RESUMEN
BACKGROUND: Early, data-driven discussion surrounding palliative care can improve care delivery and patient experience. OBJECTIVE: To develop a 30-day mortality prediction tool for older patients in intensive care unit (ICU) with pneumonia that will initiate palliative care earlier in hospital course. DESIGN: Retrospective Electronic Health Record (EHR) review. SETTING: Four urban and suburban hospitals in a Western New York hospital system. PARTICIPANTS: A total of 1237 consecutive patients (>75 years) admitted to the ICU with pneumonia from July 2011 to December 2014. MEASUREMENTS: Data abstracted included demographics, insurance type, comorbidities, and clinical factors. Thirty-day mortality was also determined. Logistic regression identified predictors of 30-day mortality. Area under the receiver operating curve (ROC) was calculated to quantify the degree to which the model accurately classified participants. Using the coordinates of the ROC, a predicted probability was identified to indicate high risk. RESULTS: A total of 1237 patients were included with 30-day mortality data available for 100% of patients. The mortality rate equaled 14.3%. Age >85 years, having active cancer, Congestive Heart Failure (CHF), Chronic Obstructive Pulmonary Disease (COPD), sepsis, and being on a vasopressor all predicted mortality. Using the derived index, with a predicted probability of mortality >0.146 as a cutoff, sensitivity equaled 70.6% and specificity equaled 65.6%. The area under the ROC was 0.735. CONCLUSION: Our risk tool can help care teams make more informed decisions among care options by identifying a patient group for whom a careful review of goals of care is indicated both during and after hospitalization. External validation and further refinement of the index with a larger sample will improve prognostic value.
Asunto(s)
Indicadores de Salud , Unidades de Cuidados Intensivos/organización & administración , Cuidados Paliativos/organización & administración , Neumonía/fisiopatología , Factores de Edad , Anciano , Anciano de 80 o más Años , Comorbilidad , Registros Electrónicos de Salud/organización & administración , Femenino , Humanos , Masculino , Pruebas de Estado Mental y Demencia , New York , Pronóstico , Curva ROC , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Factores Sexuales , Factores Socioeconómicos , Signos VitalesRESUMEN
BACKGROUND AND OBJECTIVES: Data are limited on order completion errors in primary care. The objective of this study was to determine the incidence and nature of order completion errors among community-dwelling older adults. METHODS: This prospective, cross-sectional exploratory study was conducted at a suburban family medicine clinical teaching site. Patients ?70 years old who received ?one order at the study enrollment visit were eligible for inclusion. Errors in completion of orders for prescriptions, laboratory tests, imaging studies or screening procedures, and specialist referrals were assessed. Logistic regression was used to identify the independent variables associated with non-system-based errors. RESULTS: A total of 322 orders were written for 93 enrolled patients. An order error was identified in 59 (18.3%) orders written for 39 (41.9%) patients (mean 1.5, range 1--4, SD=0.85): 10 were system-based and 49 were non-system-based errors. Non-system-based errors included unfilled prescriptions (9.0%), uncompleted orders for imaging studies and screening procedures (13.0%), and uncompleted specialist referrals (17.4%). All laboratory orders were completed. In a logistic regression model, females were four times more likely to experience a non-system-based error than males (OR=4.02, 95% CI=1.43, 11.23). CONCLUSIONS: Order completion errors were common in this sample of community-dwelling older adults, with non-system-based errors for prescriptions, imaging studies or screening procedures, and specialist referrals occurring more frequently than system-based errors, particularly among females. Providers should not assume that patients will complete orders as intended; rather, longitudinal management requires regular patient follow-up and review to ensure order completion.
