Therapeutic relationships within child and adolescent mental health inpatient services: A qualitative exploration of the experiences of young people, family members and nursing staff

Child and adolescent mental health services (CAMHS), especially inpatient units, have arguably never been more in demand and yet more in need of reform. Progress in psychotherapy and more broadly in mental health care is strongly predicted by the therapeutic relationship between professional and service user. This link is particularly pertinent in child and adolescent mental health inpatient services where relationships are especially complex and difficult to develop and maintain. This article describes a qualitative exploration of the lived experienced of 24 participants (8 young people, 8 family members/carers and 8 nursing staff) within inpatient CAMHS across four sites in the UK. We interviewed participants individually and analysed the transcripts using thematic analysis within a critical realist framework. We synthesised data across groups and present six themes, encapsulating the intricacies and impact of therapeutic relationships; their development and maintenance: Therapeutic relationships are the treatment, Cultivating connection, Knowledge is power, Being human, The dance, and It’s tough for all of us in here. We hope these findings can be used to improve quality of care by providing a blueprint for policy, training, systemic structures and staff support.

Faktor - Faktor Pendukung Keputusan Rujukan Pasien pada Fasilitas Kesehatan Tingkat Pertama (FKTP) dengan metode Analytical Hierrarchy Process (AHP)

Pratama Bakti Timah Clinic is one of the First Level Health Facilities (FKTP) that provides health services to the community in the Pangkalpinang area and its surroundings. In these health service activities, when a patient requires special medical care in terms of medical services, medical personnel, medical support, outpatient services, and inpatient services, the patient will be referred to a higher health facility. Considering the various factors that cause patients to be referred and there are several hospitals that are referred to, this condition is a multi-criteria and multi-alternative condition. To overcome this, it is necessary to design a decision support system that will make it easier for medical administration service officers at the Primary Clinic. The decision support system is designed using the Analytical Hierarchy Process (AHP) method which is able to accommodate multi-criteria and multi-alternative decision making. The results of data processing showed that the most important factor in the referral of FKTP patients at the Pratama Clinic was the outpatient service factor with a weight of 30.7%, the second factor was medical services 24.4%, the third factor was medical personnel 17.5%, the fourth factor was supporting medical services 15.9%, and the last is inpatient services 11.4%. While the first referral hospital is RSUD Ir. Soekarno with a weight of 31.1%, then Depati Hamzah Hospital with a weight of 27.5%, then Bakti Timah Hospital with 27.3%, and Bakti Wara Hospital with 14.1%.

Trends in Health Care Use and Spending for Young Children With Neurologic Impairment

BACKGROUND AND OBJECTIVES: Children with neurologic impairment (NI) are a growing subset of children who frequently use health care. We examined health care use and spending trends across services for children with NI during their first 5 years of life. METHODS: This was a retrospective study of 13 947 children with NI in the multistate IBM Medicaid MarketScan Database (2009–2017). We established birth cohorts of children with NI and analyzed claims from birth to 5 years. NI, identified by using International Classification of Diseases, 9th Revision, diagnosis codes, was defined as ≥1 neurologic diagnosis that was associated with functional and/or intellectual impairment. We measured annual health care use and per-member-per-year spending by inpatient, emergency department (ED), and outpatient services. Population trends in use and spending were assessed with logistic and linear regression, respectively. RESULTS: During their first versus fifth year, 66.8% vs 5.8% of children with NI used inpatient services, and 67.8% vs 44.4% used ED services. Annual use in both categories decreased over 0–5 years (inpatient odds ratio: 0.35, 95% confidence interval: 0.34 to 0.36; ED odds ratio: 0.78, 95% confidence interval: 0.77 to 0.79). The use of outpatient services (primary care, specialty care, home health) decreased gradually. Per-member-per-year spending on inpatient services remained the largest spending category: $83 352 (90.2% of annual spending) in the first year and $1944 (25.5%) in the fifth year. CONCLUSIONS: For children with early-onset NI from 0–5 years, use and spending on inpatient services decreased dramatically; ED and outpatient service use decreased more gradually. These findings may help systems, clinicians, and families optimize care by anticipating and adjusting for shifting use of health care services.

