Ethnic variation in personality disorder: evaluation of 6 years of hospital admissions

Aims and methodThere is limited evidence on ethnic differences in personality disorder prevalence rates. We compared rates of people with personality disorder admitted to hospital in East London from 2007 to 2013.ResultsOf all people admitted to hospital, 9.7% had a personality disorder diagnosis. The admission rate for personality disorder has increased each year. Compared with White subjects, personality disorder was significantly less prevalent among Black and other minority ethnic (BME) groups. Personality disorder was diagnosed in 20% of forensic, 11% of general adult, 8% of adolescent and 2% of old-age in-patients.Clinical implicationsThe increasing number of personality disorder diagnoses year on year indicates the increasing impact of personality disorder on in-patient services. It is important to identify and appropriately manage patients with a personality disorder diagnosis due to the significant strain they place on resources. The reasons for fewer admissions of BME patients may reflect alternative service use, a truly lower prevalence rate or under-detection.Declaration of interestNone.

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Personality disorder services in England: findings from a national survey

BJPsych Bulletin ◽

10.1192/pb.bp.116.055251 ◽

2017 ◽

Vol 41 (5) ◽

pp. 247-253 ◽

Cited By ~ 13

Author(s):

Oliver Dale ◽

Faisil Sethi ◽

Clive Stanton ◽

Sacha Evans ◽

Kirsten Barnicot ◽

...

Keyword(s):

Personality Disorder ◽

Service Provision ◽

Service Use ◽

Equal Access ◽

Clinical Implications ◽

Levels Of Service ◽

And Training ◽

English National Health ◽

English National Health Service

Aims and methodWe aimed to evaluate the availability and nature of services for people affected by personality disorder in England by conducting a survey of English National Health Service (NHS) mental health trusts and independent organisations.ResultsIn England, 84% of organisations reported having at least one dedicated personality disorder service. This represents a fivefold increase compared with a 2002 survey. However, only 55% of organisations reported that patients had equal access across localities to these dedicated services. Dedicated services commonly had good levels of service use and carer involvement, and engagement in education, research and training. However, a wider multidisciplinary team and a greater number of biopsychosocial interventions were available through generic services.Clinical implicationsThere has been a substantial increase in service provision for people affected by personality disorder, but continued variability in the availability of services is apparent and it remains unclear whether quality of care has improved.

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Therapeutic community treatment of personality disorder: service use and mortality over 3 years' follow-up

The British Journal of Psychiatry ◽

10.1192/bjp.182.44.s24 ◽

2003 ◽

Vol 182 (S44) ◽

pp. s24-s27 ◽

Cited By ~ 15

Author(s):

Steffan Davies ◽

Penelope Campling

Keyword(s):

Personality Disorder ◽

Service Use ◽

Hospital Admissions ◽

Therapeutic Community ◽

Community Treatment ◽

First Year ◽

Patient Admissions ◽

Before And After ◽

Therapeutic Community Treatment

BackgroundA number of studies have demonstrated reductions in the utilisation of psychiatric services, especially acute inpatient admissions, following therapeutic community treatment of personality disorder. These studies have, however, been of limited duration (1 year) and follow-up has not always been complete.AimsTo identify hospital admissions before and after therapeutic community treatment of personality disorder.MethodA naturalistic clinical cohort of patients admitted between January 1993 and December 1995 was followed up for 3 years. All subjects were traced to their current consultant psychiatrist, general practitioner or death.ResultsAll patients were traced at 3-year follow-up. The significant reduction in in-patient admissions seen in the first year was maintained over 3 years. Those with the poorest outcomes, suicide, accidental death or prolonged admission were all in the quartile with the shortest admissions (under 42 days) to the therapeutic community.ConclusionsPreviously reported reductions in psychiatric admissions following therapeutic community treatment of personality disorder are maintained over 3 years.

