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PubMed1986

[The mobile child and adolescent psychiatric service: an effective treatment model in rural areas].

A mobile unit for child and adolescent psychiatry is described that serves two counties with a combined population of 400 000. In both counties the unit is the third most frequently used outpatient service, providing 21% of all outpatient care in child and adolescent psychiatry in Marburg-Biedenkopf and 40% in Waldeck-Frankenberg. After the outpatient clinics this unit serves the largest number of patients from the lower social classes, in the case of psychotherapy the majority (54.1%). This unit also makes the largest number of home visits. On the whole, the mobile unit can be considered an effective means of providing mental health services in rural areas.

Adolescent↗

PubMed1997

The Italian model for long-term care.

During the past decade in Italy, delivery of long-term care has undergone many changes, with introduction of the nursing homes as the central force. High-quality residential and outpatient services have become available in new community-oriented services. Among the benefits are reduction of inappropriate admissions, improved quality of life for residents and outpatients, decreased dependence on private resources, growth of voluntary services, and creation of new occupational opportunities.

Aged↗

PubMed1995

General practitioners' requirements from a hospital cardiology department.

The requirements of 500 general practitioners from a hospital department of cardiology were sought and assessed from a questionnaire. One hundred and twenty two general practitioners caring for 766,384 patients responded. The most important inpatient service requirement was that cardiologists should be responsible for the management of patients with acute myocardial infarction and other acute cardiac conditions. The expertise and reputation of the consultant cardiologist and the waiting time for an appointment were the two most important outpatient service requirements. The least important aspect was the time patients waited in clinic to see a doctor. Fundholders considered price of outpatient consultations to be unimportant. Waiting times for cardiac catheterisation and non-invasive cardiac investigations together with the quality of the investigation equipment and the technical staff were all considered to be important requirements. Most general practitioners wanted protocols for managing common cardiac conditions. The majority wanted an open access investigation service to reduce outpatient waiting times. Those who did not want an open access service explained that they would not be confident in interpreting the results or deciding subsequent management. An understanding of the requirements of general practitioners is helpful in planning and developing hospital services.

Ambulatory Care↗

PubMed1996

Resource utilization and stage of illness: a study of an outpatient AIDS clinic.

Since the early 1990s, the trend in AIDS patient care has been to increase utilization of outpatient services, resulting in less frequent aggressive and lengthy hospital stays. This study retrospectively analyzes financial and sociodemographic data of 240 HIV/AIDS patients in a large, infectious disease program in Atlanta, GA. The results indicated the total cost of care per year for AIDS patients (alive or recently deceased) was $24,108 per year. Approximately 58% of this cost was attributable to inpatient care, 34% to outpatient care, and 8% to physician services. African-American race and IV drug use were negatively related to outpatient costs during the healthiest stage of illness. These demographics gave no prediction to the amount of cost consumed during clinical AIDS. On the other hand, males and patients on Medicaid were positive predictors of inpatient services, while homosexual patients were associated with fewer inpatient services. This study complements other projects, yet some questions remain unanswered. For example, does the seemingly low cost of care negatively impinge upon the overall care of the patient? This and further questions will have to be addressed in future studies.

Acquired Immunodeficiency Syndrome↗

PubMed1986

Personnel requirements for an outpatient chemotherapy admixture service.

Chemotherapy preparation times and personnel requirements for an outpatient chemotherapy admixture service (CAS) were determined in this study. CAS activities and time measurement endpoints were identified by process analysis. Direct time studies were performed over a 2-month period on approximately 400 variable (chemotherapy admixture) activities and on their related fixed (auxiliary) activities. Variable activities were divided into four distinct categories based upon the original formulation of the antineoplastic agent and its complexity of admixture. All CAS activities were performed by a pharmacy technician under the supervision of a pharmacist. Mean preparation times for the different categories of variable and fixed activities were determined. Variable, fixed, and estimated nonproductive time were combined with 8 months retrospective output data to determine total weakly CAS service hours and personnel requirements. Variable activity time varied widely among the four categories of admixtures and had an aggregate mean time of 9.7 minutes per admixture. Variable and fixed activity time comprised 13.5 and 4.5 mean weekly service hours, respectively. Total weekly service time was 18 hours or 0.48 full-time equivalents. These results on elemental times and personnel requirements are similar to those obtained in previous studies.

Ambulatory Care↗

PubMed1996

Rural psychiatric services.

