scholarly journals Frequent Attendance to the Emergency Department after Release from Prison: a Prospective Data Linkage Study

2019 ◽  
Vol 47 (4) ◽  
pp. 544-559
Author(s):  
Amanda Butler ◽  
Alexander D. Love ◽  
Jesse T. Young ◽  
Stuart A. Kinner
Keyword(s):  
Emergency Department ◽  
Mental Illness ◽  
Linkage Study ◽  
Future Research ◽  
Prospective Data ◽  
Logistic Regression Models ◽  
Frequent Attenders ◽  
Frequent Attendance ◽  
Dual Diagnoses

AbstractThe aim of this paper was to identify characteristics and predictors of frequent emergency department (ED) use among people released from prisons in Queensland, Australia. Baseline interview data from a sample of sentenced adults were linked to ED and hospital records. The association between baseline characteristics and frequent ED attendance was modelled by fitting multivariate logistic regression models. Participants who had ≥ 4 visits to the ED in any 365-day period of community follow-up were defined as frequent attenders (FA). The analyses included 1307 people and mean follow-up time in the community was 1063 days. After adjusting for covariates, those with a dual diagnoses of mental illness and substance use (RR = 2.42, 95% CI 1.47–3.99) and those with mental illness alone (RR = 2.47, 95% CI 1.29–4.73) were at higher risk of frequent ED attendance, compared with those with no disorder. Future research should assess whether individually tailored transition supports from prison to community reduce the frequency of ED use among this population.

scholarly journals 688 Rapid Implementation of Virtual Fracture Clinic During COVID 19 Reduces Both Face-To-Face Appointments and Facilitates Rapid Feedback and Education to Be Delivered to The Emergency Department

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
T Havenhand ◽  
L Hoggett ◽  
A Bhutta
Keyword(s):  
Emergency Department ◽  
Patient Flow ◽  
Prospective Data ◽  
Fracture Clinic ◽  
Face To Face ◽  
Return Rates ◽  
Acute Hospitals ◽  
Virtual Fracture Clinic ◽  
Improve Patient

Abstract Introduction COVID-19 has dictated a shift towards virtual clinics. Pennine Acute Hospitals NHS Trust serves over a million patients with a significant number of face-to-face fracture clinics. Introduction of a Virtual Fracture Clinic (VFC) reduces hospital return rates and improves patient experience. The referral data can be used to give immediate monthly feedback to the referring department to further improving patient flow. Method Prospective data was collected for all referrals to VFC during March 2020. Data included referral diagnosis, actual diagnosis, referrers grade, and final outcome. Results 630 referrals were made to VFC. 347 (55%) of those referrals were directly discharged without the need for physical consultation. Of these 114 (32%) were injuries which can be discharged by the Emergency Department with an advice leaflet using existing pathways. Of the remaining discharges 102 (29%) were query fractures or sprains; and 135 (39%) were minor fractures; which needed only advice via a letter and no face to face follow up. Conclusions Implementation of VFC leads to a decrease in physical appointments by 55% saving 347 face to face appointments. The new system has also facilitated effective audit of referrals in order to further improve patient flow from the Emergency Department via feedback mechanisms and education.

scholarly journals Gender differences in utilization of services and tobacco cessation outcomes at a state quitline

2018 ◽  
Vol 9 (4) ◽  
pp. 663-668 ◽  
Author(s):  
Alicia M Allen ◽  
Nicole P Yuan ◽  
Betsy C Wertheim ◽  
Laurie Krupski ◽  
Melanie L Bell ◽  
...  
Keyword(s):  
Gender Differences ◽  
Tobacco Cessation ◽  
Large Scale ◽  
Scale Effects ◽  
Future Research ◽  
Utilization Of Services ◽  
Logistic Regression Models ◽  
Point Prevalence Abstinence ◽  
Current Tobacco

