge rate within 90 days in psychiatric emergency units was 46.0-75.3% in the 1st (lowest) quintile, while it was 83.6-96.0% in the 5th (highest) quintile. The prefecture-level indicators in the NDB and the 630 survey had correlations of >0.70. CONCLUSIONS: Our study provides fundamental information on resource use of new psychiatric admissions in Japan. Although using the NDB has substantial benefits in monitoring resource use, the results should be interpreted with some caution owing to methodological issues inherent in the database.


Assuntos
Tempo de Internação/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Unidade Hospitalar de Psiquiatria/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Humanos , Lactente , Recém-Nascido , Revisão da Utilização de Seguros , Seguro Saúde , Japão , Masculino , Transtornos Mentais/terapia , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
17.
Psychiatr Q ; 90(1): 111-116, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30328019

RESUMO

Falls are adverse events affecting psychiatric inpatients that can lead to external injuries, fractures, and death. However, none have attempted to examine fall-related factors, particularly focused on balance, specifically among inpatients with schizophrenia. The present preliminary study aimed to assess the association between falls and balance in patients with schizophrenia. The authors performed baseline assessments of background factors, postural sway, and maximum step length in 120 patients with schizophrenia hospitalized in the psychiatric ward. A prospective 3-month follow-up was conducted, and participants were divided into a fall or non-fall group according to their history of falls during the follow-up. Variance among individual variables was compared between the fall group and non-fall group using the t-test, Mann-Whitney U test, and chi-square test. A total of 16 participants experienced falls in the 3-month follow-up period (13.3%). Comparative factor analysis revealed significant differences between the fall and non-fall groups in terms of the presence or absence of falls within 3 months before follow-up (p = 0.002) and Romberg quotients for sway length (p = 0.02). These findings suggest that fall history could be considered a predictor of future falls, which could help with fall prevention, and that assessment of visual contribution to postural control using the Romberg quotient could play an important role in fall prevention.


Assuntos
Acidentes por Quedas , Pacientes Internados , Equilíbrio Postural/fisiologia , Unidade Hospitalar de Psiquiatria , Esquizofrenia/fisiopatologia , Acidentes por Quedas/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Unidade Hospitalar de Psiquiatria/estatística & dados numéricos
18.
Ann Ist Super Sanita ; 54(4): 272-283, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30575563

RESUMO

The implementation of a Cognitive-Behavioural Group Intervention (CBGI) in Italian general hospital psychiatric units started in the years 2000-2001 in two Italian regions. Over the years it has became more and more popular also in other psychiatric units located in the rest of the country. Based on the "stress-vulnerability-coping" theory, the CBGI is a replicable and innovative psychosocial intervention that promotes the active involvement of inpatients in decisions concerning their individual objectives and care. In the present article, the authors briefly describe this intervention and the main findings regarding its implementation in several psychiatric units in different Regions of Italy. The authors emphasize that such a psychosocial approach to inpatient care is needed because it can produce improved clinical outcomes, reduction in untoward events and increased staff and inpatient satisfaction. However, its introduction and use still represent a major cultural and managerial challenge in our country.


Assuntos
Unidade Hospitalar de Psiquiatria/estatística & dados numéricos , Sistemas de Apoio Psicossocial , Psicoterapia de Grupo/estatística & dados numéricos , Doença Aguda , Adaptação Psicológica , Terapia Cognitivo-Comportamental/estatística & dados numéricos , Humanos , Itália , Transtornos Mentais/terapia , Educação de Pacientes como Assunto
20.
JNMA J Nepal Med Assoc ; 56(210): 593-597, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30376003

RESUMO

INTRODUCTION: The length of stay among psychiatric in-patients is usually longer than that of others. In-patient management is costly and longer length of stay can lead to catastrophic costs. We conducted this study to explore about the length of stay of psychiatric admissions and factors affecting it. METHODS: We collected the data of all the patients admitted to the psychiatric ward of B. P. Koirala Institute of Health Sciences from 1st January 2007 to 31st December 2016 from the database of the medical records section after ethical approval. The sociodemographic and clinical variables were analyzed using SPSS 20.0 version. Length of stay more than 3 weeks was considered as long stay. Bivariate and multivariable logistic regression analyses were conducted to identify factors associated with length of stay. RESULTS: There were 3687 admissions during the study period. The average length of stay was 19.36 (±13.14) days. On logistic regression, the factors associated with shorter length of stay were: male gender (aOR= 0.79, 95%CI: 0.68-0.93), being self employed (aOR= 0.17, 95%CI: 0.12-0.22), homemakers (aOR= 0.18, 95%CI: 0.14-0.24), farmers (aOR= 0.20, 95%CI: 0.15-0.27) and students (aOR= 0.23, 95%CI:0.17-0.32). Similarly, factors associated with longer length of stay were: being from other Eastern Terai districts(aOR=1.37, 95%CI: 1.11-1.70), other Eastern Hill districts (aOR= 1.68; 95%CI: 1.29-2.20), diagnosis of schizophrenia and related disorders (aOR=4.01, 95%CI: 1.34-12.0), having medical co-morbidity (aOR= 3.47; 95%CI: 2.49-4.84) and being readmitted (aOR= 1.23, 95%CI: 1.03-1.47). CONCLUSIONS: There was significant association of length of stay with gender, age, address, occupation, diagnosis and readmission.


Assuntos
Hospitalização/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Transtornos Mentais , Unidade Hospitalar de Psiquiatria/estatística & dados numéricos , Adulto , Fatores Etários , Demografia , Feminino , Humanos , Masculino , Transtornos Mentais/classificação , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Pessoa de Meia-Idade , Nepal/epidemiologia , Readmissão do Paciente/estatística & dados numéricos , Fatores de Risco , Fatores Sexuais , Fatores Socioeconômicos , Centros de Atenção Terciária/estatística & dados numéricos
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