一组农村急诊科精神疾病患者非自愿承诺的远程护理服务和背景观察研究

Telemedicine reports Pub Date : 2020-11-18 eCollection Date: 2020-01-01 DOI:10.1089/tmr.2020.0005
Roseanne Fairchild, Shiaw-Fen Ferng-Kuo, Hicham Rahmouni, Daniel Hardesty
{"title":"一组农村急诊科精神疾病患者非自愿承诺的远程护理服务和背景观察研究","authors":"Roseanne Fairchild,&nbsp;Shiaw-Fen Ferng-Kuo,&nbsp;Hicham Rahmouni,&nbsp;Daniel Hardesty","doi":"10.1089/tmr.2020.0005","DOIUrl":null,"url":null,"abstract":"<p><p><b>Background:</b> Rates for all-cause U.S. emergency department (ED) visits to rural critical access hospitals (CAHs) have increased by 50% since 2005. During the same time period, total number of U.S. hospital admissions for a mental health (MH) crisis has increased by 12.2%, with rural counties demonstrating the largest suicide rate increases overall. <b>Introduction:</b> Increasing number of rural patients are reporting need for MH care in the region's four rural EDs. Characteristics of ED telemental health services were evaluated, including MH diagnostic category, voluntary vs. involuntary commitment (IC), forensic vs. nonforensic presentation, ED throughput, disposition, and payor reimbursement. <b>Materials and Methods:</b> Observational 2.5-year program evaluation of telemental health care delivery for children (<i>n</i> = 114) and adults (<i>n</i> = 417) who were evaluated by a rural ED physician and received an MH diagnosis. Participants (<i>N</i> = 531) were treated by a licensed psychiatrist through telemental care delivery from September 2017 to April 2020. <b>Results:</b> Noncommitted ED MH patients (86%; <i>n</i> = 455) were distributed across three major diagnostic groups: (1) depression, anxiety, or other mental illness (35%); (2) substance abuse (33%); or (3) suicide risk (32%), with 47% admitted inpatients (IPs), 47% referred outpatient (OPs), and 6% admitted to CAH. Fourteen percent (<i>n</i> = 76/531) of ED MH patients were subsequently IC, with 67% of those assessed as needing IP care. Forty-nine percent (<i>n</i> = 37) of IC patients presented in police custody. Most common diagnosis for IC patients was suicidal ideation/attempt (χ<sup>2</sup> [2, <i>N</i> = 452] = 12.884, <i>p</i> = 0.002). Admitted patients experienced significantly longer length of stay than those with OP referral (<i>p</i> = 0.001). Mean total payor reimbursements for ED MH care were significantly lower than actual ED costs (<i>p</i> < 0.001). <b>Discussion:</b> Innovative approaches to telemental care for IC and non-IC patients need to be piloted and comparatively evaluated in rural CAHs. <b>Conclusion:</b> As the gateway to critically needed MH care, rural CAHs and public services pivotal to care access (e.g., law enforcement) need additional resources and support.</p>","PeriodicalId":22295,"journal":{"name":"Telemedicine reports","volume":"1 1","pages":"22-35"},"PeriodicalIF":0.0000,"publicationDate":"2020-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7714264/pdf/","citationCount":"6","resultStr":"{\"title\":\"An Observational Study of Telemental Care Delivery and the Context for Involuntary Commitment for Mental Health Patients in a Group of Rural Emergency Departments.\",\"authors\":\"Roseanne Fairchild,&nbsp;Shiaw-Fen Ferng-Kuo,&nbsp;Hicham Rahmouni,&nbsp;Daniel Hardesty\",\"doi\":\"10.1089/tmr.2020.0005\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p><b>Background:</b> Rates for all-cause U.S. emergency department (ED) visits to rural critical access hospitals (CAHs) have increased by 50% since 2005. During the same time period, total number of U.S. hospital admissions for a mental health (MH) crisis has increased by 12.2%, with rural counties demonstrating the largest suicide rate increases overall. <b>Introduction:</b> Increasing number of rural patients are reporting need for MH care in the region's four rural EDs. Characteristics of ED telemental health services were evaluated, including MH diagnostic category, voluntary vs. involuntary commitment (IC), forensic vs. nonforensic presentation, ED throughput, disposition, and payor reimbursement. <b>Materials and Methods:</b> Observational 2.5-year program evaluation of telemental health care delivery for children (<i>n</i> = 114) and adults (<i>n</i> = 417) who were evaluated by a rural ED physician and received an MH diagnosis. Participants (<i>N</i> = 531) were treated by a licensed psychiatrist through telemental care delivery from September 2017 to April 2020. <b>Results:</b> Noncommitted ED MH patients (86%; <i>n</i> = 455) were distributed across three major diagnostic groups: (1) depression, anxiety, or other mental illness (35%); (2) substance abuse (33%); or (3) suicide risk (32%), with 47% admitted inpatients (IPs), 47% referred outpatient (OPs), and 6% admitted to CAH. Fourteen percent (<i>n</i> = 76/531) of ED MH patients were subsequently IC, with 67% of those assessed as needing IP care. Forty-nine percent (<i>n</i> = 37) of IC patients presented in police custody. Most common diagnosis for IC patients was suicidal ideation/attempt (χ<sup>2</sup> [2, <i>N</i> = 452] = 12.884, <i>p</i> = 0.002). Admitted patients experienced significantly longer length of stay than those with OP referral (<i>p</i> = 0.001). Mean total payor reimbursements for ED MH care were significantly lower than actual ED costs (<i>p</i> < 0.001). <b>Discussion:</b> Innovative approaches to telemental care for IC and non-IC patients need to be piloted and comparatively evaluated in rural CAHs. <b>Conclusion:</b> As the gateway to critically needed MH care, rural CAHs and public services pivotal to care access (e.g., law enforcement) need additional resources and support.</p>\",\"PeriodicalId\":22295,\"journal\":{\"name\":\"Telemedicine reports\",\"volume\":\"1 1\",\"pages\":\"22-35\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2020-11-18\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7714264/pdf/\",\"citationCount\":\"6\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Telemedicine reports\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1089/tmr.2020.0005\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2020/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Telemedicine reports","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1089/tmr.2020.0005","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2020/1/1 0:00:00","PubModel":"eCollection","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 6