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81 Integrating A Front Door Frailty Service in the Emergency Department: Results of A Pilot Study

Age and Ageing ◽

10.1093/ageing/afab030.42 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

pp. i12-i42

Author(s):

L Dunnell ◽

A Shrestha ◽

E Li ◽

Z Khan ◽

N Hashemi

Keyword(s):

Emergency Department ◽

Hospital Admissions ◽

Admission Rate ◽

Community Services ◽

Service Improvement ◽

Specialist Nurse ◽

Front Door ◽

Medication Changes ◽

Health Service Improvement

Abstract Introduction Increasing old age and frailty is putting pressure on health services with 5–10% of patients attending the emergency department (ED) and 30% of patients in acute medical units classified as older and frail. National Health Service improvement mandates that by 2020 hospital trusts with type one EDs provide at least 70 hours of acute frailty service each week. Methodology A two-week pilot (Monday–Friday 8 am-5 pm) was undertaken, with a “Front Door Frailty Team” comprising a consultant, junior doctor, specialist nurse and pharmacist, with therapy input from the existing ED team. They were based in the ED seeing patients on arrival, referrals from the ED team and patients in the ED observation ward—opposed to the usual pathway of referral from the ED team to medical team. Data was captured using “Cerner” electronic healthcare records. A plan, do, study, act methodology was used throughout with daily debrief and huddle sessions. Results 95 patients were seen over two weeks. In the over 65 s, average time to be seen was 50 minutes quicker than the ED team over the same period, with reduced admission rate (25.7% vs 46.5%). The wait between decision to admit and departure was shortened by 119 minutes. Overall, this led to patients spending on average 133 minutes less in the ED. 64 patients were discharged, of which 44 had community follow-up (including 37.5% of 64 referred to acute elderly clinic and 25% to rapid response). 47 medications were stopped across 25 patients. Conclusion The pilot shows that introduction of an early comprehensive geriatric assessment in the ED can lead to patients being seen sooner, with more timely decisions over their care and reduction in hospital admissions. It allowed for greater provision of acute clinics and community services as well as prompt medication review and real time medication changes.

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How does general practitioner discontinuity affect healthcare utilisation? An observational cohort study of 2.4 million Norwegians 2007–2017

BMJ Open ◽

10.1136/bmjopen-2020-042391 ◽

2021 ◽

Vol 11 (2) ◽

pp. e042391

Author(s):

Lena Janita Skarshaug ◽

Silje Lill Kaspersen ◽

Johan Håkon Bjørngaard ◽

Kristine Pape

Keyword(s):

Cohort Study ◽

General Practitioner ◽

Service Use ◽

Hospital Admissions ◽

Age Groups ◽

Healthcare Utilisation ◽

Acute Hospital ◽

Secondary Outcome ◽

Out Of Hours ◽

Adult Age

ObjectivesPatients may benefit from continuity of care by a personal physician general practitioner (GP), but there are few studies on consequences of a break in continuity of GP. Investigate how a sudden discontinuity of GP care affects their list patients’ regular GP consultations, out-of-hours consultations and acute hospital admissions, including admissions for ambulatory care sensitive conditions (ACSC).DesignCohort study linking person-level national register data on use of health services and GP affiliation with data on GP activity and GP characteristics.SettingPrimary care.Participants2 409 409 Norwegians assigned to the patient lists of 2560 regular GPs who, after 12 months of stable practice, had a sudden discontinuity of practice lasting two or more months between 2007 and 2017.Primary and secondary outcome measuresMonthly GP consultations, out-of-hours consultations, acute hospital admissions and ACSC admissions in periods during and 12 months after the discontinuity, compared with the 12-month period before the discontinuity using logistic regression models.ResultsAll patient age groups had a 3%–5% decreased odds of monthly regular GP consultations during the discontinuity. Odds of monthly out-of-hours consultations increased 2%–6% during the discontinuity for all adult age groups. A 7%–9% increase in odds of ACSC admissions during the period 1–6 months after discontinuity was indicated in patients over the age of 65, but in general little or no change in acute hospital admissions was observed during or after the period of discontinuity.ConclusionsModest changes in health service use were observed during and after a sudden discontinuity in practice among patients with a previously stable regular GP. Older patients seem sensitive to increased acute hospital admissions in the absence of their personal GP.

