nach oben

Social Psychiatry and Psychiatric Epidemiology

Erschienen in:

19.02.2016 | Original Paper

Examining the need profiles of patients with multiple emergency department visits for mental health reasons: a cross-sectional study

verfasst von: Frank Sirotich, Anna Durbin, Janet Durbin

Erschienen in: Social Psychiatry and Psychiatric Epidemiology | Ausgabe 5/2016

Einloggen, um Zugang zu erhalten

Abstract

Objectives

Study objectives were to: (1) provide an estimate of the prevalence of repeat emergency department (ED) use for mental health reasons among individuals enrolled in intensive case management programs; and (2) to identify socio-demographic, diagnostic, and service need characteristics associated with repeat ED visits among this service population.

Methods

The study utilized administrative health data from community mental health organizations in Toronto, Canada on a sample of 2274 individuals enrolled in intensive case management programs. Patients with 2+ ED visits for mental health reasons within the prior 6 months were compared with individuals who had no ED visits or one visit on the basis of demographic, diagnostic and service need characteristics.

Results

Approximately 6 % of intensive case management clients had two or more ED visits over a 6-month period. Membership in the repeat ED user group was associated with younger age (OR 0.98), a mood disorder (OR 1.58), being in service less than 1 year (OR 1.94) and unmet needs related to psychotic symptoms (OR 2.19), substance use (OR 2.27), and safety to self/others (OR 3.42).

Conclusions

The repeat ED user group within case management may have distinct need profiles that require different treatment responses. Moreover, clinical needs rather than psychosocial needs have the greatest relationship with repeat psychiatric ED utilization. These unmet needs suggest areas for future interventions aimed at reducing the use of ED services for mental health reasons and improving care for patients who repeatedly present at the ED.

Sun BC, Burstin HR, Brennan TA (2003) Predictors and outcomes of frequent emergency department users. Acad Emerg Med 10(4):320–328. doi:10.1111/j.1553-2712.2003.tb01344.x PubMedCrossRef

Wooden MD, Air TM, Schrader GD, Wieland B, Goldney RD (2009) Frequent attenders with mental disorders at a general hospital emergency department. Emerg Med Aust 21(3):191–195. doi:10.1111/j.1742-6723.2009.01181.x CrossRef

Chaput YV, Lebel MJ (2007) Demographic and clinical profiles of patients who make multiple visits to psychiatric emergency services. Psychiatr Serv 58(3):335–341. doi:10.1176/ps.2007.58.3.335 PubMedCrossRef

LaCalle E, Rabin E (2010) Frequent users of emergency departments: the myths, the data and the policy implications. Ann Emerg Med 56(1):42–48. doi:10.1016/j.annemergmed.2010.01.032 PubMedCrossRef

Blanks FS, Li H, Hennenman PL, Smithline HA, Santoro JS, Provost D, Maynard AM (2005) A descriptive study of heavy emergency department users at an academic emergency department reveals heavy ED users have better access to care than average users. J Emerg Nurs 31(2):139–144. doi:10.1016/j.jen.2005.02.008 CrossRef

Riggs JE, Davis SM, Hobbs GR, Paulson DJ, Chinnis AS, Heilman PL (2003) Association between early returns and frequent ED visits at a rural academic medical center. Am J Emerg Med 21(1):30–31. doi:10.1053/ajem.2003.50017 PubMedCrossRef

Cook LJ, Knight S, Junkins EP Jr, Mann NC, Dean JM, Olson LM (2004) Repeat patients to the emergency department in a statewide database. Acad Emerg Med 11(3):256–263. doi:10.1111/j.1553-2712.2004.tb02206.x PubMedCrossRef

Hunt KA, Weber EJ, Showstack JA, Colby DC, Callaham ML (2006) Characteristics of frequent users of emergency departments. Ann Emerg Med 48(1):1–8. doi:10.1016/j.annemergmed.2005.12.030 PubMedCrossRef

Vandyk AD, Harrison MB, VanDenLerkhof EG, Graham ID, Ross-White A (2013) Frequent emergency department use by individuals seeking mental healthcare: a systematic search and review. Arch Psychiatr Nurs 27(4):171–178. doi:10.1016/j.apnu.2013.03.001 PubMedCrossRef

10.

Mehl-Madrona LE (2008) Prevalence of psychiatric diagnoses among frequent users of rural emergency medical services. Can J Rural Med 13(4):22–30PubMed

11.