OBJECTIVE: The objective was to describe and evaluate a community mental health service developed during 1991-1992 in an attempt to meet the mental illness needs of an isolated rural community. The setting was the Grampians health region in Western Victoria: this region has an area of 45,000 square kilometers and a population of 182,000. METHOD: The method involved firstly describing the evolution of the service delivery model. This comprised a team of travelling psychiatrists and community psychiatric nurses which succeeded in providing a combined inpatient and outpatient service which was integrated with general practitioners. Secondly, diagnostic and case load descriptions of patients receiving service were compared for both the inpatient and outpatient settings. RESULTS: The results were that reduced reliance on inpatient beds and increased consumer satisfaction were achieved. CONCLUSION: It was concluded that on initial evaluation of the service it was seen to be meeting its objective of treating the seriously mentally ill in an isolated rural community-based setting.

Adolescent↗

PubMed1987

Survey of outpatient diet counselling services in British Columbia hospitals.

A fall 1985 mail survey of British Columbia (B.C.) hospitals offering outpatient diet counselling services documented a diversity of policies and procedures regarding both structural factors (i.e. personnel and facilities) and generic factors (i.e. referrals accepted and services provided). Results indicate a need to address many issues in outpatient dietetics in B.C. with a view to implementing changes and an ongoing program of evaluation, to ensure cost-effectiveness. Implications inferred from these results may be of value to dietitians elsewhere in Canada faced with the challenges of increasing competition for scarce health care resources.

Ambulatory Care↗

PubMed2006

Differences in access to outpatient medical care for black and white adults in the rural South.

OBJECTIVES: We compared black and white adults in the rural South on multiple indicators of access to outpatient medical care and assessed whether any differences might be explained by group differences in socioeconomic situations or proximity to medical resources. DESIGN: Cross-sectional telephone survey. SUBJECTS: Survey respondents were 1237 black and 2158 white adults from 113 rural counties in 6 southern states. MEASURES: Blacks and whites were compared on a variety of commonly used survey measures of access, some followed in the Healthy People 2010 Initiative. Access comparisons were adjusted for age, gender, and health status and then reassessed with adjustments for individual socioeconomic indicators and county medical resources: physician-to-population ratios, the presence of hospitals and federally qualified health centers, and urban adjacency. RESULTS: Compared with whites, blacks reported similar or higher use of outpatient services over the previous year, including the likelihood of having had an outpatient physician visit and regular checkup. Nevertheless, blacks more often reported forgoing needed care, encountering various barriers, and experiencing dissatisfaction with some aspects of care. Adjusting for socioeconomic factors generally reduced but did not eliminate black-white access differences, whereas adjusting for county medical care resources did not affect measured group differences. CONCLUSIONS: Blacks and whites in the rural South report similar use rates of outpatient medical care, but blacks more often report unmet needs, barriers to care, and dissatisfaction with care. Beyond socioeconomic differences, black versus white differences in sites of care, the quality of care received, the quality of interactions with providers, and expectations for their care may explain group reported access differences.

Adolescent↗

PubMed1990

The cost of acquired immunodeficiency syndrome in northern California. The experience of a large prepaid health plan.

We studied the cost of acquired immunodeficiency syndrome (AIDS) in the Kaiser Permanente Medical Care Program (KPMCP), northern California region. We report the costs of care to the KPMCP and introduce an innovative application of survival methods to cost analysis. From the beginning of the AIDS epidemic in 1981 to the end of June 1987, 866 cases of AIDS were recorded among members of the KPMCP. Estimates of the costs of care of these patients were derived from comprehensive chart reviews of a random sample of 71 patients whose conditions were diagnosed from January 1984 through June 1987. Total mean lifetime costs per patient were $32,816 (median, $28,677), whereas the mean hospital per diem cost was $20,446 per patient. As more care was shifted to outpatient services overtime, overall costs dropped, despite marked increases in the cost of outpatient medications such as zidovudine. The overall estimate of cost compared closely with other estimates of the cost of care in San Francisco, Calif, and it is lower than estimates from elsewhere in the United States, probably because of the low proportion of cases associated with intravenous drug use and the well-developed social support networks available to patients with AIDS in the San Francisco Bay Area.

Acquired Immunodeficiency Syndrome↗

PubMed1991

Community care in child psychiatry. An empirical approach using the concept of travel time.

Community care is a crucial element in the organization and development of psychiatric services. The basic idea of community care is that it guarantees equal access to services for all people in need. In this study an empirical approach to community care is undertaken using the concept of travel time. The importance of distance to the use or nonuse of mental health services has been documented for a long time. But if distance is measured by travel time, additional elements, as for example the available transport system are considered relevant for the accessibility of services. It can be shown that most patients of two child psychiatric outpatient services do not accept a travel time exceeding half an hour. Outreach activities of services located in rural areas can partly compensate for the geographic disadvantage of those patients living at long distance to the service.

