Patient readmission and support utilization following anterior temporal lobectomy.
The aim of this study was to examine factors precipitating patient readmission, following anterior temporal lobectomy (ATL) for refractory epilepsy. A second aim was to explore the use of hospital outpatient and community support services ('outpatient services') by this patient population. These aims served the more general goal of identifying patients most likely in need of services additional to those routinely provided by our Seizure Surgery Follow-up and Rehabilitation Programme. The medical records of 100 consecutive ATL patients were retrospectively examined for the incidence and diagnoses precipitating acute readmission, and the utilization of additional outpatient services. Twenty-one patients (21%) required readmission post-ATL, totalling 47 readmissions between them. Psychiatric diagnoses were the most prevalent (53%), including anxiety, depression and/or post-ictal psychosis. Epileptological diagnoses were the other main precipitant (28%). Additional outpatient services were predominantly utilized for ongoing psychological support. Of the 21 patients requiring readmission, 10(10%) also needed additional outpatient services. These patients were predominantly female or unemployed, in contrast to male or employed patients who tended to require readmission only. Seventeen patients (17%) were maintained within the community using additional outpatient services only. Characteristics of these patients included disrupted family dynamics, limited social networks, and/or a psychiatric history. These patients were also more frequently beyond the 24-month follow-up period of the programme. A profile of patients most in need of additional support services can be constructed to assist team planning of proactive management strategies for the rehabilitation phase of ATL. (+info)
Mental health care in Cambodia.
An effort is being made in Cambodia to involve grass-roots personnel in the integration of the care of the mentally ill into a broad framework of health services. This undertaking is examined with particular reference to the work of the Transcultural Psychosocial Organization. (+info)
Pathways to care for alcohol use disorders.
BACKGROUND: The aim of the present study was to examine access to care for people with alcohol use disorders. METHOD: An alcohol screening questionnaire was completed by 444 respondents in a community survey. During a designated week, 1009 patients presenting in primary care were assessed by their doctor and 773 of these completed the same questionnaire. Over a six month period 223 people with alcohol use disorders were identified using specialist addiction and psychiatric services, of whom 58 were admitted to hospital. One month prevalence rates of alcohol morbidity were determined for people aged between 16 and 64 years at all five levels in the pathways to care model. RESULTS: Around half the people with alcohol morbidity in the community never consulted their general practitioner and of those who did only half had their problem identified. Case recognition was particularly poor for women, young people and Asians. The main filter to people accessing specialist services came at the point of referral from primary care. This was especially marked for young people and for ethnic minorities. CONCLUSIONS: Strategies are required to improve the identification and treatment of alcohol morbidity in primary care. Deficits in access to specialist services for women, young people and ethnic minorities need to be addressed. (+info)
Assertive community treatment for people with severe mental illness: the effect on hospital use and costs.
OBJECTIVE: To determine the effect of the Program for Assertive Community Treatment (PACT) model on psychiatric inpatient service use in a population of non-emergency psychiatric patients with severe chronic mental illness, and to test for variations in this effect with program staffing levels and patient characteristics such as race and age. DATA SOURCES/STUDY SETTING: Data are taken from a randomized trial of PACT in Charleston, South Carolina for 144 patients recruited from August 1989 through July 1991. STUDY DESIGN: Subjects were randomly assigned either to one of two PACT programs or to usual care at a local mental health center. Effects on hospital use were measured over an 18-month follow-up period via multiple regression analysis. DATA COLLECTION METHODS: Data were obtained from Medicaid claims, chart reviews, subject, case manager, and family interviews; searches of the computerized patient and financial databases of the South Carolina Department of Mental Health and relevant hospitals; and searches of the hard copy and computerized financial databases of the two major local hospitals providing inpatient psychiatric care. PRINCIPAL FINDINGS: PACT participants were about 40 percent less likely to be hospitalized during the follow-up period. The effect was stronger for older patients. Lower PACT client/staff ratios also reduced the risk of hospitalization. No evidence of differential race effects was found. Given some hospital use, PACT did not influence the number of days of use. CONCLUSIONS: Controlling for other covariates, PACT significantly reduces hospitalizations but the size of this effect varies with patient and program characteristics. This study shows that previous results on PACT can be applied to non-emergency patients even when the control condition is an up-to-date CMHC office-based case management program. (+info)
Outcome of long stay psychiatric patients resettled in the community: prospective cohort study.
OBJECTIVE: To examine the outcome of a population of long stay psychiatric patients resettled in the community. DESIGN: Prospective study with 5 year follow up. SETTING: Over 140 residential settings in north London. SUBJECTS: 670 long stay patients from two London hospitals (Friern and Claybury) discharged to the community from 1985 to 1993. MAIN OUTCOME MEASURES: Continuity and quality of residential care, readmission to hospital, mortality, crime, and vagrancy. RESULTS: Of the 523 patients who survived the 5 year follow up period, 469 (89.6%) were living in the community by the end of follow up, 310 (59.2%) in their original community placement. A third (210) of all patients were readmitted at least once. Crime and homelessness presented few problems. Standardised mortality ratios for the group were comparable with those reported for similar populations. CONCLUSIONS: When carefully planned and adequately resourced, community care for long stay psychiatric patients is beneficial to most individuals and has minimal detrimental effects on society. (+info)
Improving staff nutritional practices in community-based group homes: evaluation, training, and management.
We evaluated the effectiveness of a staff training and management package on nutritional practices in two community-based group homes serving adults with developmental disabilities. Food storage, menu development, and meal preparation were trained in a multiple baseline format, followed by supervisor feedback. All staff behaviors increased after training and were maintained for up to 1 year. Biological indices reflected collateral improvements in the health of consumers, and surveys of staff and parents established social validity. (+info)
Quality of care in mental health: the case of schizophrenia.
Scientific evidence supporting the efficacy of a range of treatments for persons with schizophrenia set the stage for the recent development of evidence-based quality-of-care indicators for this disorder. On the heels of these quality indicators, research has found that treatment services for many persons with schizophrenia are inadequate. Because most of these patients receive their care under public auspices (Medicaid, Medicare, and Veterans Affairs), public health policy can exert considerable influence to address these quality-of-care problems. Publicly funded managed care could promote evidence-based care. It also could coordinate specialty and primary care to improve early detection and general medical care for persons with schizophrenia. (+info)
Managed behavioral health care: a Medicaid carve-out for youth.
This DataWatch assesses the impact of a public sector-managed Medicaid mental health carve-out pilot for North Carolina youth. Access to, volume of, and costs of mental health/substance abuse services are reported. We compared a pilot managed care program, with an incentive to shift hospital use and costs to community-based services, with usual fee-for-service Medicaid. Aggregate data from Medicaid claims for youth (from birth to age seventeen) statewide are reported for five years. We found dramatic reductions in use of inpatient care, with a shift to intensive outpatient services, and less growth in mental health costs. These findings demonstrate that public sector-managed care can be viable and more efficient than a fee-for-service model. (+info)