A National Audit of New Long-Stay Psychiatric Patients

1994 ◽  
Vol 165 (2) ◽  
pp. 170-178 ◽  
Author(s):  
Paul Lelliott ◽  
John Wing
Keyword(s):  
Northern Ireland ◽  
Psychiatric Patients ◽  
Hospital Setting ◽  
Residential Setting ◽  
National Audit ◽  
Community Based ◽  
Community Placement ◽  
Lengths Of Stay ◽  
Psychiatric Beds ◽  
Rate Of Accumulation

Background.This second report of a national audit of new long-stay (NLS) psychiatric patients describes the services caring for the patients and the reasons why patients were still in hospital.Method.Data analyses addressed the prevalence of NLS patients, the residential resources available to services, the distributions of patients within services, clinicians' views as to the appropriateness of current placement and the reasons for any inappropriate placements.Results.The average point prevalence was 6.1 per 100 000 population; it was significantly lower in England and Wales (5.6, s.d. = 3.2) than in Scotland and Northern Ireland (10.7, s.d. = 6.4, ANOVA F ratio = 10.9, P < 0.01). The estimated rate of accumulation was 1.3 per 100 000 population per year. Many English services had very few non-acute psychiatric beds and 31 % of English NLS patients, despite their protracted lengths of stay, were housed on acute wards. Assessors thought that 61 % of patients would be better placed in a non-hospital setting; 47% were thought to require a community-based residential setting, and of these over one-half were still in hospital because no suitable community placement was available.Conclusions.Many NLS patients remain in hospital because their residential needs are not met by existing community provision.

Psychiatric patients' behavior and adjustment as appraised in the community and hospital setting

1967 ◽  
Author(s):  
Robert Ellsworth ◽  
Gilbert Arthur ◽  
Duane Kroeker ◽  
Barry Childers
Keyword(s):  
Psychiatric Patients ◽  
Hospital Setting

scholarly journals 139. Impact of Pharmacist Driven Outpatient Fluoroquinolone Stewardship Initiative in Community Based Setting

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S81-S81
Author(s):  
Sarah Norman ◽  
Sara Jones ◽  
Cara Acklin ◽  
Christian Cheatham
Keyword(s):  
Antimicrobial Stewardship ◽  
Healthcare Providers ◽  
Hospital Setting ◽  
Secondary Outcome ◽  
Quality Improvement Initiative ◽  
Oral Antibiotic ◽  
Ambulatory Care Setting ◽  
Community Based ◽  
Before And After ◽  
Physician Network

Abstract Background Antimicrobial stewardship initiatives and efforts have historically had a greater emphasis in the inpatient hospital setting. There is a need for outpatient stewardship, and additionally, accreditation standards are starting to require antimicrobial stewardship efforts in the ambulatory care setting. Fluoroquinolones are a target for antimicrobial stewardship based on their broad-spectrum activity, pharmacokinetics/pharmacodynamics, safety profile, downstream resistance, and risk of super infections. The objective of this study was to compare outpatient fluoroquinolone prescribing rates before and after pharmacist led initiative. Methods This was a prospective, quality improvement initiative between October 1, 2019 to June 1, 2020 at a community-based physician network across Indiana. The pharmacist initiative incorporated a live, educational presentation with intervention 1 and an informational letter to healthcare providers across the outpatient physician network with intervention 2. Data was collected from a computer-generated, prescription report. The primary outcome was fluoroquinolone prescribing rates at Central Indiana (CI) sites before and after pharmacist led interventions. Rate of fluoroquinolone prescribing was defined as total number of fluoroquinolone prescriptions per month. The secondary outcome included percentage of fluoroquinolone use at CI sites. Percentage of fluoroquinolone use was defined as monthly number of fluoroquinolones prescriptions compared to monthly number of all oral antibiotic prescriptions. Results There was a 29.8% decrease (382 vs 268 prescriptions) in outpatient fluoroquinolone prescriptions at CI sites after intervention 1 compared to same month of previous year. There was a 43.7% decrease (428 vs 241 prescriptions) in outpatient fluoroquinolone prescriptions at CI sites after intervention 2. There was an overall 2.4% decrease (4.9% vs 2.5%) in percentage of fluoroquinolone use compared to all oral antibiotics at CI sites after intervention 2 compared to same month of previous year. Conclusion These findings suggest the pharmacist led outpatient antimicrobial stewardship initiative successfully decreased fluoroquinolone prescribing rates across the network. Disclosures Christian Cheatham, PharmD, BCIDP, Antimicrobial Resistance Solutions (Shareholder)