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Invasive Devices and Sensors for Remote Care of Heart Failure Patients

Sensors ◽

10.3390/s21062014 ◽

2021 ◽

Vol 21 (6) ◽

pp. 2014

Author(s):

Sumant P. Radhoe ◽

Jesse F. Veenis ◽

Jasper J. Brugts

Keyword(s):

Heart Failure ◽

Remote Monitoring ◽

Hospital Admissions ◽

Acute Decompensated Heart Failure ◽

Admission Rate ◽

Decompensated Heart Failure ◽

Hospital Admission Rate ◽

Remote Care ◽

New Sensors ◽

Near Future

The large and growing burden of chronic heart failure (CHF) on healthcare systems and economies is mainly caused by a high hospital admission rate for acute decompensated heart failure (HF). Several remote monitoring techniques have been developed for early detection of worsening disease, potentially limiting the number of hospitalizations. Over the last years, the scope has been shifting towards the relatively novel invasive sensors capable of measuring intracardiac filling pressures, because it is believed that hemodynamic congestion precedes clinical congestion. Monitoring intracardiac pressures may therefore enable clinicians to intervene and avert hospitalizations in a pre-symptomatic phase. Several techniques have been discussed in this review, and thus far, remote monitoring of pulmonary artery pressures (PAP) by the CardioMEMS (CardioMicroelectromechanical system) HF System is the only technique with proven safety as well as efficacy with regard to the prevention of HF-related hospital admissions. Efforts are currently aimed to further develop existing techniques and new sensors capable of measuring left atrial pressures (LAP). With the growing body of evidence and need for remote care, it is expected that remote monitoring by invasive sensors will play a larger role in HF care in the near future.

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Hospitalization Rates Among Dialysis Patients During Hurricane Katrina

Prehospital and Disaster Medicine ◽

10.1017/s1049023x12000945 ◽

2012 ◽

Vol 27 (4) ◽

pp. 325-329 ◽

Cited By ~ 16

Author(s):

David Howard ◽

Rebecca Zhang ◽

Yijian Huang ◽

Nancy Kutner

Keyword(s):

Hurricane Katrina ◽

Large Scale ◽

Service Use ◽

Hospital Admissions ◽

Gulf Coast ◽

The United States ◽

Time Varying ◽

Dialysis Patients ◽

Hospitalization Rates ◽

The Impact

AbstractIntroductionDialysis centers struggled to maintain continuity of care for dialysis patients during and immediately following Hurricane Katrina's landfall on the US Gulf Coast in August 2005. However, the impact on patient health and service use is unclear.ProblemThe impact of Hurricane Katrina on hospitalization rates among dialysis patients was estimated.MethodsData from the United States Renal Data System were used to identify patients receiving dialysis from January 1, 2001 through August 29, 2005 at clinics that experienced service disruptions during Hurricane Katrina. A repeated events duration model was used with a time-varying Hurricane Katrina indicator to estimate trends in hospitalization rates. Trends were estimated separately by cause: surgical hospitalizations, medical, non-renal-related hospitalizations, and renal-related hospitalizations.ResultsThe rate ratio for all-cause hospitalization associated with the time-varying Hurricane Katrina indicator was 1.16 (95% CI, 1.05-1.29; P = .004). The ratios for cause-specific hospitalization were: surgery, 0.84 (95% CI, 0.68-1.04; P = .11); renal-related admissions, 2.53 (95% CI, 2.09-3.06); P < .001), and medical non-renal related, 1.04 (95% CI, 0.89-1.20; P = .63). The estimated number of excess renal-related hospital admissions attributable to Katrina was 140, representing approximately three percent of dialysis patients at the affected clinics.ConclusionsHospitalization rates among dialysis patients increased in the month following the Hurricane Katrina landfall, suggesting that providers and patients were not adequately prepared for large-scale disasters.Howard D, Zhang R, Huang Y, Kutner N. Hospitalization rates among dialysis patients during Hurricane Katrina. Prehosp Disaster Med. 2012;27(4):1-5.