Asunto(s)
Errores Médicos/estadística & datos numéricos , Cooperación del Paciente/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Enfermedad Crónica/terapia , Estudios Transversales , Femenino , Humanos , Modelos Logísticos , Masculino , Pacientes , Estudios Prospectivos , Factores SexualesRESUMEN
OBJECTIVE: This study examines the association between perceived social support and the prevalence of physical and mental health conditions among adult patients of an urban free medical clinic. METHODS: Patients (n = 289) completed a health risk assessment (HRA) questionnaire that addressed a number of medical and social issues, including perceived social support and whether patients had been told they had certain health conditions. Among these questions were 2 validated instruments: the PRIME-MD for mental health disorder assessment and CAGE for alcohol risk assessment. A deidentified database of responses was analyzed for statistical associations between perceived social support and these health conditions. RESULTS: Among those with insufficient perceived social support there were higher rates of having physician-measured overweight/obesity, a heart condition, a previous heart attack, anxiety, and depression. The association between perceived social support and cardiovascular health existed among women but not among men. Higher income, not smoking, and consumption of high-fiber foods were associated with sufficient social support. CONCLUSION: Perceiving sufficient social support was associated with lower rates of several mental and physical health disorders. Social support may act as a barrier or buffer to poor health caused by the stressful living conditions often experienced by low-income underinsured people. Males and females may experience this social support buffering differently.
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Instituciones de Atención Ambulatoria/estadística & datos numéricos , Cardiopatías , Trastornos Mentales , Salud Mental , Percepción Social , Apoyo Social , Atención no Remunerada/estadística & datos numéricos , Población Urbana/estadística & datos numéricos , Adulto , Negro o Afroamericano/estadística & datos numéricos , Femenino , Conductas Relacionadas con la Salud , Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Salud de las Minorías , Prevalencia , Psicometría/estadística & datos numéricos , Medición de Riesgo , Factores Socioeconómicos , Encuestas y Cuestionarios , Estados UnidosRESUMEN
BACKGROUND: Patients' race or ethnic background may affect their ability to access health care due to their socioeconomic status, hereditary predispositions to illnesses, or discrimination either perceived or actual by those providing health care. For patients with mental health disorders, additional barriers are created due to poor experiences with the health care system. METHODS: This was a mixed methods randomized control study examining the effectiveness of care managers linking patients to primary care after psychiatric crisis. The aim reported in this paper was to analyze differences by minority status in patients' quantitative and qualitative responses before and after facilitation to primary care (N=85). Patients responded to a "patient enablement" and primary care index assessing their feelings of empowerment after a primary care visit; and to qualitative questions about their experiences and perceptions of care. FINDINGS: Following a primary care visit, responses by minority and non-minority individuals did not differ significantly on either the patient enablement or primary care index score. On qualitative inquiry, both non-minorities and minorities reported positive and negative views of their health, with corresponding positive and negative health experiences. DISCUSSION: In sum, there were no differences in patient enablement between the minority and non-minority subgroups over the course of the study, nor were there any changes in patient's perception of their relationship with healthcare providers. However, this cohort found primary care services less satisfactory than a general population without mental illness. Patients with psychiatric disorders experience stigmatization in their attempts to access health care. This stigma may have a greater impact than race and ethnicity, thereby leading to a similarity in perception of health care between minorities and non-minorities with mental illness.
