PubMed · 10103668
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M Carew-McColl, E Buckles. 1990-01-04. A workload shared.. https://pubmed.ncbi.nlm.nih.gov/10103668/
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UNLABELLED: A series of articles reviews the problem of patients with high utilization of health care. Many of these patients display somatization behaviour, presenting with physical symptoms unaccounted for by any demonstrable medical condition. High utilizers often get insufficient help from doctors and other health care providers, who are not trained to understand and manage the underlying psychosocial problems. The same problem occurs in different settings of health care, such as: Primary care: Seven out of ten high utilizers of primary care have no physical disease; they attend primarily for somatic symptoms, although there is a predominance of psycho-social problems. Emergency room care: High utilizers of emergency room care are characterized by insufficient social support, often in combination with substance abuse. Physical symptoms are often perceived as life-threatening, even though there is no known underlying disease. Non-psychiatric hospital care: There is a six fold increase in high utilization of non-psychiatric hospital care among patients with a somatoform diagnosis. MEDICATION: Patients treated with anti-depressants--implying depressive disorder--have a two or three fold increased utilization of non-psychopharmacological drugs, of primary care and of non-psychiatric hospital care as compared to those with no treatment for depression.
Efficacy of reperfusion therapy in acute myocardial infarction (AMI) is strictly time-dependent. Most benefit is achieved with initiation of therapy within the first 60-90 min after onset of symptoms. The majority of patients with AMIs are seen within this time window by emergency medical services. Moreover, average time gain of about 60 min is possible by prehospital thrombolysis. Randomized studies yielded a better outcome when a time gain of 90 min and more was achieved. Prehospital diagnosis of AMI is reliable. Moreover, out-of-hospital thrombolysis has no additional specific risks nor is it an obstacle for later percutaneous intervention. Consequently, patients seen within the first 60-90 min after onset of symptoms or for whom a time gain of 90 min or more can be expected should receive immediate prehospital thrombolysis.