Reinternamentos Hospitalares num Serviço de Pedopsiquiatria: Taxa de Readmissão e Fatores de Risco

Introduction: Most mental disorders have a chronic evolution and therefore a certain amount of psychiatric readmissions are inevitable. Several studies indicate that over 25% of child and adolescent inpatients were readmitted within one year of discharge. Several risk factors for psychiatric readmissions have been reported in the literature, but the history of repeated readmissions is the most consistent risk factor. Our aim is to calculate the readmission rates at 30 days and 12 months after discharge and to identify associated risk factors.Material and Methods: The authors consulted the clinical files of patients admitted to the Inpatient Unit between 2010 and 2013, in order to calculate the readmission rates at 30 days and at 12 months. The demographic and clinical characteristics of the readmitted patients were analyzed and compared with a second group of patients with no hospital readmissions, in order to investigate possible predictors of readmission.Results: A total of 445 patients were admitted to our inpatient unit between 2010 and 2013. Six adolescents were readmitted in a 30 days period (1.3%) and 52 were readmitted in a 12 month period after discharge (11.5%). Duration of the hospitalization and the previous number of mental health admissions were significant predictors of future hospital readmissions (p = 0.04 and p = 0.014).Discussion: The low readmission rates may reflect the positive clinical and sociofamilial support being provided after discharge.Conclusion: Rehospitalisation is considered a fundamental target for intervention concerning prevention and intervention in mental healthcare. Thus, knowledge regarding their minimisation is crucial.

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Samhällsvårdens Svarte Petter

Socialvetenskaplig tidskrift ◽

10.3384/svt.2019.26.1.2359 ◽

2019 ◽

Vol 26 (1) ◽

Author(s):

Ulrika Levander ◽

Lina Sturfelt

Keyword(s):

Mental Health ◽

Residential Care ◽

Mental Healthcare ◽

Preventive Actions ◽

Child Psychiatric ◽

History Of ◽

Mental Health Interventions ◽

Public Responsibility ◽

Open Question ◽

Children In Care

Drawing the short straw. Contemporary and historical categorizations of children in foster and residential care with mental health disordersAbout 67 per cent of children placed in residential care in Sweden suffer from mental health disorders. Although the problem has been recognized for decades, the group’s access to sufficient mental healthcare is still lagging. In this article we examine contemporary and historical categorizations of mental health issues among children in foster and residential care. The study examines Swedish commission reports, government bills, and Children’s Acts published between 1902 and 2016 where the issue is discussed. Hereby, ”the history of the present”, and its implications for the targeted group, is analysed and problematized. Our findings show that continuous talk of preventive actions in the name of the all-embracing welfare state repeatedly has downplayed the group’s access to mental health interventions. Ever since the establishment of the child psychiatric field in the 1940s, a discursive battle about the public responsibility for the group is also raging. In the 1970s, coordination is articulated as the grand solution, but the problem still persists. Neither the contemporary child rights perspective nor the latest law regulations of forced coordination for children in care have changed the group’s underprivileged position. Whether the legal turn will finally lead to recognition of the group’s right to adequate mental health care remains an open question.

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Abstract 17352: Differences in Clinical Characteristics, Risk Factors, Rate of Recurrence and 1-year Outcome Between Acute Heart Failure Patients With Stroke or TIA and Those Without This Co-morbidity. Results From the Gulf aCute heArt failuRe rEgistry (gulf Care)

Circulation ◽

10.1161/circ.130.suppl_2.17352 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Mohammed A Al Hashemi ◽

Kadhim Sulaiman ◽

Jassim Al-Suwaidi ◽

Khalid F AlHabib ◽

Husam AlFaleh ◽

...

Keyword(s):

Heart Failure ◽

Acute Heart Failure ◽

Clinical Characteristics ◽

De Novo ◽

Stroke Patients ◽

Lv Dysfunction ◽

Co Morbidity ◽

History Of ◽

One Year ◽

Ischemic Attack

Background: Chronic heart failure (CHF) is a known risk for stroke and morbidities and mortalities are known to be higher in CHF patients compared to stroke patients without CHF we here study the prevalence and the clinical significance in a group of patient with stroke or transient ischemic attack (TIA) who were admitted to hospital with acute heart failure (AHF) compared to those without stroke and are admitted with acute heart failure Methods: Data were derived from a prospective, multicenter, multinational study of 5005 patients hospitalized with AHF from February 2013 to November 2012. Data were analyzed according to the presence or absence of Stroke or bronchial TIA. Demographic, management, in-hospital and 1-year outcomes were compared Results: Stroke patients were likely to have a decompensation of chronic failure rather than De-Novo AHF when compared to those without Stroke/TIA (see table). Stroke patients were older; more likely to be female, have history of DM, HTN, dyslipidemia and CKD. Stroke patients were likely to have Atrial fibrillation, PVD, systolic LV dysfunction as well as CAD when compared to those without Stroke, they were also more likely receive NIV, IV inotropes and likely to have had cardiac PCI prior to this admission with AHF. Stroke patients had higher recurrence of stroke and one-year mortality rates. Conclusion: Patients who presented with AHF and history of stroke/TIA were having different clinical characteristics as well as comorbidities as compared to those without Stroke, with worse in-hospital and one-year outcome. The current study underlies the need to aggressively manage these high-risk patients.