摘要

背景:自2005年以来,美国急诊科(ED)到农村危重医院(CAHs)就诊的全因率增加了50%。在同一时期,美国因精神健康(MH)危机而入院的总人数增加了12.2%,其中农村县的自杀率总体上升幅度最大。导言:越来越多的农村患者报告需要在该地区的四个农村急诊科接受医院护理。评估了ED远程心理健康服务的特征,包括MH诊断类别、自愿与非自愿承诺(IC)、法医与非法医陈述、ED吞吐量、处置和付款人报销。材料和方法:观察性的2.5年计划评估远程精神卫生保健服务的儿童(n = 114)和成人(n = 417),他们由农村急诊科医生评估并接受MH诊断。从2017年9月至2020年4月,参与者(N = 531)由一名有执照的精神科医生通过远程护理提供治疗。结果:未入院的ED MH患者(86%;N = 455)分布在三个主要诊断组:(1)抑郁、焦虑或其他精神疾病(35%);(2)药物滥用(33%);(3)自杀风险(32%),其中住院患者47%,门诊患者47%,CAH患者6%。14% (n = 76/531)的ED MH患者随后出现IC,其中67%的患者被评估为需要IP护理。49% (n = 37)的IC患者在警察拘留期间出现。IC患者最常见的诊断是自杀意念/企图(χ2 [2, N = 452] = 12.884, p = 0.002)。入院患者的住院时间明显长于OP转诊患者(p = 0.001)。ED MH护理的平均总付款人报销明显低于实际ED费用(p)。讨论:需要在农村CAHs试点和比较评估针对IC和非IC患者的远程护理创新方法。结论:作为获得急需的医院护理的门户,农村CAHs和对获得护理至关重要的公共服务(如执法)需要额外的资源和支持。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
An Observational Study of Telemental Care Delivery and the Context for Involuntary Commitment for Mental Health Patients in a Group of Rural Emergency Departments.

Background: Rates for all-cause U.S. emergency department (ED) visits to rural critical access hospitals (CAHs) have increased by 50% since 2005. During the same time period, total number of U.S. hospital admissions for a mental health (MH) crisis has increased by 12.2%, with rural counties demonstrating the largest suicide rate increases overall. Introduction: Increasing number of rural patients are reporting need for MH care in the region's four rural EDs. Characteristics of ED telemental health services were evaluated, including MH diagnostic category, voluntary vs. involuntary commitment (IC), forensic vs. nonforensic presentation, ED throughput, disposition, and payor reimbursement. Materials and Methods: Observational 2.5-year program evaluation of telemental health care delivery for children (n = 114) and adults (n = 417) who were evaluated by a rural ED physician and received an MH diagnosis. Participants (N = 531) were treated by a licensed psychiatrist through telemental care delivery from September 2017 to April 2020. Results: Noncommitted ED MH patients (86%; n = 455) were distributed across three major diagnostic groups: (1) depression, anxiety, or other mental illness (35%); (2) substance abuse (33%); or (3) suicide risk (32%), with 47% admitted inpatients (IPs), 47% referred outpatient (OPs), and 6% admitted to CAH. Fourteen percent (n = 76/531) of ED MH patients were subsequently IC, with 67% of those assessed as needing IP care. Forty-nine percent (n = 37) of IC patients presented in police custody. Most common diagnosis for IC patients was suicidal ideation/attempt (χ2 [2, N = 452] = 12.884, p = 0.002). Admitted patients experienced significantly longer length of stay than those with OP referral (p = 0.001). Mean total payor reimbursements for ED MH care were significantly lower than actual ED costs (p < 0.001). Discussion: Innovative approaches to telemental care for IC and non-IC patients need to be piloted and comparatively evaluated in rural CAHs. Conclusion: As the gateway to critically needed MH care, rural CAHs and public services pivotal to care access (e.g., law enforcement) need additional resources and support.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
自引率
0.00%
发文量
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信