Abstract Research suggests that women may have poorer tobacco cessation outcomes than men; however, the literature is somewhat mixed. Less is known about gender differences in cessation within quitline settings. This study examined gender differences in the utilization of services (i.e., coaching sessions, pharmacotherapy) and tobacco cessation among callers to the Arizona Smokers’ Helpline (ASHLine). The study sample included callers enrolled in ASHLine between January 2011 and June 2016. We tracked number of completed coaching sessions. At the 7-month follow-up, callers retrospectively reported use of cessation pharmacotherapy (gum, patch, or lozenge), as well as current tobacco use. Associations between gender and tobacco cessation were tested using logistic regression models. At month 7, 36.4% of women (3,277/9,004) and 40.3% of men (2,960/7,341) self-reported 30-day point prevalence abstinence. Compared to men, fewer women reported using pharmacotherapy (women: 71.4% vs. men: 73.6%, p = .01) and completed at least five coaching sessions (women: 35.1% vs. men: 38.5%, p < .01). After adjusting for baseline characteristics, women had significantly lower odds of reporting tobacco cessation than men (OR = 0.91, 95% CI: 0.84 to 0.99). However, after further adjustment for use of pharmacotherapy and coaching, there was no longer a significant relationship between gender and tobacco cessation (OR: 0.96, 95% CI: 0.87 to 1.06). Fewer women than men reported tobacco cessation. Women also had lower utilization of quitline cessation services. Although the magnitude of these differences were small, future research on improving the utilization of quitline services among women may be worth pursuing given the large-scale effects of tobacco.

Frequent attendance: a Clinical and Epidemiological Study

2016 ◽  
Vol 33 (S1) ◽  
pp. S442-S443
Author(s):  
S. López-Romeo ◽  
G. Ledesma-Iparraguirre
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Retrospective Study ◽  
Emergency Services ◽  
Care Facility ◽  
Health Care Facility ◽  
Frequent Attenders ◽  
Frequent Attendance ◽  
Competing Interest ◽  
New Strategies

BackgroundFrequent attenders (F a) are patients who attend a health care facility repeatedly. The frequency of frequent attendance at emergencies department has been defined as 4 or more attendances/annum. F a are few in number but they produce a high number of attendances.aimsTo determine prevalence of F a, mean attendances/year generated by F a and frequency of visits by months.Methodsa retrospective study was performed on psychiatry's emergency department database from January until December 2013. F a was defined as those with ≥ 4 attendances at emergency services in a year.Prevalence of F a, attendances’ prevalence, diagnosis’ prevalence, Mean attendances generated by F a and frequency of visits by months were analysed.Resultsamong 4824 attendances we found 181 F as (5.98%). Men represented 50.80% and women 49.20%. F a presented a mean of 6.33 attendances/year, while non-F a presented a mean of 1.29 attendances/year.in accordance with frequency of visits by months, it was observed that number of attendances was increased in april and May, in both F a and non-F a.ConclusionPrevalence of F a was 5.98%, F a generated a 23.74% of attendances. Most prevalent F a’ diagnoses were: anxiety disorder, personality disorder non-specified and schizophrenia.F a at emergency department contributes to overcrowd them. for this reason, it is important to take into account these results to develop new strategies to improve F a’ attention and prevent its occurrence.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Coping with the Dual Demands of Severe Mental Illness and Parenting: The Parents' Perspective

2003 ◽  
Vol 84 (1) ◽  
pp. 109-118 ◽  
Author(s):  
Barry J. Ackerson
Keyword(s):  
Mental Illness ◽  
Severe Mental Illness ◽  
Interpersonal Relationships ◽  
Mentally Ill ◽  
Role Reversal ◽  
Future Research ◽  
Single Parenthood ◽  
Sources Of Support ◽  
Boundary Issues

The experience of parenthood by individuals with severe mental illness has not been well studied. Research on mentally ill parents has focused on their pathology and the potential risk for their children without considering the parents' perspective. This qualitative study used interviews to explore how these parents coped with the dual demands of parenthood and their illness. Participants included individuals whose children are now young adults as well as those with younger children. Themes that emerged were problems with diagnosis and treatment, stigma, chaotic interpersonal relationships, the strain of single parenthood, custody issues, relationship with children, social support, and pride in being a parent. Follow-up interviews focused on the themes of relationship with children, strain of single parenthood, and sources of support. Relationship with children contained three specific topics: discipline, boundary issues, and role reversal. Implications for practice are discussed along with recommendations for future research involving other family members.