Asunto(s)
Actitud Frente a la Salud/etnología , Servicios de Urgencia Psiquiátrica , Trastornos Mentales/etnología , Grupos Minoritarios/psicología , Atención Primaria de Salud/organización & administración , Derivación y Consulta/organización & administración , Adulto , Análisis de Varianza , Manejo de Caso , Diversidad Cultural , Urgencias Médicas/psicología , Servicios de Urgencia Psiquiátrica/organización & administración , Análisis Factorial , Femenino , Accesibilidad a los Servicios de Salud , Disparidades en Atención de Salud , Humanos , Masculino , New York , Investigación Metodológica en Enfermería , Prejuicio , Investigación Cualitativa , Factores Socioeconómicos , Estereotipo , Encuestas y CuestionariosRESUMEN
PURPOSE: Patients with serious psychiatric problems experience difficulty accessing primary care. The goals of this study were to assess whether care managers improved access and to understand patients' experiences with health care after a psychiatric crisis. METHODS: A total of 175 consecutive patients seeking care in a psychiatric emergency department were randomly assigned to an intervention group with care managers or a control group. Brief, semistructured interviews about health care encounters were conducted at baseline and 1 year later. Five raters, using the content-driven, immersion-crystallization approach, analyzed 112 baseline and year-end interviews from 28 participants in each group. The main outcomes were patients' responses about their care experiences, connections with primary care, and integration of medical and mental health care. Scores for physical function and mental function were compared by analysis of variance (ANOVA). RESULTS: At baseline, most participants described negative experiences in receiving care and emphasized the importance of listening, sensitivity, and respect. Fully 71% of patients in the intervention group said that having a care manager to assist them with primary care connections was beneficial. Patients in the intervention group had significantly better physical and mental function than their counterparts in the control group at 6 months (P = .03 for each) but not at 12 months. There was also a trend toward functional improvement over the course of the study in the intervention group. CONCLUSIONS: This analysis suggests that care management is effective in helping patients access primary care after a psychiatric crisis. It provides evidence on and insight into how care may be delivered more effectively for this population. Future work should assess the sustainability of care connections and longer-term patient health outcomes.
Asunto(s)
Enfermos Mentales/psicología , Manejo de Atención al Paciente/estadística & datos numéricos , Satisfacción del Paciente , Atención Primaria de Salud/organización & administración , Adulto , Análisis de Varianza , Comorbilidad , Prestación Integrada de Atención de Salud/métodos , Prestación Integrada de Atención de Salud/organización & administración , Servicios de Urgencia Psiquiátrica/estadística & datos numéricos , Femenino , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Disparidades en Atención de Salud , Humanos , Relaciones Interprofesionales , Entrevistas como Asunto , Masculino , Enfermos Mentales/estadística & datos numéricos , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud , Atención Primaria de Salud/estadística & datos numéricos , Investigación CualitativaRESUMEN
BACKGROUND: Patients' race or ethnic background may affect their ability to access health care due to their socioeconomic status, hereditary predispositions to illnesses, or discrimination either perceived or actual by those providing health care. For patients with mental health disorders, additional barriers are created due to poor experiences with the health care system. METHODS: This was a mixed methods randomized control study examining the effectiveness of care managers linking patients to primary care after psychiatric crisis. The aim reported in this paper was to analyze differences by minority status in patients' quantitative and qualitative responses before and after facilitation to primary care (N=85). Patients responded to a "patient enablement" and primary care index assessing their feelings of empowerment after a primary care visit; and to qualitative questions about their experiences and perceptions of care. FINDINGS: Following a primary care visit, responses by minority and non-minority individuals did not differ significantly on either the patient enablement or primary care index score. On qualitative inquiry, both non-minorities and minorities reported positive and negative views of their health, with corresponding positive and negative health experiences. DISCUSSION: In sum, there were no differences in patient enablement between the minority and non-minority subgroups over the course of the study, nor were there any changes in patient's perception of their relationship with healthcare providers. However, this cohort found primary care services less satisfactory than a general population without mental illness. Patients with psychiatric disorders experience stigmatization in their attempts to access health care. This stigma may have a greater impact than race and ethnicity, thereby leading to a similarity in perception of health care between minorities and non-minorities with mental illness.