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Facilities for carers of in-patients in forensic psychiatric services in England and Wales

The Psychiatrist ◽

10.1192/pb.bp.109.025833 ◽

2010 ◽

Vol 34 (9) ◽

pp. 381-384 ◽

Cited By ~ 2

Author(s):

Irene Cormac ◽

Drew Lindon ◽

Hannah Jones ◽

Trevor Gedeon ◽

Michael Ferriter

Keyword(s):

Mental Health ◽

Postal Survey ◽

Psychiatric Services ◽

Clinical Implications ◽

England And Wales ◽

Mental Health Settings ◽

Forensic Psychiatric ◽

Minority Ethnic ◽

Psychiatric Facilities

Aims and methodA postal survey of forensic psychiatric facilities in England and Wales was undertaken to obtain information about the services provided for carers of in-patients within these services.ResultsForensic psychiatric services vary in the support and facilities provided for carers. Many do not comply with current legislation for carers. Most units informed carers of their rights to have an assessment, but only a minority provided facilities for carers from Black and minority ethnic backgrounds.Clinical implicationsForensic psychiatric services should meet standards for the involvement and support of carers in mental health settings, and comply with legislation for carers.

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Smoking Ban: A Long-term Analysis of the Malta Paradox in a Population of over 400,000 Subjects

International Cardiovascular Forum Journal ◽

10.17987/icfj.v1i4.50 ◽

2015 ◽

Vol 1 (4) ◽

pp. 184 ◽

Cited By ~ 2

Author(s):

Caroline Magri ◽

Robert Xuereb ◽

Sandra Distefano ◽

Neville Calleja ◽

Victor Grech

Keyword(s):

Hospital Admissions ◽

Public Awareness ◽

Age Groups ◽

Admission Rate ◽

Coronary Heart Disease Mortality ◽

Smoking Ban ◽

Annual Data ◽

Public Areas ◽

Coronary Syndromes ◽

The Impact

Objectives: The introduction of laws that make indoor public areas and workplaces smoke-free has resulted in a significant reduction in the incidence of acute coronary syndromes (ACS). Malta was the second European country to introduce the smoking ban legislation in April 2004. The purpose of the study was to investigate the impact of the smoking ban in Malta on ACS morbidity and mortality. Methods: The number of ACS hospital admissions and the number of cardiovascular deaths were retrospectively analysed. The annual data for 5 years prior to and following the introduction of the Tobacco Act were obtained according to age-groups for both genders. Poisson regression analyses were performed to assess for decline in ACS admission and cardiovascular death. Results: The ACS admission rate increased throughout the 5 years following the introduction of the smoking ban. There was no change in mortality rate in the 5 years following the legislation, except in 2007 when a small but significant decline was noted. Conclusions: The Malta smoking ban did not have a significant impact on cardiovascular mortality and ACS admissions rates, indicating the need for proper enforcement of the public smoking ban and increase in public awareness regarding the adverse effects of smoking. Key words: Coronary heart disease; Mortality; Prevention; Smoking.

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The Stepping On Fall Prevention Program Scale-Up in NSW: Program Reach and Fall-Related Health Service Use

International Journal for Population Data Science ◽

10.23889/ijpds.v5i5.1538 ◽

2020 ◽

Vol 5 (5) ◽

Author(s):

Serene S Paul ◽

Qiang Li ◽

Lara Harvey ◽

Therese Carroll ◽

Annabel Priddis ◽

...