Community Capacity to Provide Mental/Behavioral Health Services for People With IDD Transitioning From State-Operated Developmental Centers

2021 ◽  
Vol 59 (3) ◽  
pp. 224-238
Author(s):  
Amie Lulinski ◽  
Tamar Heller
Keyword(s):  
Health Services ◽  
Behavioral Health ◽  
Psychiatric Diagnosis ◽  
Technical Assistance ◽  
Community Capacity ◽  
Intellectual And Developmental Disabilities ◽  
Community Based ◽  
Individual Level ◽  
Lengths Of Stay ◽  
Survey Results

Abstract The study's aim was to explore the capacity of community-based providers of residential supports and services to support people with intellectual and developmental disabilities who transitioned out of state-operated institutions into community-based settings. Receiving agency survey results from 65 agencies and individual-level variables of 2,499 people who had transitioned from an institution to a community-based setting indicated that people who returned to an institution post-transition tended to be younger, have a higher IQ score, were more likely to have a psychiatric diagnosis, tended to have shorter previous lengths of stay at an institution, transitioned to larger settings, and received services from an agency receiving behavioral health technical assistance as compared to those who remained in their transition settings.

scholarly journals "EMMA Study: a Brazilian community-based cohort study of stroke mortality and morbidity"

2016 ◽  
Vol 134 (6) ◽  
pp. 543-554 ◽  
Author(s):  
Alessandra Carvalho Goulart ◽  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Hemorrhagic Stroke ◽  
Local Community ◽  
Hospital Setting ◽  
Public Healthcare ◽  
Stroke Mortality ◽  
Community Based ◽  
Mortality And Morbidity ◽  
Risk Of Death

ABSTRACT CONTEXT AND OBJECTIVE: Stroke has a high burden of disability and mortality. The aim here was to evaluate epidemiology, risk factors and prognosis for stroke in the EMMA Study (Study of Stroke Mortality and Morbidity). DESIGN AND SETTINGS: Prospective community-based cohort carried out in Hospital Universitário, University of São Paulo, 2006-2014. METHODS: Stroke data based on fatal and non-fatal events were assessed, including sociodemographic data, mortality and predictors, which were evaluated by means of logistic regression and survival analyses. RESULTS: Stroke subtype was better defined in the hospital setting than in the local community. In the hospital phase, around 70% were first events and the ischemic subtype. Among cerebrovascular risk factors, the frequency of alcohol intake was higher in hemorrhagic stroke (HS) than in ischemic stroke (IS) cases (35.4% versus 12.3%, P < 0.001). Low education was associated with higher risk of death, particularly after six months among IS cases (odds ratio, OR, 4.31; 95% confidence interval, CI, 1.34-13.91). The risk of death due to hemorrhagic stroke was greater than for ischemic stroke and reached its maximum 10 days after the event (OR: 3.31; 95% CI: 1.55-7.05). Four-year survival analysis on 665 cases of first stroke (82.6% ischemic and 17.4% hemorrhagic) showed an overall survival rate of 48%. At four years, the highest risks of death were in relation to ischemic stroke and illiteracy (hazard ratio, HR: 1.83; 95% CI: 1.26-2.68) and diabetes (HR: 1.45; 95% CI: 1.07-1.97). Major depression presented worse one-year survival (HR: 4.60; 95% CI: 1.36-15.55). CONCLUSION: Over the long term, the EMMA database will provide additional information for planning resources destined for the public healthcare system.

scholarly journals Organization of Community Psychiatric Services in Finland

10.17816/cp64 ◽  
2021 ◽  
Vol 2 (1) ◽  
pp. 55-64
Author(s):  
Jyrki Korkeila
Keyword(s):  
Psychiatric Treatment ◽  
Psychiatric Patients ◽  
Economic Recession ◽  
Psychiatric Services ◽  
Severe Mental Disorders ◽  
Community Based ◽  
Institutional Settings ◽  
Primary Organization ◽  
Methods Of Treatment ◽  
Rapid Transformation