Asunto(s)
Actitud Frente a la Salud/etnología , Negro o Afroamericano/psicología , Accesibilidad a los Servicios de Salud , Trastornos Mentales/rehabilitación , Derivación y Consulta , Adulto , Servicios de Urgencia Psiquiátrica , Femenino , Humanos , Masculino , Trastornos Mentales/etnología , Grupos Minoritarios/psicología , Atención Primaria de Salud , Estados Unidos , Población Blanca/psicologíaRESUMEN
BACKGROUND: This study explores the health status and the social and economic correlates of adults 20 years of age and older who presented at an urban free medical clinic in Buffalo, NY, between 2002 and 2005. METHODS: Clinic staff asked patients to fill out a Health Risk Assessment questionnaire that addressed their chronic disease and illness history, mental health, social support, substance use, income, education, and housing. Through statistical analysis of 469 anonymous patient questionnaires, we identified prevalent health conditions in this patient population and compared these rates to regional and national data. RESULTS: Of those patients 20 years of age and older, 70% earned less than US $10,000 a year. The rates of obesity, hypertension, asthma, diabetes, anxiety, and depression were higher in this population than in the Buffalo, NY, region and the general United States population. CONCLUSION: The data reflect the health disparity experienced by low-income minority populations in the United States and emphasize a need to plan additional services that target hypertension, heart disease, obesity, diabetes, and mental health disorders such as anxiety and depression. Findings also serve as an introduction to the patient population for volunteer medical students who have limited exposure to urban, low-income populations.
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Instituciones de Atención Ambulatoria , Disparidades en el Estado de Salud , Estado de Salud , Estudiantes de Medicina , Población Urbana , Adulto , Femenino , Indicadores de Salud , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , New York , Proyectos Piloto , Pobreza , Psicometría , Medición de Riesgo , Apoyo Social , Factores Socioeconómicos , Encuestas y CuestionariosRESUMEN
Buprenorphine and methadone are both effective for the control of the acute signs and symptoms of opiate withdrawal, but it is not known if there are differences between these two medications for other important clinical outcomes. This observational, non-randomized study evaluated completion rates of patients over a 13-month period when buprenorphine replaced methadone as the medication used for short-term inpatient opiate detoxification. Of the 644 patients in the study, the 303 treated with buprenorphine were more likely to complete detoxification than the 341 treated with methadone (89% vs. 78%; P < .001). Improvement in completion rates coincided with the introduction of buprenorphine. We conclude that as compared to methadone, buprenorphine is associated with greater rates of completion of inpatient detoxification.
Asunto(s)
Buprenorfina/administración & dosificación , Metadona/administración & dosificación , Narcóticos/administración & dosificación , Trastornos Relacionados con Opioides/rehabilitación , Pacientes Desistentes del Tratamiento/estadística & datos numéricos , Adolescente , Adulto , Femenino , Estudios de Seguimiento , Hospitales de Enseñanza , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , New York , Trastornos Relacionados con Opioides/epidemiología , Centros de Tratamiento de Abuso de Sustancias , Síndrome de Abstinencia a Sustancias/rehabilitaciónRESUMEN
Safety has not been well studied in the long-term care setting. This pilot study assesses staff attitudes regarding safety culture at one 250-bed skilled nursing facility. A valid and reliable Safety Attitudes Questionnaire (SAQ) was administered once to a sample of 51 employees. Nursing staff and other health care staff were generally satisfied with their jobs (42% and 67% had a positive attitude, respectively) but gave low scores to Management (22% and 13%, respectively) and Safety Climate (28% and 33%, respectively). Registered nurses, licensed practical nurses, and nurse management/supervisors received the highest ratings for quality of collaboration and communication (range: 3.6-4.1 on a 5-point Likert scale with 1 = very low, 5 = very high), whereas nurse practitioners and physician assistants received the lowest (range: 2.5-2.9). The SAQ provided insight into employees' safety attitudes and can be used to identify opportunities for improvements in safety.