Williams ER, Guthrie E, Mackway-Jones K, James M, Tomenson B, Eastham J, McNally D (2001) Psychiatric status, somatisation, and health care utilization of frequent attenders at the emergency department: a comparison with routine attenders. J Psychosom Res 50(3):161–167. doi:10.1016/S0022-3999(00)00228-2 PubMedCrossRef

12.

Curran GM, Sullivan G, Williams K, Hans X, Collins K, Key J, Kotria KJ (2003) Emergency department use of persons with comorbid psychiatric and substance abuse disorders. Ann Emerg Med 41(5):659–667. doi:10.1067/mem.2003.154 PubMedCrossRef

13.

Oven HJ, Chan BT (2001) Heavy users of emergency services: a population-based review. Can Med Assoc J 165(8):1049–1050

14.

Markham D, Graudin A (2011) Characteristics of frequent emergency department presenters to an Australian emergency medicine network. BMC Emerg Med 11:21–26. doi:10.1186/1471-227X-11-21 PubMedPubMedCentralCrossRef

15.

Mandelberg JH, Kuhn RE, Kohn MA (2000) Epidemiologic analysis of an urban, public emergency department’s frequent users. Acad Emerg Med 7(6):637–646. doi:10.1111/j.1553-2712.2000.tb02037.x PubMedCrossRef

16.

Aagaard J, Aagaard A, Buus N (2014) Predictors of frequent visits to a psychiatric emergency room: a large-scale register study combined with a small-scale interview study. Int J Nurs Stud 51(7):1003–1013. doi:10.1016/j.ijnurstu.2013.11.002 PubMedCrossRef

17.

Ledoux Y, Minner P (2006) Occasional and frequent repeaters in a psychiatric emergency room. Soc Psychiatry Psychiatric Epidemiol 41(2):115–121. doi:10.1007/s00127-005-0010-6 CrossRef

18.

Chaput YJ, Lebel MJ (2007) An examination of the temporal and geographical patterns of psychiatric emergency service use by multiple visit patients as a means for their early detection. BMC Psychiatry 7:60. doi:10.1186/1471-244X-7-60 PubMedPubMedCentralCrossRef

19.

Bruffaerts R, Sabbe M, Demyttenaere K (2006) Who visits the psychiatric emergency room for the first time? Soc Psychiatry Psychiatr Epidemiol 41(7):580–586. doi:10.1007/s00127-006-0062-2 PubMedCrossRef

20.

Dhossche DM, Ghani SO (1998) A study on recidivism in the psychiatric emergency room. Ann Clin Psychiatry 10(2):59–67. doi:10.3109/10401239809147744 PubMedCrossRef

21.

Arfken CL, Zeman LL, Yeager L, White A, Mischel E, Amirsadri A (2004) Case-control study of frequent visitors to an urban psychiatric emergency service. Psychiatr Serv 55(3):295–301. doi:10.1176/appi.ps.55.3.295 PubMedCrossRef

22.

Pasic J, Russo J, Roy-Byrne P (2005) High utilizers of psychiatric emergency services. Psychiatr Serv 56(6):678–684. doi:10.1176/appi.ps.56.6.678 PubMedCrossRef

23.

Saarento O, Hakko H, Joukamaa M (1998) Repeated use of psychiatric emergency out-patient services among new patients: a 3-year follow-up study. Acta Psychiatr Scand 98(4):276–282. doi:10.1111/j.1600-0447.1998.tb10084.x PubMedCrossRef

24.

Perez E, Minoletti A, Blouin J, Blouin A (1986) Repeated users of a psychiatric emergency service in a Canadian general hospital. Psychiatr Q 58(3):189–201. doi:10.1007/BF01064733 PubMedCrossRef

25.

Ellison JM, Blum N, Barsky AJ (1989) Frequent repeaters in a psychiatric emergency service. Hosp Comm Psychiatry 44(4):372–375. doi:10.1176/ps.40.9.958

26.

Althaus F, Paroz S, Hugll O, Ghall WA, Daeppen JB, Peytremann-Bridevaux I, Bodenmann P (2011) Effectiveness of interventions targeting frequent users of emergency departments: a systematic review. Ann Emerg Med 58(1):41–52. doi:10.1016/j.annemergmed.2011.03.007 PubMedCrossRef

27.

Curtis J, Millman E, Struening E, D’Ercore A (1992) Effects of case management on rehospitalization and utilization of ambulatory care services. Hosp Community Psychiatr 43(9):895–908

28.