Analisis Kualitas Pelayanan Rawat Inap Pada Puskesmas Winongan Kabupaten Pasuruan

The study was compiled to see and analyze the quality of care services at Winongan Public Health Center, Pasuruan Regency, and to see the factors that affect inpatient services. This research is a qualitative descriptive study by observing data through interviews, documentation, and observation. The informants taken by the researcher were the Head of the Inpatient Division of the Winongan Public Health Center, Pasuruan Regency, Administrative Officers, Nurses and patients and / or their families. In this study, the researcher used 5 public service indicators, namely Tangible, Reliability, Responsiveness, Assurance, and Empathy. The results showed that the total quality of services at Winongan Health Center has been carried out well. This means that the quality of the services provided by the Winongan Health Center is maximized. This can be seen from the results of interviews and data that have been previously described that the Tangible, Reliability, Responsiveness, Assurance, and Empathy indicators. then the implementation of Inpatient services at Winongan Health Center is running well, but still requires improvement in several ways, namely: lack of supplies of medical equipment, linen and household tools, cleanliness of rooms and bathrooms, implementation of actions according to Standard Operating Procedures (SOP) and motto that has been set.

The indirect impact of COVID-19 pandemic on inpatient admissions in 204 Kenyan hospitals: An interrupted time series analysis

The first case of severe acute respiratory coronavirus 2 (SARS-CoV-2) was identified in March 2020 in Kenya resulting in the implementation of public health measures (PHM) to prevent large-scale epidemics. We aimed to quantify the impact of COVID-19 confinement measures on access to inpatient services using data from 204 Kenyan hospitals. Data on monthly admissions and deliveries from the District Health Information Software version 2 (DHIS 2) were extracted for the period January 2018 to March 2021 stratified by hospital ownership (public or private) and adjusting for missing data using multiple imputation (MI). We used the COVID-19 event as a natural experiment to examine the impact of COVID-19 and associated PHM on use of health services by hospital ownership. We estimated the impact of COVID-19 using two approaches; Statistical process control (SPC) charts to visualize and detect changes and Interrupted time series (ITS) analysis using negative-binomial segmented regression models to quantify the changes after March 2020. Sensitivity analysis was undertaken to test robustness of estimates using Generalised Estimating Equations (GEE) and impact of national health workers strike on observed trends. SPC charts showed reductions in most inpatient services starting April 2020. ITS modelling showed significant drops in April 2020 in monthly volumes of live-births (11%), over-fives admissions for medical (29%) and surgical care (25%) with the greatest declines in the under-five’s admissions (59%) in public hospitals. Similar declines were apparent in private hospitals. Health worker strikes had a significant impact on post-COVID-19 trends for total deliveries, live-births and caesarean section rate in private hospitals. COVID-19 has disrupted utilization of inpatient services in Kenyan hospitals. This might have increased avoidable morbidity and mortality due to non-COVID-19-related illnesses. The declines have been sustained. Recent data suggests a reversal in trends with services appearing to be going back to pre- COVID levels.

74. Evaluation of the Differences in Appropriateness of BioFire® FilmArray® Gastrointestinal Panel Testing between Emergency Department and Inpatient Services

Background Use of rapid molecular diagnostic panels in the evaluation of diarrhea provides increased sensitivity for organism identification and decreased time to results. However, their inappropriate use can lead to unnecessary expenditures and antimicrobial exposures. We aimed to characterize the appropriateness of testing using the BioFire® FilmArray® Gastrointestinal Panel (SFA) in different clinical settings and to describe the impact of SFA results on patient care. Methods Retrospective study of adult patients presenting to hospitals part of an integrated health system in Des Moines, Iowa, between July 30 and September 30, 2019, and who had a SFA ordered and collected in the Emergency Department (ED) or an inpatient service. The appropriateness of SFA testing was determined according to adherence to a local algorithm available through the hospital’s intranet (Figure 1). Reason for testing, appropriateness of SFA test, molecular targets identified, and antibiotic exposures were collected. Results We identified 257 patients, 111 (43.2%) who had SFA done in the ED and 146 (56.8%) as inpatients. Testing was deemed inappropriate in 46 (41.4%) of ED patients compared to 100 (68.5%) of inpatients (p< 0.0001). Documented indications for SFA are presented in Table 1. Among ED patients testing was most frequently considered inappropriate due to absence of diarrhea on the day of test collection (41.3%), and among inpatients due to the use of SFA for assessment of hospital-onset diarrhea (47.0%) (Table 2). Overall, there were 94 (36.6%) positive SFA (Figure 2). Among ED patients, the percentage of positive SFA samples was 30.4% and 50.8% for inappropriate and appropriate testing respectively (p=0.03), while for inpatients it was 33.0% for inappropriate orders and 30.4% for appropriate orders (p=0.76). Antibiotics were prescribed to 28.2% and 28.1% of patients tested in the ED and inpatient service respectively. Conclusion High proportions of inappropriate SFA testing were identified both in the ED and inpatient services, with distinct issues in each site. Characterization of the reasons underlying inappropriate use of SFA can aid in the design of diagnostic stewardship interventions tailored to each clinical setting. Disclosures All Authors: No reported disclosures