scholarly journals Association between Psychological Integration and Permanent Supportive Housing: An Exploratory Study with a Focus on Ethnicity

2021 ◽  
Vol 10 (12) ◽  
pp. 468
Author(s):  
Annette S. Crisanti ◽  
Shelley Alonso-Marsden ◽  
Leah Puglisi ◽  
Richard Neil Greene ◽  
Tyler Kincaid ◽  
...  
Keyword(s):  
Mental Illness ◽  
Exploratory Study ◽  
Target Population ◽  
Supportive Housing ◽  
Future Research ◽  
Ptsd Symptoms ◽  
Permanent Supportive Housing ◽  
Psychological Integration ◽  
And Control

There is limited research on the association between Permanent Supportive Housing (PSH) and psychological integration. The purpose of this study was to explore this association among individuals with mental illness and/or substance use disorder (SUD) enrolled in PSH and to identify variables associated with sense of belonging. Given differences in outcomes of PSH by ethnicity, we were interested to determine if an association existed between PSH and psychological integration and whether it was equally observed among Hispanics and non-Hispanics. The target population included individuals who were chronically homeless and diagnosed with a mental illness and/or SUD. Baseline data were collected upon intake (N = 370). Follow-up data were collected at six-months post baseline (N = 286) and discharge (N = 143). Predictor and control variables included demographics, overall health, PTSD symptom severity, interactions with family and friends, and participation in recovery-related groups in the community. Psychological integration scores increased significantly from the baseline to the 6-month follow-up (t = −3.41, p = 0.003) and between the 6-month follow-up and discharge (t = −2.97, p = 0.007). Significant predictors of psychological integration included overall health, interactions with family and/or friends, PTSD symptoms, income, education, and diagnosis. No differences were observed between Hispanics and non-Hispanics. The findings from this exploratory study suggest that future research in this area is warranted.

scholarly journals Neighborhood Environment and Type 2 Diabetes Comorbidity in Serious Mental Illness

2020 ◽  
Vol 11 ◽  
pp. 215013272092498
Author(s):  
Ramya Walsan ◽  
Xiaoqi Feng ◽  
Darren J. Mayne ◽  
Nagesh Pai ◽  
Andrew Bonney
Keyword(s):  
Type 2 Diabetes ◽  
Mental Illness ◽  
Serious Mental Illness ◽  
Fast Food ◽  
Health Care Services ◽  
Neighborhood Environment ◽  
Future Research ◽  
Logistic Regression Models ◽  
Neighborhood Level

Aim: The aim of this study was to examine the association between neighborhood characteristics and type 2 diabetes (T2D) comorbidity in serious mental illness (SMI). We investigated associations of neighborhood-level crime, accessibility to health care services, availability of green spaces, neighborhood obesity, and fast food availability with SMI-T2D comorbidity. Method: A series of multilevel logistic regression models accounting for neighborhood-level clustering were used to examine the associations between 5 neighborhood variables and SMI-T2D comorbidity, sequentially adjusting for individual-level variables and neighborhood-level socioeconomic disadvantage. Results: Individuals with SMI residing in areas with higher crime rates per 1000 population had 2.5 times increased odds of reporting T2D comorbidity compared to the individuals with SMI residing in lower crime rate areas after controlling for individual and areal level factors (95% CI 0.91-6.74). There was no evidence of association between SMI-T2D comorbidity and other neighborhood variables investigated. Conclusion: Public health strategies to reduce SMI-T2D comorbidity might benefit by targeting on individuals with SMI living in high-crime neighborhoods. Future research incorporating longitudinal designs and/or mediation analysis are warranted to fully elucidate the mechanisms of association between neighborhoods and SMI-T2D comorbidity.

