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Alternatives to acute hospital psychiatric care in east-end Montreal.

https://arctichealth.org/en/permalink/ahliterature191229
Source
Can J Psychiatry. 2002 Feb;47(1):49-55
Publication Type
Article
Date
Feb-2002
Author
Alain D Lesage
Charles Bonsack
Doris Clerc
Claude Vanier
Maryse Charron
Marc Sasseville
André Luyet
Daniel Gélinas
Author Affiliation
Centre de recherche Fernand-Seguin, Hôpital Louis-H Lafontaine, Unité 218, 7401 Hochelaga, Montréal, PQ H1N 3M5. alesage@ssss.gouv.gc.ca
Source
Can J Psychiatry. 2002 Feb;47(1):49-55
Date
Feb-2002
Language
English
Publication Type
Article
Keywords
Acute Disease
Adult
Aged
Catchment Area (Health)
Community Mental Health Services - economics - organization & administration - utilization
Female
Hospitalization - economics
Hospitals, Psychiatric - economics - utilization
Humans
Male
Mental Disorders - economics - epidemiology - rehabilitation
Middle Aged
Needs Assessment
Patient Admission - statistics & numerical data
Quebec - epidemiology
Abstract
As pressure mounts to reduce the number of costly acute care beds, governments and the literature propose top-down ratios. Is this reasonable and fair to the responsible medical officers who, as the key care providers, will need to admit patients and develop discharge plans in a reduced-beds environment?
Treating physicians of all acute care inpatients on a given day (n = 212) and all new acute care admissions over a 2-week period (n = 125) completed an adapted version of the Nottingham Acute Beds Use Survey (NABUS) Questionnaire.
On a given day, only 62 of 212 inpatients were unsuited for any alternative to acute care hospitalization. A floor ratio of 18 acute care beds per 100,000 inhabitants seems adequate for the catchment area in question, provided that alternatives to hospitalization are fully and efficiently available. Alternatives essentially involve an array of the following: supervised residential settings, day hospitals, and intensive home care (2 to 6 hours weekly). The ratio of intensive home care workers required would be 25 per 100,000 inhabitants.
PubMed ID
11873708 View in PubMed
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[Assertive community treatment of psychoses].

https://arctichealth.org/en/permalink/ahliterature199042
Source
Ugeskr Laeger. 2000 Feb 28;162(9):1197-204
Publication Type
Article
Date
Feb-28-2000
Author
M. Nordentoft
P. Vendsborg
Author Affiliation
Psykiatrisk afdeling, H:S Bispebjerg Hospital, København.
Source
Ugeskr Laeger. 2000 Feb 28;162(9):1197-204
Date
Feb-28-2000
Language
Danish
Publication Type
Article
Keywords
Behavior Therapy
Community Mental Health Services - economics
Cost Savings
Denmark
Hospitalization
Humans
Meta-Analysis as Topic
Outpatients
Patient care team
Patient satisfaction
Prognosis
Psychotic Disorders - therapy
Socioeconomic Factors
Abstract
Long-term institutionalization is no longer the preferred treatment for the severely mentally ill. Several models for outpatient treatment of the severely mentally ill have been developed, among them Assertive Community Treatment (ACT). The literature on this model is reviewed in a Cochrane review and in randomized trials comparing ACT with hospital admission. ACT is a clinically effective approach to managing the care of severely ill people in the community. ACT, if correctly targeted on high users of in-patient-care, can substantially reduce costs of hospital care whilst improving outcome and patient and relatives satisfaction. Setting up ACT teams should be supported by politicians, professionals and consumers.
Notes
Comment In: Ugeskr Laeger. 2000 Apr 17;162(16):2349-5010827569
PubMed ID
10741223 View in PubMed
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Better Beginnings, Better Futures: a community-based approach to primary prevention.

https://arctichealth.org/en/permalink/ahliterature215593
Source
Can J Commun Ment Health. 1994;13(2):183-8
Publication Type
Article
Date
1994
Author
R D Peters
Author Affiliation
Better Futures Research Coordination Unit, Queen's University, Kingston, Ontario.
Source
Can J Commun Ment Health. 1994;13(2):183-8
Date
1994
Language
English
Publication Type
Article
Keywords
Affective Symptoms - prevention & control
Child
Child Behavior Disorders - prevention & control
Child, Preschool
Community Mental Health Services - economics
Cost-Benefit Analysis
Developmental Disabilities - prevention & control
Early Intervention (Education) - economics
Female
Humans
Infant
Learning Disorders - prevention & control
Male
Ontario
Poverty
Psychosocial Deprivation
Risk factors
Abstract
Better Beginnings, Better Futures is a 25-year primary prevention policy research demonstration project. Its major purpose is to assess the extent to which community-based primary prevention programs can be effective in preventing emotional, behavioural, physical and cognitive problems in children from economically disadvantaged communities. The project grew out of a number of primary prevention initiatives introduced by the Ontario Ministry of Community and Social Services (MCSS) since the late 1970s. Eleven sites, four of them located on native reserves, received funding in January, 1991 to establish programs in their communities. From the beginning, a qualitative, naturalistic research approach has been utilized to document and understand the ways in which the programs have developed in the various Better Beginnings communities.
PubMed ID
10151074 View in PubMed
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Calgary Diversion Program: A Community-based Alternative to Incarceration for Mentally Ill Offenders.