Background. The Finnish psychiatric treatment system has undergone a rapid transformation from operating in institutional settings to a adopting a community-based approach, through implementation of national plans; this process was carried out quickly, due to a severe economic recession in the early 1990s. Methods. This paper is a narrative review, based on relevant documents by national authorities, academic dissertations and published scientific literature, between 1984 and 2018, as well as the interviews of key experts in 2019. Results. The municipality is currently the primary organization, responsible for all health services. Municipalities may also work together in organizing the services, either through unions of municipalities or hospital districts. Services are to a great extent outpatient-oriented. The number of beds is one fifth of the previous number, around four decades ago, despite the increase in population. In 2017, 191,895 patients in total (4% of Finns) had used outpatient psychiatric services, and the number of visits totalled 2.25 million. Psychotherapy is mainly carried out in the private sector by licensed psychotherapists. Homelessness in relation to discharged psychiatric patients has not been in evidence in Finland and deinstitutionalization has not caused an increase in the mortality rate among individuals with severe mental disorders. Conclusion. Psychiatric patients have, in general, benefitted greatly from the shift from institutions to the community. This does not preclude the fact that there are also shortcomings. The development of community care has, to date, focused too heavily on resource allocation, at the expense of strategic planning, and too little on methods of treatment.

The Primary Physician and the Death of a Child in a Specialized Hospital Setting

PEDIATRICS ◽  
1983 ◽  
Vol 71 (3) ◽  
pp. 443-445
Author(s):  
MORRIS A. WESSEL
Keyword(s):  
Social Workers ◽  
Hospital Setting ◽  
Infants And Children ◽  
Hospital Service ◽  
Community Based ◽  
Medical Centers ◽  
Primary Physician ◽  
Hospital Physicians ◽  
Death Of A Child ◽  
Specialized Hospital

Pediatricians offer ongoing comprehensive and coordinate care for children. Community-based primary pediatricians assume a large proportion of this repsonsibility, referring a few patients to collegues with specialized skills for consultation and treatment. These consultants, who are often fulltime members of university or other medical centers, provide care extending the lives of many children suffering illnesses that formerly were fatal early in the course of the disease. Some infants and children unfortunately do die after many months or years of treatment at a specialized clinic or hospital service. When this tragedy occurs, parents and siblings have the difficult task of relinquishing their relationship to hospital physicians, nurses, and social workers who have sustained them for many months or years.

scholarly journals Capacity-related interfacility patient transports: patients affected, wait times involved and associated morbidity

CJEM ◽  
2006 ◽  
Vol 8 (04) ◽  
pp. 262-268 ◽  
Author(s):  
Esther Stolte ◽  
Rod Iwanow ◽  
Christine Hall
Keyword(s):  
Transport Process ◽  
Transitional Care ◽  
Psychiatric Patients ◽  
Wait Time ◽  
The Other ◽  
Health Records ◽  
Lengths Of Stay ◽  
Patient Morbidity ◽  
Canadian City ◽  
Full Capacity

ABSTRACTObjectives:The trend toward operating Canadian hospitals at full capacity necessitates in some settings the transfer of patients from one hospital's emergency department (ED) to another hospital for admission, due to lack of bed availability at the first hospital. Our objectives were to determine how many and which patients are transported, to measure how much time is spent in the peri-transport process and to document any morbidity or mortality associated with these periods of transitional care.Methods:In this retrospective, observational health records review, we obtained health records during February, June and October 2002 for patients evaluated in any 1 of 3 adult EDs from a single Canadian city and subsequently transferred for admission to 1 of the other 2 hospitals. Data included the reason for transport, admitting service, transport process times and administration of key medications (asthma, cardiac, diabetes, analgesic or antibiotics).Results:Five hundred and thirteen records of transported patients were reviewed, and 507 were evaluated. Of those, 372 (73.4%) transfers were capacity-related and 135 (26.6%) were transferred for specialty services. Of the capacity transports, 219 (58.9%) were admissions for psychiatry and 123 (33.1%) for medicine. Median wait time at the first hospital was 6.7 hours, being longest for psychiatric patients. Thirty patients (8.1%) missed 1 or more doses of a key medication in the peri-transport process, and 8 (2.2%) missed 2 or more.Conclusions:Overcrowding of hospitals is a significant problem in many Canadian EDs, resulting in measurable increases in lengths of stay. Transfers arranged to other facilities for admission further prolong lengths of stay. Increased boarding times can result in missed medications, which may increase patient morbidity. Further study is needed to assess the need for capacity transfers and the possible risk to patients associated with periods of transitional care.