Characterization of Emergency Department Rabies Post-Exposure Prophylaxis Procedures with an Infectious Diseases Clinic Referral Process

2020 ◽  
pp. 001857872097388
Author(s):  
Jessica J. Frederickson ◽  
Alexandra K. Monroe ◽  
Gregory A. Hall ◽  
Kyle A. Weant
Keyword(s):  
Emergency Department ◽  
Retrospective Chart Review ◽  
Future Research ◽  
Post Exposure Prophylaxis ◽  
Referral Process ◽  
Post Exposure ◽  
Care Plans ◽  
Number Of Patients ◽  
Exposure Prophylaxis

Purpose: Rabies post-exposure prophylaxis (rPEP) in the emergency department (ED) is associated with high costs, complicated administration protocols, and a time-sensitive vaccination series that often requires ED follow-up visits for subsequent vaccine administration. This study sought to characterize the number of redirected vaccine administrations in those patients referred to ID Clinic, guideline compliance, and opportunities for improvement. Methods: Retrospective chart review of adult and pediatric patients presenting to the ED from 2016 to 2019 and prescribed rabies immunoglobulin. Results: Of the 89 patients included, 66.3% were referred to ID Clinic. Those referred to clinic had significantly fewer average visits to the ED for repeat vaccination ( P < .001). Of the 177 vaccinations prescribed for patients referred, 105 were administered in clinic. Overall, having insurance significantly increased the odds of completing the prescribed vaccination series (Odds Ratio (OR) = 4.34, 95% Confidence Interval (CI) = 1.34 to 15.52). Among those patients referred to clinic, having insurance significantly increased the odds of receiving any follow-up doses in clinic (OR = 6.00, 95% CI = 1.48 to 25.98), receiving all of their prescribed follow-up doses in clinic (OR = 10.00, 95% CI = 1.72 to 190.80), and completing the entirety of their vaccination series (OR = 5.89, 95% CI = 1.50 to 26.21). Conclusions: The use of an ID Clinic referral process for rPEP resulted in a significant reduction in the average number of visits to the ED for repeat vaccination, hence avoiding 105 ED visits. Insurance status was a significant factor in both the utilization of the ID Clinic referral system and overall completion of the vaccination series. Future research should explore workflows inclusive of both ED care and outpatient follow-up, care plans for the uninsured, and mechanisms to limit the number of patients that fail to complete the recommended vaccination series.

scholarly journals Mood disorders and circulating levels of inflammatory markers in a longitudinal population-based study

2017 ◽  
Vol 48 (6) ◽  
pp. 961-973 ◽  
Author(s):  
J. Glaus ◽  
R. von Känel ◽  
A. M. Lasserre ◽  
M.-P. F. Strippoli ◽  
C. L. Vandeleur ◽  
...  
Keyword(s):  
Mood Disorders ◽  
Inflammatory Markers ◽  
Depressive Disorders ◽  
High Sensitivity ◽  
Population Based ◽  
Future Research ◽  
Low Grade ◽  
Logistic Regression Models ◽  
Reactive Protein

BackgroundThere has been increasing evidence that chronic low-grade inflammation is associated with mood disorders. However, the findings have been inconsistent because of heterogeneity across studies and methodological limitations. Our aim is to prospectively evaluate the bi-directional associations between inflammatory markers including interleukin (IL)-6, tumor necrosis factor (TNF)-α and high sensitivity C-reactive protein (hsCRP) with mood disorders.MethodsThe sample consisted of 3118 participants (53.7% women; mean age: 51.0, s.d. 8.8 years), randomly selected from the general population, who underwent comprehensive somatic and psychiatric evaluations at baseline and follow-up (mean follow-up duration = 5.5 years, s.d. 0.6). Current and remitted mood disorders including bipolar and major depressive disorders (MDD) and its subtypes (atypical, melancholic, combined atypical and melancholic, and unspecified) were based on semi-structured diagnostic interviews. Inflammatory biomarkers were analyzed in fasting blood samples. Associations were tested by multiple linear and logistic regression models.ResultsCurrent combined MDD [β = 0.29, 95% confidence interval (CI) 0.03–0.55] and current atypical MDD (β = 0.32, 95% CI 0.10–0.55) at baseline were associated with increased levels of hsCRP at follow-up. There was little evidence for inflammation markers at baseline predicting mood disorders at follow-up.ConclusionsThe prospective unidirectional association between current MDD subtype with atypical features and hsCRP levels at follow-up suggests that inflammation may be a consequence of this condition. The role of inflammation, particularly hsCRP that is critically involved in cardiovascular diseases, warrants further study. Future research that examines potential influences of medications on inflammatory processes is indicated.