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Mental Healthcare in Rural Latin America

Práctica Familiar Rural ◽

10.23936/pfr.v0i4.172 ◽

2017 ◽

Author(s):

Jody Epstein

Keyword(s):

Mental Health ◽

Latin America ◽

Latin American ◽

Mental Healthcare ◽

Health Service Delivery ◽

Healthcare Systems ◽

Mental Health Disorders ◽

Mental Health Service Delivery ◽

History Of ◽

Health Disorders

<p class="normal">The goal of this article is to provide an overview of epidemiology of mental health disorders in Latin America, discuss unique issues in mental health faced by rural Latin American communities, summarize the history of Latin American healthcare systems, and describe current strategies to improve and innovate mental health service delivery in Latin America. </p>

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Digital Heath Interventions in Mental Health

Research Anthology on Mental Health Stigma, Education, and Treatment ◽

10.4018/978-1-7998-8544-3.ch019 ◽

2021 ◽

pp. 328-340

Author(s):

Aleksandra Stanimirovic

Keyword(s):

Mental Health ◽

Remote Monitoring ◽

Mental Healthcare ◽

Therapeutic Interventions ◽

Passive Monitoring ◽

Science Regulation ◽

History Of ◽

Healthcare Interventions ◽

Tracking Devices ◽

Digital Healthcare

Technological renaissance of the last century stimulated the application of digital interventions in the healthcare domain. Digital healthcare interventions (DHIs) could be implemented through smartphone applications (apps), remote monitoring and tracking devices, and wearable computers. Technology is positioned to transform how mental healthcare is delivered and accessed. In fact, remote active and passive monitoring of parameters, such as mood, activity, and sleep, could be integrated with therapeutic interventions. However, the transformation entails combined conscription of science, regulation, and design. Implementation, adoption, and evaluation of DHI present special challenges. This chapter presents brief history of DHIs in mental health and frameworks an evaluation strategy in terms of the appropriate methods required for appraisal of DHIs.

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New horizons: Forensic mental health services for older people

BJPsych Advances ◽

10.1192/apt.bp.113.012021 ◽

2017 ◽

Vol 23 (1) ◽

pp. 44-53 ◽

Cited By ~ 6

Author(s):

Muthusamy Natarajan ◽

Sophie Mulvana

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Older People ◽

Clinical Characteristics ◽

Adult Population ◽

Mental Healthcare ◽

Forensic Mental Health ◽

Mentally Disordered Offenders ◽

Healthcare Needs

SummaryAlthough the older adult population makes up only a small percentage of mentally disordered offenders, there is a clear need for forensic mental health services for older people. However, these services to date have developed ad hoc and with no coordination. In this article we discuss the evolution, current provision, future direction and therapeutic implications of such services. Although the epidemiology, criminology and clinical characteristics of older people are sufficiently different from those of younger people to warrant such service specificity, we suggest that the provision of care should be geared to services based on older people's multiple and complex needs, rather than on arbitrary age cut-offs.Learning Objectives• Be able to use an understanding of epidemiology, criminology and clinical characteristics of older people in the provision of forensic mental healthcare• Understand the forensic mental healthcare needs of older people• Be able to develop forensic mental health services for older people

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Improvement of postinpatient psychiatric follow-up for veterans using telehealth

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxz314 ◽

2020 ◽

Vol 77 (4) ◽

pp. 288-294 ◽

Cited By ~ 2

Author(s):

Timothy W Brearly ◽

Courtney S Goodman ◽

Calandra Haynes ◽

Katherine McDermott ◽

Jared A Rowland

Keyword(s):