scholarly journals Why Psychosexual Disorders Equally Important in India

2020 ◽  
Vol 2 (1) ◽  
pp. 16-18
Author(s):  
R. K. Solanki ◽  
Rishika Agarwal
Keyword(s):  
Human Sexuality ◽  
Hospital Setting ◽  
General Medicine ◽  
Routine Practice ◽  
Common Belief ◽  
Psychological Consequences ◽  
Community Based ◽  
The Past ◽  
Number Of Patients ◽  
Health Disorders

Human sexuality is a complex with multidimensional aspects such as biological, psychological, social, and cultural. Cultural factors influence their development as prevalence rates of these disorders vary in different communities. The nature of problems and their psychological consequences make it difficult to assess the exact prevalence of these dysfunctions, even more difficult in developing countries like India. In India, care for people is not proper as large number of patients suffering from psychosexual problems visit unauthorized “sex clinics” rather than an authorized hospital setting. Specialists like dermatologists are often consulted for these problems in their routine practice as common belief shared by them is that these problems are caused by dysfunctions in their sex organs. So they are hesitant to go to sexual clinics and psychiatrists for the same in the first place. The question that arises is where does sexual medicine stand, as asked by many in the past too but remains unanswered in terms of general medicine and psychiatry. Thus, the need of the hour is to identify these cases in early stages, which can prevent a lot of other disorders occurring due to them such as homicide, suicide, domestic violence, battered wife syndrome, etc. in society. The advance in psychosexual medicine is much needed. Despite the importance of these disorders and sensitivity, in India, there is scarcity of data about the burden of sexual health disorders from community-based studies, unlike Western countries.

Mortality Among Patients with Psychiatric Illness a Ten-Year Case Register Study in an Area with a Community-based System of Care

1995 ◽  
Vol 166 (6) ◽  
pp. 783-788 ◽  
Author(s):  
Francesco Amaddeo ◽  
Giulia Bisoffi ◽  
Paola Bonizzato ◽  
Rocco Micciolo ◽  
Michele Tansella
Keyword(s):  
Poisson Regression ◽  
Psychiatric Patients ◽  
Age Groups ◽  
System Of Care ◽  
Register Study ◽  
First Year ◽  
Community Based ◽  
Pattern Of Care ◽  
Case Register ◽  
Specialist Services

BackgroundMost studies which showed an excess mortality in psychiatric patients have been conducted on hospitalised samples.MethodThis was a case register study. All South Verona patients with an ICD diagnosis who had psychiatric contacts with specialist services in 1982–1991 were included. Mortality was studied in relation to sex, age, diagnosis, pattern of care and interval from registration. Standardised Mortality Rates (SMRs) and Poisson regression analysis were calculated.ResultsThe overall SMR was 1.63 (95% CI = 1.5–1.8), which is the lowest value reported so far. Mortality was higher among men (SMR = 2.24; 95% CI = 1.9–2.6), among patients who were admitted to hospital (SMR = 2.23; 95% CI = 1.9–2.6), among younger age groups (SMR = 8.82; 95% CI = 4.9–14.6) and in the first year after registration (SMR = 2.32; 95% CI = 1.8–2.9). Higher mortality was found in patients with a diagnosis of alcohol and drug dependence (SMR = 3.87; 95% CI = 3.0–4.9). The SMR for suicide was 17.41. Using a Poisson regression model, diagnosis, pattern of care and interval from registration were all found to be significantly associated with mortality. When all these variables were entered together in the model, each maintained its predictive role.ConclusionsThe overall mortality of psychiatric patients treated in a community-based system of care was higher than expected, but lower than the mortality reported in other psychiatric settings. The highest mortality risk was found in the first year after registration.

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