Identifying Characteristics of Frequent and Highly Frequent Users of the Emergency Department: A Cross-Sectional Observational Study

2020 ◽  
Author(s):  
Byeung Ki An ◽  
Tiffany Jane Lee ◽  
Sang Mi Kim ◽  
Suck Ju Cho ◽  
Joonbum Park
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Observational Study ◽  
Care Program ◽  
Future Research ◽  
Cross Sectional ◽  
Frequent Users ◽  
Logistic Regression Models ◽  
Ed Overcrowding ◽  
Ed Visits

Abstract Introduction: Since the characteristics of frequent emergency department (ED) users are heterogeneous, it is impossible to mitigate the overcrowding of the ED without the basic data of diagnoses and risk factors of frequent ED users. Our study will provide invaluable information that will help predict patient demand for medical resources while also providing important information that can be used to improve emergency medical services. Methods This is the cross-sectional observational study using records from The Korea Health Insurance Review Agency. Frequent ED users were defined as patients who visited an ED more than 7–17 times per calendar year and highly frequent ED users were defined as patients who visited an ED eighteen or more times during the same period. The diseases were ranked by prevalence in each of the three ED frequency groups (less frequent, frequent, and highly frequent ED user groups). Our study then developed two logistic regression models comparing frequent users with less frequent users and highly frequent users with frequent users. Standardized ß values were used to rank risk factor importance. Results Although less frequent ED users composed 98.98% of all patients, they only consisted of 92.27% of all ED visits. Compared with less frequent users, a greater proportion of frequent ED users were aged 65 years or older and were insured by Medicaid or Veterans Affair Health Care Program. Frequent ED users were also most strongly defined by wound dressing follow-up visits and liver diseases (standardized ß value of 3.29 and 2.31). However, this study did not show highly frequent ED users differed from frequent ED users in regard to the different disease categories. Conclusion The diagnoses and risk factors related to frequent ED visits in Korea identified in this study will be an important reference for future research aimed at reducing ED overcrowding. By further analyzing the risk factors associated with frequent ED use, non-emergency administrative systems or medical facilities can be utilized to reduce the overload on the ED.

scholarly journals Frequent attenders at risk of disability pension: a longitudinal study combining routine and register data

2019 ◽  
Vol 48 (2) ◽  
pp. 181-189 ◽  
Author(s):  
Tiia T.M. Reho ◽  
Salla A. Atkins ◽  
Nina Talola ◽  
Markku P.T. Sumanen ◽  
Mervi Viljamaa ◽  
...  
Keyword(s):  
Disability Pension ◽  
Healthcare Services ◽  
Chronic Illnesses ◽  
The Other ◽  
Study Group ◽  
Frequent Attenders ◽  
Frequent Attendance ◽  
Increased Risk ◽  
Occupational Healthcare

Aims: Frequent attendance in healthcare services is associated with ill-health and chronic illnesses. More information is needed about the phenomenon’s connection with disability pensions (DPs). Methods: The study group comprised 59,676 patients divided into occasional- (1yFAs) and persistent frequent attenders (pFAs) and non-frequent attenders (non-FAs). Odds ratios for DP were analysed for these groups taking into account preceding sickness absence days. The awarded DPs were obtained from the Finnish Centre for Pensions and data on primary care visits were obtained from Pihlajalinna, a nationwide occupational healthcare provider. Results: 1yFAs and pFAs have more DPs than non-FAs. During follow-up, 14.9% of pFAs, 9.6% of 1yFAs and 1.6% of non-FAs had a DP decision of any kind. pFAs receive more partial and fixed-term decisions than the other groups and most permanent DPs are granted to 1yFAs. Musculoskeletal disorders are the most common reason for illness-based retirement in all groups but 1yFAs and pFAs have proportionally more mental disorders leading to DP. The group of non-FAs, on the other hand, has more DPs granted based on neoplasms. Both 1yFAs and pFAs have an increased risk of DP but the effect is diluted after taking into account preceding sick-leave. Conclusions: Frequent attendance of healthcare services, both occasional and persistent, is associated with increased risk of future DP. The association is linked to increased sickness absences. Frequent attenders should be identified and their rehabilitative needs evaluated. Frequency of consultation could be used in selecting candidates for early rehabilitation before sickness absences develop.

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