Craig TJ, Bracken J (1995) A case-control study of rapid readmission in a state hospital population. Ann Clin Psychiatry 7(2):79–85. doi:10.3109/10401239509149031 PubMedCrossRef

29.

Phillips GA, Brphy DS, Weiland TJ, Chenhall AJ, Dent AW (2006) The effect of multidisciplinary case management on selected outcomes for frequent attenders at an emergency department. Med J Aust 184(12):602–606PubMed

30.

Ontario Ministry of Health and Long-Term Care (2005) Intensive case management services standards for mental health services and supports. Queen’s Printer for Ontario. http://health.gov.on.ca/en/common/ministry/publications/reports/mentalhealth/intens_cm.pdf. Accessed 25 May 2015

31.

Ontario Ministry of Health and Long-Term Care (2004) Community Mental Health—Common Data Set—Mental Health (CDS-MH) Version 2. Toronto: Information Management Unit, Finance and Information Management Branch, Ministry of Health and Long-Term Care

32.

Community Care Information Management (2010) Ontario common assessment of need (OCAN): OCAN user guide 2.0. https://www.ccim.on.ca/CMHA/OCAN/Private/Document/Education%20and%20Training%20v2.0/OCAN%202%20Day%20Training%20Materials/OCAN%202%20Day%20Training%20-%20User%20Binder/Tab%201%20-%20OCAN%20User%20Guide.pdf. Accessed 25 May 2015

33.

IBM Corp. (2013) IBM SPSS Statistics for Windows, Version 22.0. IBM Corp, Armonk

34.

Wennström E, Wiesel FA (2006) The Camberwell assessment of need as an outcome measure in routine mental health care. Soc Psychiatry Psychiatr Epidemiol 41(9):728–733. doi:10.1007/s00127-006-0084-9 PubMedCrossRef

35.

Community Care Information Management and Ontario Common Assessment of Need (OCAN): Community mental health common assessment project: Full OCAN 2.0 Revision 2.0.5. https://www.ccim.on.ca/CMHA/OCAN/Private/Document/Assessment%20Tool%20v2.0/OCAN_2.0/OCAN_2.0_FULL_v2.0.5i.pdf. Accessed 25 May 2015

36.

Doupe MB, Palatnick W, Day S, Chateau D, Soodeen RA, Burchill C, Derksen S (2012) Frequent users of emergency departments: developing standard definitions and defining prominent risk factors. Ann Emerg Med 60(1):24–32. doi:10.1016/j.annemergmed.2011.11.036 PubMedCrossRef

37.

National Collaborating Centre for Mental Health (2014) Psychosis and schizophrenia in adults: treatment and management. National Institute for Health and Care Excellence, London. http://www.guideline.gov/content.aspx?id=47863. Accessed 25 May 2015

38.

Malik N, Kingdon D, Pelton J, Mehta R, Turkington D (2009) Effectiveness of brief cognitive-behavioral therapy for schizophrenia delivered by mental health nurses: relapse and recovery at 24 months. J Clin Psychiatry 70(2):201–207. doi:10.4088/JCP.07m03990 PubMedCrossRef

39.

Rathod S, Turkington D (2005) Cognitive-behaviour therapy for schizophrenia: a review. Curr Opin Psychiatry 18(2):159–163. doi:10.1097/00001504-200503000-00009 PubMedCrossRef

40.

Turkington D, Munetz M, Pelton J, Monesano V, Sivec HJ, Nausheen B, Kingdon D (2014) High-yield cognitive behavioral techniques for psychosis delivered by case managers to their clients with persistent psychotic symptoms: an exploratory trial. J Nerv Ment Dis 202(1):30–34. doi:10.1097/NMD.0000000000000070 PubMedCrossRef

41.

Jung XT, Newton R (2009) Cochrane reviews of non-medication-based psychotherapeutic and other interventions for schizophrenia, psychosis, and bipolar disorder: a systematic literature review. Int J Ment Health Nurs 18(4):239–249. doi:10.1111/j.1447-0349.2009.00613.x PubMedCrossRef

42.

Burns T, Catty J, Dash M, Roberts C, Lockwood A, Marshall M (2007) Use of intensive case management to reduce time in hospital in people with severe mental illness: systematic review and meta-regression. BMJ 335(7615):336–340. doi:10.1136/bmj.39251.599259.55 PubMedPubMedCentralCrossRef

43.

Drukker M, Maarschalkerweerd M, Bak M, Driessen G, a Campo J, de Bie A, Poddighe G, van Os J, Delespaul P (2008) A real-life observational study of the effectiveness of FACT in a Dutch mental health region. BMC Psychiatry 8:93. doi:10.1186/1471-244X-8-93 PubMedPubMedCentralCrossRef

44.