Asunto(s)
Actitud del Personal de Salud , Personal de Salud/psicología , Administración de la Seguridad , Instituciones de Cuidados Especializados de Enfermería , Competencia Clínica/normas , Comunicación , Conducta Cooperativa , Femenino , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud/educación , Necesidades y Demandas de Servicios de Salud , Humanos , Relaciones Interprofesionales , Satisfacción en el Trabajo , Masculino , New York , Enfermeras Administradoras/educación , Enfermeras Administradoras/psicología , Enfermeras Practicantes/educación , Enfermeras Practicantes/psicología , Asistentes de Enfermería/educación , Asistentes de Enfermería/psicología , Investigación Metodológica en Enfermería , Personal de Enfermería/educación , Personal de Enfermería/psicología , Enfermería Práctica/educación , Enfermería Práctica/organización & administración , Cultura Organizacional , Asistentes Médicos/educación , Asistentes Médicos/psicología , Proyectos Piloto , Administración de la Seguridad/organización & administración , Instituciones de Cuidados Especializados de Enfermería/organización & administración , Encuestas y CuestionariosRESUMEN
CONTEXT: Rural primary care is a complex environment in which multiple patient safety challenges can arise. To make progress in improving safety with limited resources, each practice needs to identify those safety problems that pose the greatest threat to patients and focus efforts on these. PURPOSE: To describe and field-test a novel approach to prioritizing safety problems in rural primary care based on the method of Failure Modes and Effects Analysis. METHODS: A survey instrument designed to assess perceptions of medical error frequency, severity, and cause was administered anonymously to staff of 2 rural primary care practices in New York State. Responses were converted to quantitative hazard scores, which were used to make priority rankings of safety problems. Concordance analysis was conducted. RESULTS: Response rate was 94% at each site. Analysis yielded a list of priorities for each site. Comparison between staff groups (provider vs nursing vs administration), based on the top 10 priorities perceived by staff, showed 53% concordance at one site and 30% at the other. Concordance between sites was lower, at 20%. CONCLUSIONS: Initial field-testing of a Failure Modes and Effects Analysis approach in rural primary care suggests that it is feasible and can be used to estimate, based on staff perceptions, the greatest threats to patient safety in an individual practice so that limited resources can be focused appropriately. Higher concordance between staff within a practice than between practices lends preliminary support to the validity of the approach.
Asunto(s)
Actitud del Personal de Salud , Encuestas de Atención de la Salud/métodos , Prioridades en Salud , Atención Primaria de Salud/normas , Garantía de la Calidad de Atención de Salud , Servicios de Salud Rural/normas , Seguridad/normas , Actitud Frente a la Salud , Estudios de Factibilidad , Humanos , Errores Médicos , New York , Modelos de Riesgos Proporcionales , Medición de RiesgoRESUMEN
CONTEXT: Increasing numbers of patients with multiple chronic conditions present in the primary care setting and pose a challenge to physicians who must cope with competing demands while adhering to clinical practice guidelines. PURPOSE: We tested a chart audit tool to assess how physicians are managing patients with multiple comorbidities in an inner-city family medicine practice serving minority patients. METHODS: We developed an evidence-based comorbidity chart audit tool that captures the number of diagnosed, coexisting general medical conditions and adherence to key clinical practice guidelines for each condition. A randomized chart audit was undertaken, with one in every five charts selected, yielding a total of 314 patient charts. FINDINGS: The majority of patients (59%) had > or = 2 comorbid chronic conditions, and 32% had > or = 3 comorbid chronic conditions. The highest overall adherence to guidelines was for chronic obstructive pulmonary disease (90%) and asthma (80%), followed by congestive heart failure (75%) and coronary artery disease (58%). For all other conditions, overall adherence to guidelines was < or = 50%. CONCLUSIONS: The chart review tool identified inconsistencies in adherence to guidelines across multiple diagnosed conditions, suggesting the importance of adopting a patient-centered approach to management as well as prevention.