Mental Health ◽

Psychological Symptoms ◽

Mental Healthcare ◽

Patient Discharge ◽

Self Report ◽

Wait Times ◽

Recidivism Rate ◽

Readmission Rates ◽

Medication Discontinuation

Abstract Purpose To describe the implementation and initial outcomes of a pilot interdisciplinary telehealth clinic, Allied Transitional Telehealth Encounters post-iNpatient Discharge (ATTEND), providing clinical pharmacy specialist follow-up for veterans transitioning from inpatient to outpatient mental healthcare in a Department of Veterans Affairs (DVA) hospital. Summary The ATTEND clinic’s primary intervention was providing medication management appointments through clinical video telehealth (CVT) to patient discharge locations through a DVA-provided tablet. An interdisciplinary team supported care through on-unit inpatient training, secure messaging, and self-help applications. Clinical outcomes were measured through readmission rates, wait times, self-report measures, and follow-up interview at the completion of ATTEND services. Twenty patients completed on-unit training, and 16 unique patients were seen for at least 1 outpatient appointment. Inpatient readmission rates were lower for ATTEND patients than with standard care (5% versus 19%, respectively). Wait times until first postdischarge mental health appointment were reduced by a mean of 18.6 (S.D., 8.8) days. The pharmacist made medication interventions, including dosing changes, education on incorrect administration, and medication discontinuation. Self-reported psychological symptoms decreased during ATTEND participation. Post-ATTEND interviews indicated high levels of acceptance and interest in continued tablet-based care. Primary challenges included unique technological limitations and effective care coordination. Conclusion The ATTEND telehealth clinic provided postinpatient mental health follow-up that was more prompt and convenient than conventional on-site appointments. Psychiatric self-report improved during ATTEND-facilitated transition to outpatient care, and the recidivism rate for ATTEND patients was lower than the general inpatient rate during the same time period.

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Mental Healthcare in Rural Latin America

Práctica Familiar Rural ◽

10.23936/pfr.v2i1.59 ◽

2017 ◽

Vol 2 (1) ◽

Author(s):

Jody Epstein

Keyword(s):

Mental Health ◽

Latin America ◽

Latin American ◽

Mental Healthcare ◽

Health Service Delivery ◽

Healthcare Systems ◽

Mental Health Disorders ◽

Mental Health Service Delivery ◽

History Of ◽

Health Disorders

The goal of this article is to provide an overview of epidemiology of mental health disorders in Latin America, discuss unique issues in mental health faced by rural Latin American communities, summarize the history of Latin American healthcare systems, and describe current strategies to improve and innovate mental health service delivery in Latin America.

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Sociodemographic and clinical characteristics in child and youth mental health; comparison of routine outcome measurements of an Australian and Dutch outpatient cohort

Epidemiology and Psychiatric Sciences ◽

10.1017/s2045796021000652 ◽

2021 ◽

Vol 30 ◽

Author(s):

S. L. Roest ◽

B. M. Siebelink ◽

H. van Ewijk ◽

R. R. J. M. Vermeiren ◽

C. M. Middeldorp ◽

...

Keyword(s):

Mental Health ◽

Clinical Trials ◽

Selection Criteria ◽

Clinical Characteristics ◽

Outcome Measurement ◽

Mental Healthcare ◽

Youth Mental Health ◽

Healthcare Services ◽

Routine Outcome Measurement ◽

Strict Selection

Routine outcome measurement (ROM) data offer unique opportunities to study treatment outcomes in clinical practice, and can help to assess the real-world impact of mental health services for children and adolescents (youth). This is illustrated by studies using naturalistic data from specialist child and adolescent mental healthcare services (CAMHS), showing the proportion of patients with reliable improvement, recovery or deterioration (Burgess et al., 2015; Wolpert et al., 2016), and revealing specific subgroups of patients with greater risk of poor outcome (Garralda et al., 2000; Lundh et al., 2013; Murphy et al., 2015; Edbrooke-Childs et al., 2017). Naturalistic data are therefore undeniably necessary in addition to data derived from randomised clinical trials, which often have limited generalisability due to strict selection criteria (Rothwell, 2005; Van Noorden et al., 2014).

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Socio-Demographic and Clinical Characteristics of Adults With Psychotic Symptomatology Under Involuntary Admission and Readmission for Compulsory Treatment in a Referral Psychiatric Hospital in Cyprus

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.602274 ◽

2021 ◽

Vol 12 ◽

Author(s):

Katerina Kaikoushi ◽

Nicos Middleton ◽

Andeas Chatzittofis ◽

Evanthia Bella ◽

Giorgos Alevizopoulos ◽

...