Horsfall J, Cleary M, Hunt GE, Walter G (2009) Psychosocial treatments for people with co-occuring severe mental illnesses and substance user disorders (dual diagnosis): a review of empirical evidence. Harv Rev Psychiatry 17(1):24–34. doi:10.1080/10673220902724599 PubMedCrossRef

45.

Sinclair JH, Gray A, Rivero-Arias O, Saunders KE, Hoawton K (2011) Healthcare and social services resource use and costs of self-harm patients. Soc Psychiatry Psychiatr Epidemiol 46(4):263–271. doi:10.1007/s00127-010-0183-5 PubMedCrossRef

46.

Larkin C, Blasi Z, Arensman E (2014) Risk factors for repetition of self-harm: a systematic review of prospective hospital-based studies. PLoS One 9(1):e84282. doi:10.1371/journal.pone.0084282 PubMedPubMedCentralCrossRef

47.

Kliem S, Kröger C, Kosfelder J (2010) Dialectical behavior therapy for borderline personality disorder: a meta-analysis using mixed effects modelling. J Consult Clin Psychol 78(6):936–951. doi:10.1037/a0021015 PubMedCrossRef

48.

Stoffers JM, Vollm BA, Rucker G, Timmer A, Husband N, Lieb K (2012) Psychological therapies for people with borderline personality disorder. Cochrane Database Syst Rev 8:CD005652PubMed

49.

Linehan MM, Korslund KE, Harned MS, Gallop RJ, Lungu A, Neacsiu AD, McDavid J, Comtois KA, Murray-Gregory AM (2015) Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: a randomized clinical trial and component analysis. JAMA Psychiatry 72(5):475–482. doi:10.1001/jamapsychiatry.2014.3039 PubMedCrossRef

Titel: Examining the need profiles of patients with multiple emergency department visits for mental health reasons: a cross-sectional study
verfasst von: Frank Sirotich
Anna Durbin
Janet Durbin
Publikationsdatum: 19.02.2016
Verlag: Springer Berlin Heidelberg
Erschienen in: Social Psychiatry and Psychiatric Epidemiology / Ausgabe 5/2016
Print ISSN: 0933-7954
Elektronische ISSN: 1433-9285
DOI: https://doi.org/10.1007/s00127-016-1188-5

Neu im Fachgebiet Psychiatrie

Demenzkranke durch Antipsychotika vielfach gefährdet

23.04.2024 Demenz Nachrichten

Wenn Demenzkranke aufgrund von Symptomen wie Agitation oder Aggressivität mit Antipsychotika behandelt werden, sind damit offenbar noch mehr Risiken verbunden als bislang angenommen.

Weniger postpartale Depressionen nach Esketamin-Einmalgabe

23.04.2024 Depression antepartal oder postpartal Nachrichten

Bislang gibt es kein Medikament zur Prävention von Wochenbettdepressionen. Das Injektionsanästhetikum Esketamin könnte womöglich diese Lücke füllen.

„Psychotherapie ist auch bei sehr alten Menschen hochwirksam!“

22.04.2024 DGIM 2024 Kongressbericht

Die Kombination aus Medikamenten und Psychotherapie gilt als effektivster Ansatz bei Depressionen. Das ist bei betagten Menschen nicht anders, trotz Besonderheiten.

Auf diese Krankheiten bei Geflüchteten sollten Sie vorbereitet sein

22.04.2024 DGIM 2024 Nachrichten

Um Menschen nach der Flucht aus einem Krisengebiet bestmöglich medizinisch betreuen zu können, ist es gut zu wissen, welche Erkrankungen im jeweiligen Herkunftsland häufig sind. Dabei hilft eine Internetseite der CDC (Centers for Disease Control and Prevention).

Update Psychiatrie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Objectives

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 5/2016

The relationship between genetic and environmental influences on resilience and on common internalizing and externalizing psychiatric disorders

Mental illness, problem behaviour, needs and service use in adults with intellectual disability

Early-life predictors of resilience and related outcomes up to 66 years later in the 6-day sample of the 1947 Scottish mental survey

Perceived ethnic discrimination and depressive symptoms: the buffering effects of ethnic identity, religion and ethnic social network

An examination of the long-term impact of job strain on mental health and wellbeing over a 12-year period

Information giving challenges and support strategies at the time of a mental health diagnosis: qualitative views from Australian health professionals