Asunto(s)
Negro o Afroamericano , Enfermedad Crónica/etnología , Enfermedad Crónica/prevención & control , Medicina Familiar y Comunitaria/normas , Adhesión a Directriz/estadística & datos numéricos , Auditoría Médica , Atención Primaria de Salud/normas , Garantía de la Calidad de Atención de Salud , Servicios Urbanos de Salud/normas , Anciano , Comorbilidad , Medicina Basada en la Evidencia , Femenino , Humanos , Masculino , Persona de Mediana Edad , New York/epidemiología , Proyectos Piloto , Evaluación de Programas y Proyectos de SaludRESUMEN
Additional treatment after inpatient detoxification is recommended; however, many patients fail to initiate aftercare. The purpose of this observational study was to determine which patients hospitalized for alcohol or drug withdrawal subsequently fail to initiate recommended outpatient aftercare treatment by using existing data from medical records. Of 406 patients, 180 (44.3%) did not initiate outpatient aftercare treatment after hospitalization for detoxification. Compared with those who did initiate aftercare, those who did not were less likely to have education beyond high school (44% vs. 32%; P = 0.018), to be enrolled in a managed care health insurance plan (46% vs. 34%; P = 0.013), and to have a family history of chemical dependency (81% vs. 72%; P = 0.049). These values were similar with multiple regression analysis. Of the 406 patients, 11 of 56 (20%) without any of these risk factors, 145 of 314 (46%) with 1 or 2 risk factors, and 24 of 36 (67%) with all 3 of these risk factors did not keep scheduled outpatient appointment for aftercare. These findings suggest that some patients admitted for inpatient detoxification, identifiable by certain admission characteristics, are at risk for failure to link with appropriate outpatient aftercare treatment.
RESUMEN
This prospective cohort study compared in-patients who remained abstinent and initiated aftercare treatment following detoxification with those who did not. Of 110 patients enrolled, 58% (46/79) were totally abstinent and 72% (67/93) initiated treatment during the first 30 days following hospital discharge. Patients who relapsed after hospital discharge were more likely than those who remained abstinent to have a primary drug-use disorder (p = 0.05), prior mental health treatment (p = .007), or previous incarceration (p = 0.035). Those who initiated aftercare treatment were less likely to have had prior mental health treatment than those who did not (p = .046).
Asunto(s)
Cuidados Posteriores/estadística & datos numéricos , Alcoholismo/rehabilitación , Aceptación de la Atención de Salud/estadística & datos numéricos , Admisión del Paciente , Trastornos Relacionados con Sustancias/rehabilitación , Templanza/estadística & datos numéricos , Adulto , Cuidados Posteriores/psicología , Anciano , Alcoholismo/epidemiología , Alcoholismo/psicología , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Hospitales Públicos , Hospitales de Enseñanza , Humanos , Masculino , Persona de Mediana Edad , New York , Aceptación de la Atención de Salud/psicología , Admisión del Paciente/estadística & datos numéricos , Estudios Prospectivos , Recurrencia , Derivación y Consulta/estadística & datos numéricos , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/psicología , Templanza/psicología , Resultado del TratamientoRESUMEN
CONTEXT: Medical schools have responded to the increasing diversity of the population of the USA by incorporating cultural competency training into their curricula. This paper presents results from pre- and post-programme surveys of medical students who participated in a training programme that included evening clinical sessions for refugee patients and related educational workshops. METHODS: A self-assessment survey was administered at the beginning and end of the academic year to measure the cultural awareness of participating medical students. RESULTS: Over the 3 years of the programme, over 133 students participated and 95 (73%) completed pre- and post-programme surveys. Participants rated themselves significantly higher in all 3 domains of the cultural awareness survey after completion of the programme. CONCLUSIONS: The opportunity for medical students to work with refugees in the provision of health care presents many opportunities for students, including lessons in communication, and scope to learn about other cultures and practise basic health care skills. An important issue to consider is the power differential between those working in medicine and patients who are refugees. To avoid reinforcing stereotypes, medical programmes and medical school curricula can incorporate efforts to promote reflection on provider attitudes, beliefs and biases.