Adolescent↗

PubMed1984

[Development and function of the psychiatric crisis and emergency service in Mannheim].

The setting up of a psychiatric emergency and crisis service during the years 1974 to 1980 in Mannheim forms part of the evolvement of a central psychiatric overall care programme with emphasis on patients residing in the same region, that is to say, close to the psychiatric facilities; within this framework, the role played by the emergency service is preferably of an auxiliary and additional nature, over and above the already existing regular care facilities. Since the emergency and crisis service forms a part of a regular psychiatric care network, its principal functions are: 1. First diagnosis and, in connection therewith, the decision whether 2. acute intervention in an existing crisis should be effected within the emergency service, or 3. whether further treatment must be instituted with a psychiatric or internistic or social partner of the emergency service. The emergency service has to look after an increasing proportion of patients with severe mental disturbances who are seen by the emergency service in moments of extreme crisis (high rate of attempted suicides) or in acute severe relapses, and who are normally also looked after by the regular psychiatric services. Over and above, the emergency service has to look after a special small group of patients not covered by any other psychiatric service on account of their social disorganisation , frequently also because they are addicts. As should be expected, there is an almost continuous drop in the referral to the psychiatric service, the farther away the patients live from the seat of the emergency service. This, however, applies in a very similar manner to the regular outpatient services and also to the entire psychiatric care available to the residents of Mannheim.

Alcoholism↗

PubMed2004

Effectiveness of atypical antipsychotic medications in reducing violent behavior among persons with schizophrenia in community-based treatment.

This study prospectively compared the effectiveness of atypical antipsychotic medications to that of conventional neuroleptics in reducing violent behavior among patients with schizophrenia under "usual care" conditions in the community. Participants (n = 229) were adults with schizophrenia spectrum disorders receiving inpatient or outpatient services in public sector mental health systems in North Carolina. Subjects were followed for 2 years in an observational study using multiple methods of data collection at 6-month intervals to assess treatment, sociodemographic characteristics, clinical features, and violence outcomes. Treatment with atypical antipsychotic medications (clozapine, risperidone, or olanzapine) was found to significantly reduce the risk of violent behavior, whereas treatment with conventional neuroleptics did not have this same beneficial effect. A cumulative effect on reduced violence was attributable to consistent compliance with atypical antipsychotic medications over a 2-year period. Concurrent reductions in psychotic symptoms, substance abuse, and adverse medication side effects were found to mediate the association between adherence with atypicals and lower violence risk. Treatment with atypical antipsychotic medications should be considered as an important component of violence risk management for schizophrenia patients at risk for violent behavior.

Adolescent↗

PubMed2003

Emergency nurse practitioners: a three part study in clinical and cost effectiveness.

AIMS: To compare the clinical effectiveness and costs of minor injury services provided by nurse practitioners with minor injury care provided by an accident and emergency (A&E) department. METHODS: A three part prospective study in a city where an A&E department was closing and being replaced by a nurse led minor injury unit (MIU). The first part of the study took a sample of patients attending the A&E department. The second part of the study was a sample of patients from a nurse led MIU that had replaced the A&E department. In each of these samples the clinical effectiveness was judged by comparing the "gold standard" of a research assessment with the clinical assessment. Primary outcome measures were the number of errors in clinical assessment, treatment, and disposal. The third part of the study used routine data whose collection had been prospectively configured to assess the costs and cost consequences of both models of care. RESULTS: The minor injury unit produced a safe service where the total package of care was equal to or in some cases better than the A&E care. Significant process errors were made in 191 of 1447 (13.2%) patients treated by medical staff in the A&E department and 126 of 1313 (9.6%) of patients treated by nurse practitioners in the MIU. Very significant errors were rare (one error). Waiting times were much better at the MIU (mean MIU 19 minutes, A&E department 56.4 minutes). The revenue costs were greater in the MIU (MIU pound 41.1, A&E department pound 40.01) and there was a great difference in the rates of follow up and with the nurses referring 47% of patients for follow up and the A&E department referring only 27%. Thus the costs and cost consequences were greater for MIU care compared with A&E care (MIU pound 12.7 per minor injury case, A&E department pound 9.66 per minor injury case). CONCLUSION: A nurse practitioner minor injury service can provide a safe and effective service for the treatment of minor injury. However, the costs of such a service are greater and there seems to be an increased use of outpatient services.

Adolescent↗

PubMed1996

English language ability and mental health service utilisation: a census.