Keyword(s):

Health Service ◽

Fall Prevention ◽

Prevention Program ◽

Service Use ◽

Hospital Admissions ◽

Scale Up ◽

Service Utilisation ◽

Program Outcomes ◽

Fall Prevention Program ◽

Routinely Collected Data

IntroductionFalls in older adults are associated with increased healthcare costs. Falls may be prevented or minimised with multifactorial interventions including exercise and behavioural modification. Objectives and ApproachTo describe the reach of the scale-up of Stepping On, a fall prevention program targeting community-dwellers aged 65 years and older in NSW, Australia; and fall-related ambulance service use and fall-related hospitalisations after scale-up. Routinely-collected data on program reach, fall-related ambulance usage and fall-related hospital admissions in NSW residents aged ≥65 years between 2009 and 2015 were compared within Statistical Local Areas prior to and following implementation of Stepping On using multilevel models. ResultsFrom 2009 to 2014 the program was delivered in 1,077 sites to 10,096 people with an average (SD) age of 81.0 (7.2) years. Rates of fall-related ambulance use and hospital admissions per 100-person-years were 1-2 in people aged 66-74, 4-5 in people aged 75-84 and 12-13 in people aged ≥85. These rates increased over time (p<.001). Overall, the interaction between time and program delivery was not significant for fall-related ambulance use or hospital admissions. The time-related increase in fall-related ambulance usage in people aged 75-84 years may have been moderated by Stepping On (RR 0.97, 95% CI 0.93–1.00, p=.045). Conclusion / ImplicationsThere was no indication of either a reduced rate of fall-related ambulance use or hospital admissions across the entire sample. There was a suggestion of a reduction in ambulance call-outs for falls in people aged 75-84. The lack of a detectable impact on fall-related health service usage may be due to the use of routinely collected data not intended for research purposes or inability to remove those who would be ineligible for Stepping On from the data analyses. Increasing the program reach and targeting groups contributing most to health service utilisation may improve program outcomes.

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Biphasic pattern in the effect of severe measles infection; the difference between additive and multiplicative scale

BMC Infectious Diseases ◽

10.1186/s12879-021-06930-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Nhat Thanh Hoang Le ◽

Nhan Thi Ho ◽

Bryan Grenfell ◽

Stephen Baker ◽

Ronald B. Geskus

Keyword(s):

Infectious Diseases ◽

Hospital Admission ◽

Measles Virus ◽

Hospital Admissions ◽

Admission Rate ◽

Second Phase ◽

Before And After ◽

The Difference ◽

Two Phases ◽

Additive Scale

Abstract Background Infection with measles virus (MeV) causes immunosuppression and increased susceptibility to other infectious diseases. Only few studies reported a duration of immunosuppression, with varying results. We investigated the effect of immunosuppression on the incidence of hospital admissions for infectious diseases in Vietnamese children. Methods We used retrospective data (2005 to 2015; N = 4419) from the two pediatric hospitals in Ho Chi Minh City, Vietnam. We compared the age-specific incidence of hospital admission for infectious diseases before and after hospitalization for measles. We fitted a Poisson regression model that included gender, current age, and time since measles to obtain a multiplicative effect measure. Estimates were transformed to the additive scale. Results We observed two phases in the incidence of hospital admission after measles. The first phase started with a fourfold increased rate of admissions during the first month after measles, dropping to a level quite comparable to children of the same age before measles. In the second phase, lasting until at least 6 years after measles, the admission rate decreased further, with values up to 20 times lower than in children of the same age before measles. However, on the additive scale the effect size in the second phase was much smaller than in the first phase. Conclusion The first phase highlights the public health benefits of measles vaccination by preventing measles and immune amnesia. The beneficial second phase is interesting, but its strength strongly depends on the scale. It suggests a complicated interaction between MeV infection and the host immunity.

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