Asunto(s)
Competencia Clínica/normas , Educación de Pregrado en Medicina/métodos , Atención Primaria de Salud/normas , Refugiados , Adulto , Actitud del Personal de Salud , Diversidad Cultural , Femenino , Humanos , Masculino , Relaciones Médico-Paciente , Estados UnidosRESUMEN
Some individuals hospitalized for alcohol or drug detoxification leave against medical advice (AMA). We hypothesized that certain characteristics would be associated with AMA discharges. A case-control study of 1,426 hospital admissions for detoxification (representing 1,080 individuals) was conducted to compare patients leaving the hospital AMA (n=231) with a random sample of those completing detoxification (n=286). Latino ethnicity, detoxification from drugs, Friday or Saturday discharge, Medicaid or no health insurance, and not being treated by one specific attending physician were characteristics associated with an AMA discharge in a backward logistic regression model. Although 85% of the patients with all these characteristics left AMA, only one patient, without any of these five characteristics, did so. We conclude that clinicians can use certain clinical features to predict AMA discharge. Additional research could evaluate if treatment strategies that consider these ethnic and socioeconomic disparities may reduce rates of AMA discharge.
Asunto(s)
Pacientes Desistentes del Tratamiento , Trastornos Relacionados con Sustancias/terapia , Negativa del Paciente al Tratamiento , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Femenino , Registros de Hospitales , Humanos , Pacientes Internos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Pacientes Desistentes del Tratamiento/estadística & datos numéricos , Negativa del Paciente al Tratamiento/estadística & datos numéricosRESUMEN
Following hospitalization for orthopedic trauma, some patients continue to use opioids following fracture healing. This retrospective cohort study of 50 patients with high-energy fractures was conducted to determine if toxicology screening tests upon admission can predict subsequent opioid use. Data were collected from clinical records and a statewide electronic database of prescription records. Six months following hospital discharge, those with positive toxicology used more Following hospitalization for orthopedic trauma, some patients continue to use opioids following fracture healing. This retrospective cohort study of 50 patients with high-energy fractures was conducted to determine if toxicology screening tests upon admission can predict subsequent opioid use. Data were collected from clinical records and a statewide electronic database of prescription records. Six months following hospital discharge, those with positive toxicology used more. Following hospitalization for orthopedic trauma, some patients continue to use opioids following fracture healing. This retrospective cohort study of 50 patients with high-energy fractures was conducted to determine if toxicology screening tests upon admission can predict subsequent opioid use. Data were collected from clinical records and a statewide electronic database of prescription records. Six months following hospital discharge, those with positive toxicology used more opioids (730 mg vs. 364 mg; P = .04) expressed as morphine equivalents than those with negative toxicology and were more likely to continue using opiates at the end of the 3rd, 4th, 5th, and 6th month after discharge. Patients hospitalized for high-energy fractures with positive admission toxicology are at risk for prolonged opiate use during the initial six months following discharge.
Asunto(s)
Analgésicos Opioides/uso terapéutico , Prescripciones de Medicamentos/estadística & datos numéricos , Fracturas Óseas/epidemiología , Fracturas Óseas/cirugía , Ortopedia/estadística & datos numéricos , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/epidemiología , Detección de Abuso de Sustancias/métodos , Trastornos Relacionados con Sustancias/epidemiología , Toxicología/métodos , Adulto , Estudios de Cohortes , Demografía , Femenino , Fracturas Óseas/diagnóstico , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Estudios Retrospectivos , Trastornos Relacionados con Sustancias/sangre , Trastornos Relacionados con Sustancias/orina , Factores de TiempoRESUMEN
502 university students completed survey items on attitudes, experiences, knowledge, and behaviors related to organ and tissue donation (OTD). Despite positive attitudes toward organ donation, only 11% of students formally have declared their intentions to donate through the state registry or by signing an organ card. When asked to report why they have not signed an organ donor card/registry, students reported, "not considering the topic," "intentions to donate in the future," and "general negative attitudes" among other reasons. Students also reported a generally positive attitude toward the topic of OTD and moderate to strong intentions to become organ donors in the future despite feeling somewhat uninformed on the topic. The results are discussed in relation to future campaign message strategies to promote OTD to university students.