OBJECTIVE: To explore the relationship between English language proficiency and mental health service utilisation. METHODS: In September 1993, a sample census was conducted of all mental health services in the State of Victoria, including public and private hospital wards, outpatient consultations provided by psychiatrists and clinical psychologists, and primary mental health care provided by general practitioners. Response rates ranged from 37% for monolingual general practitioners (GPs) to 96% for inpatient units. Particular emphasis was placed on patients' English language proficiency and the role played by bilingual clinicians. RESULTS: Over 80% of inpatients received a diagnosis of either dementia or psychosis. This proportion was even greater in the case of patients with English language difficulties. The latter group of patients underutilised specialist outpatient services, and those using these services were less likely to receive psychotherapy than fluent English speakers. They utilised GPs for mental disorder at at least the same rate as other patients. There was a marked preference for bilingual GPs, with 80% of patients with poor English language skills consulting GPs who spoke their native language. CONCLUSION: There appears to be considerable underutilisation of specialist mental health services by patients who are not fluent in English. The liaison-consultation model of psychiatric care may be an effective way of addressing this problem, given the important role already played by billingual GPs in the psychiatric care of those whose native language is not English.

Adolescent↗

PubMed2001

Medicare program; changes to the hospital outpatient prospective payment system for calendar year 2002. Final rule.

This final rule revises the Medicare hospital outpatient prospective payment system to implement applicable statutory requirements, including relevant provisions of the Medicare, Medicaid,and SCHIP Benefits Improvement and Protection Act of 2000, and changes arising from our continuing experience with this system. In addition, it describes changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the prospective payment system. This final rule also announces a uniform reduction of 68.9 percent to be applied to each of the transitional pass-through payments.These changes are applicable to services furnished on or after January 1, 2002.

Centers for Medicare and Medicaid Services, U.S.↗

PubMed1987

An acute inpatient geriatric assessment and treatment unit.

The inpatient geriatric assessment unit (GAU) is an important component of the Geriatric Assessment and Treatment Centre (GATC) at the Royal Jubilee Hospital in Victoria, British Columbia. The Centre attempts to accomplish the following: to provide, at the request of the attending physician, diagnostic, treatment, and management services where it best suits the patient (ie, at home, in the outpatient service, or following admission to the ward); and to provide, if necessary, follow-up service after discharge to help prevent readmission to the acute hospital or any part of the geriatric service.

Aged↗

PubMed1988

ASHP national survey of hospital pharmaceutical services--1987.

The results of a fall 1987 national mail survey of pharmaceutical services in short-term hospitals are reported and compared with similar surveys conducted in 1975, 1978, 1982, and 1985. A sample of 875 hospitals was selected randomly from among the estimated 5600 U.S. short-term hospitals that employ a pharmacist on at least a part-time basis. The survey had a 71.1% response rate (617 usable replies). Nearly three-fourths of the respondents had complete unit dose drug distribution services (UDD), 68% reported complete i.v. admixture services (IVA), and 57% reported both complete UDD and complete IVA. Nearly 5% of respondents offered five specified clinical services (up from 1.8% in 1985); 24% reported having no clinical services (versus 38% in 1985). Nineteen percent said their departments had one or more clinical specialists. Overall, about one-third of pharmacy technicians had completed formal training. The number of respondents with programs to contain drug costs increased about 10% since 1985. Weekly hours of pharmacy operation averaged 102; 36.7% of respondents had pharmacy service around the clock. The percentage of hospitals with computerized drug distribution systems increased from 32% in 1985 to 52% in 1987. Prime vendors were used by 94.6% of respondents, and only 2% reported that they did not use a purchasing group. National expenditures for drugs and fluids for community hospitals were projected at $4.7 billion, personnel costs at $1.8 billion, and other pharmacy expenditures at $0.4 billion. The projected numbers of open positions nationally for pharmacists in community hospitals was 1950. The survey also collected data on the use of personal computers, inventory turnover, quality assurance, continuing-education philosophy, revenue-generating programs, and outpatient services. Drug control in community hospitals is improving, and clinical services are more widespread. Twenty percent of respondents had comprehensive pharmaceutical services, defined as complete UDD and complete IVA plus three or more clinical services.

Computers↗

PubMed1996

Preparing for the new outpatient reimbursement system.

The Health Care Financing Administration is expected to soon introduce a prospective payment method for reimbursement of hospital-based outpatient services provided to Medicare recipients. This payment system most likely will make use of an outpatient classification system based on ambulatory patient groups (APGs). Although the details of the new ambulatory payment system have not yet been finalized, healthcare facilities should start planning for implementation.

Ambulatory Care↗