Keyword(s):

Mental Health ◽

Substance Use ◽

Suicidal Behavior ◽

Clinical Characteristics ◽

Mental Health Problems ◽

Psychiatric Treatment ◽

Positive Family History ◽

Compulsory Treatment ◽

Cross Sectional ◽

History Of

Socio-demographic and clinical characteristics of adults under compulsory psychiatric treatment, have not been reported adequately in Southern European countries. We investigated the socio-demographic and clinical characteristics of adults with psychotic symptomatology who were involuntarily treated in the acute Mental Health Services in Cyprus. A descriptive cross-sectional study was applied. Data collection (December 2016 to February 2018) achieved via a structured questionnaire including demographic and clinical variables. Census sampling was applied in Cyprus referral center for compulsory psychiatric treatment. The sample included 406 individuals (262 males, 144 females). Approximately 86.2% were single, 77.6% were unemployed, and 24.9% held a bachelor's degree. The most frequent clinical diagnosis was schizophrenia or a relevant psychotic disorder (86.4%). The most frequent admission cause was non-adherence to pharmacotherapy along with disorganized behavior (agitation and/or self-care deficit, and/or aggressive behavior, and/or suicidal behavior) (53.6%). Moreover, 70.7% of the sample reported a positive personal history of mental health problems, while 42.1% reported a positive family history of mental health disorders. Half of the participants (52%) were previously involuntarily admitted for compulsory treatment. Adjusted associations of readmission status were reported with Cypriot ethnicity (OR: 4.40, 95%CI: 2.58–7.50), primary education only (OR: 3.70, 95%CI: 1.64–8.37), readmission due to disorganized behavior along with non-adherence to pharmacotherapy (OR: 10.84, 95%CI: 2.69–43.72), as well as along with substance use (OR: 6.39, 95%CI: 1.52–26.82). Readmission was almost five times more likely to occur due to suicidal behavior (OR: 5.01, 95%CI: 1.09–22.99) compared to disorganized behavior not otherwise specified. Additionally, those with a diagnosis of schizophrenia were more than 12 times more frequently readmitted for compulsory treatment compared to other diagnoses (OR 12.15, 95%CI: 1.04–142). Moreover, the participants with higher secondary education had 54.6% less odds to be involuntarily re-admitted compared to Bachelor degree holders (OR 0.442, 95%CI: 0.24–0.79). A high percentage of involuntary treatment was noted due to non-adherence to pharmacotherapy and substance use. Re-evaluation of the effectiveness of relevant community interventions is suggested, as well as implementation of structured educational programs on therapy adherence during psychiatric hospitalization.

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Missing the Mark: Inaccuracy of administrative data in identification of hospitalized patients with pneumonia and results of a systematic clinical reclassification process on readmission rates

Journal of Hospital Administration ◽

10.5430/jha.v6n6p35 ◽

2017 ◽

Vol 6 (6) ◽

pp. 35

Author(s):

Marcus D. Ruopp ◽

Joel C. Boggan ◽

Thomas L. Holland ◽

Mary Jane Stillwagon ◽

Joseph A. Govert ◽

...

Keyword(s):

Administrative Data ◽

Readmission Rate ◽

Medical Center ◽

Academic Medical Center ◽

Hospital Readmissions ◽

Final Diagnosis ◽

Healthcare Systems ◽

Readmission Rates ◽

Control And Prevention ◽

One Year

Objective: Pneumonia readmissions carry financial ramifications under the Hospital Readmissions Reduction Program (HRRP). As readmission determination utilizes administrative data, healthcare systems should evaluate accuracy of pneumonia diagnoses. We sought to develop a systemic process for pneumonia classification review and determine potential effects on pneumonia readmissions in a tertiary academic medical center in the United States.Methods: We performed independent reviews of all pneumonia discharges within 48 hours of discharge over a one-year period. We reclassified all pneumonia discharges into four categories based on the Centers for Disease Control and Prevention reference standard. Secondary review of discordant classifications was performed by discharging providers to determine final diagnosis. The primary outcome was readmission rate within 30 days by pneumonia clinical classification category.Results: Two hundred seventy-eight discharges were reviewed, with overall readmission rate of 18.0%. Independent review confirmed 191 cases (68.7%) as definite or probable pneumonia, while 87 cases (31.3%) were classified as either probably not or not pneumonia. Readmission rates differed significantly between cases reviewed as pneumonia vs. those reviewed as unlikely to be pneumonia (14.1% vs. 26.4%, p < .02). Discharging attending physicians agreed with independent reviewers in 58/87 cases (66.6%), attenuating readmission differences (rate 16.8% for those finalized as pneumonia vs. 22.4% for another diagnosis, p = .32). Pneumonia readmissions were reduced by 1.2% using the classification standard.Conclusions: Complex conditions such as pneumonia may be inaccurately diagnosed in many patients, potentially affecting penalties associated with readmission rates. Therefore, it is imperative that healthcare systems adopt systematic review processes to standardize diagnoses and improve comparative administrative data.

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