Asunto(s)
Actitud , Donadores Vivos/psicología , Estudiantes/psicología , Adulto , Humanos , Modelos Logísticos , New York , Sistema de Registros , Encuestas y CuestionariosRESUMEN
BACKGROUND: Patients presenting with a psychiatric emergency face a unique set of challenges in connecting to primary care. OBJECTIVES: We tested the hypothesis that, in contrast to usual care, case management will result in higher rates of connection to primary care. We examined variables affecting primary care entry, including insurance status, hospital admission, and concurrent linkages to mental health care. RESEARCH DESIGN/METHODS: This article reports on a preliminary outcome of an ongoing randomized controlled trial conducted with 101 patients presenting in an urban psychiatric setting. Patients were randomized to a case management team or to usual care. The need for medical care was assessed by documenting medical comorbidity. RESULTS: Average age of the sample was 37.5; 65% were male, and 78% had low income; 37% were African American and 9% were Hispanic. Within 3 months of study enrollment, 57% of the intervention group was successfully linked to primary care compared with 16% of the usual care group, a difference that was statistically significant (P < .001). Associated positive predictors for linkage to primary care included mental health care visits and success in obtaining health insurance. Inpatient hospital stay at the time of psychiatric crisis was negatively associated with later attendance at primary care. CONCLUSIONS: Case management intervention was effective in establishing linkage to primary care within 3 months. Ongoing work will evaluate primary care retention and physical and mental health outcomes.
Asunto(s)
Continuidad de la Atención al Paciente/estadística & datos numéricos , Servicios de Urgencia Psiquiátrica/estadística & datos numéricos , Trastornos Mentales/epidemiología , Atención Primaria de Salud/estadística & datos numéricos , Adulto , Manejo de Caso , Femenino , Humanos , Masculino , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores SocioeconómicosRESUMEN
BACKGROUND: Substance abuse is associated with injuries, but these associations have not been well characterized by type of substance and injury type. METHODS: A cross-sectional study of patients selected for toxicology screening compared those with positive and those with negative test results for drugs and alcohol. RESULTS: Patients with positive alcohol toxicology results were more likely to have violence-related and penetrating injuries than patients with negative results. However, after adjustment for positive cocaine toxicology results, the association between alcohol and penetrating injury was no longer significant. Positive test results for any drug were not associated with any specific injury type, but cocaine was independently associated with violence-related injury. The associations of alcohol and cocaine with violence-related injury appear to be additive. In contrast, opiates were independently associated with nonviolent injuries and burns. CONCLUSIONS: Alcohol and cocaine use is independently associated with violence-related injuries, whereas opiate use is independently associated with nonviolent injuries and burns.
Asunto(s)
Hospitalización/estadística & datos numéricos , Tamizaje Masivo/métodos , Detección de Abuso de Sustancias/métodos , Trastornos Relacionados con Sustancias/diagnóstico , Trastornos Relacionados con Sustancias/epidemiología , Heridas y Lesiones/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Causalidad , Comorbilidad , Estudios Transversales , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Medio Oeste de Estados Unidos/epidemiología , Evaluación de Necesidades , Oportunidad Relativa , Sistema de Registros , Trastornos Relacionados con Sustancias/complicaciones , Trastornos Relacionados con Sustancias/metabolismo , Tomografía Computarizada por Rayos X , Centros Traumatológicos , Violencia/estadística & datos numéricos , Heridas y Lesiones/complicacionesRESUMEN
The shift in care for individuals with psychiatric disabilities from the psychiatric hospital to the community has been accompanied by an increased emphasis on the measurement of quality of life (QOL) for these clients. It is the goal of this paper to measure the impact of a voluntary outpatient wellness program on individuals' self-reports of QOL over time. QOL for 49 wellness center participants was assessed at baseline, three months, and six months. There was a significant increase in QOL over the assessment period, particularly for those participants who used the center's services more frequently. Limitations and future directions are discussed.