https://arctichealth.org/en/permalink/ahliterature161155
Source
J Ment Health Policy Econ. 2007 Sep;10(3):145-51
Publication Type
Article
Date
Sep-2007
Author
Craig Mitton
Liz Simpson
Leslie Gardner
Fran Barnes
Gerald McDougall
Author Affiliation
Faculty of Health and Social Development, University of British Columbia Okanagan, 3333 University Way, Kelowna, B.C., V1H1P5, Canada, craig.mitton@ubc.ca
Source
J Ment Health Policy Econ. 2007 Sep;10(3):145-51
Date
Sep-2007
Language
English
Publication Type
Article
Keywords
Alberta
Community Mental Health Services - economics - utilization
Evaluation Studies as Topic
Humans
Mental disorders
Organizational Case Studies
Prisons
Abstract
The management of mentally ill people committing minor criminal offences has been a social concern in Canada for more than thirty years. Processing of these individuals through the Justice system results in a well-known 'revolving door' syndrome. One approach to this problem is the diversion of these offenders from the Justice system to the network of health and social services that can address their overall well-being. A lack of empirical evidence on diversion programs has been identified as a main roadblock to their acceptance.
To describe outcomes and service utilization of clients using the Calgary Diversion Program, a community-based alternative to incarceration for persons with serious mental disorders who commit minor offences.
The study employed mixed quantitative and qualitative methods, and used a quasi-experimental design with the clients serving as their own controls. The Calgary Diversion Program was formed in 2002, with this study spanning client enrollment (n=179) from 2002-2003.
Before to after program enrolment comparisons found justice system complaints, charges and court appearances to have been reduced between 84% and 91% in those clients that participated successfully in the program, while at the same time found reductions of between 25% and 48% of acute services. Both quantitative and qualitative results indicated a high degree of satisfaction on the part of both providers and clients. Statistically significant improvement in the Brief Psychiatric Rating Scale values between baseline and three months after program entry were observed, while quality of life measurement showed statistically significant improvements in six of nine indicators. Acute health care and justice system costs were compared for the nine months prior to referral and the nine months following referral, with an average reduction in total costs of CAD 1,721 per client.
The findings presented in this paper are the first significant contribution to empirical research on diversion programs in Canada. The study suggests improved outcomes, support from clients and providers, and reduced overall costs. However, the nature of the study design limits firm conclusions to be made. Longer term follow-up is a key area for future research. IMPLICATION FOR HEALTH POLICIES: This results identified through the study, as well as the accompanying information on the Calgary program's implementation and functioning, are an important building block in moving towards a strategy to address a long-standing social concern. In an era of cost-consciousness, policy makers need to consider programs that not only have the opportunity to improve patient outcomes, but as well show promise in reducing health and other social service costs.
PubMed ID
17890831 View in PubMed
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[Changed treatment of schizophrenic syndromes. More open care is not cheaper].

https://arctichealth.org/en/permalink/ahliterature215107
Source
Lakartidningen. 1995 May 24;92(21):2203-6, 2209
Publication Type
Article
Date
May-24-1995

[Clinico-economic study of schizophrenia: methodology and comparative analysis of expenditures in the hospital and ambulatory care networks].

https://arctichealth.org/en/permalink/ahliterature103947
Source
Zh Nevropatol Psikhiatr Im S S Korsakova. 1990;90(11):114-7
Publication Type
Article
Date
1990
Author
Iu V Ushakov
L I Kalugina
M G Mirzoian
Source
Zh Nevropatol Psikhiatr Im S S Korsakova. 1990;90(11):114-7
Date
1990
Language
Russian
Publication Type
Article
Keywords
Ambulatory Care - economics
Community Mental Health Services - economics
Costs and Cost Analysis
Hospitalization - economics
Hospitals, Psychiatric - economics
Humans
Moscow
Outpatient Clinics, Hospital - economics
Schizophrenia - economics - therapy
Abstract
The paper is concerned with part of the results of an analysis of expenditures for the treatment of schizophrenic patients. The task of the present fragment was to delineate ways of optimizing the functioning of the psychiatric assistance services. Research methods including clinico-economic, statistic, mathematic and epidemiological approaches are described in detail. Based on an examination of the representative group of schizophrenic patients (n-386) of one of the psychoneurological dispensaries of Moscow, it has been established that the main "direct" (793.8 rubels per patient/year on the average) and "indirect" (3520.94 rubels per patient/year on the average) expenditures are connected with expensive inpatient treatment and disability allowance payments. It is suggested that redistribution of investments with a purpose of eliminating economic unbalance between different psychiatric services (hospital and ambulatory) will contribute to optimizing their functioning and enable the efficacy of their work to be enhanced.
PubMed ID
1963963 View in PubMed
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[Communal housing for the mentally ill. A supplement or an alternative to the existing psychiatric institutions]

https://arctichealth.org/en/permalink/ahliterature73655
Source
Ugeskr Laeger. 1991 Feb 4;153(6):432-5
Publication Type
Article
Date
Feb-4-1991
Author
K W Maarbjerg
A. Vogel
Author Affiliation
Københavns Kommunehospital, psykiatrisk afdeling.
Source
Ugeskr Laeger. 1991 Feb 4;153(6):432-5
Date
Feb-4-1991
Language
Danish
Publication Type
Article
Keywords
Adult
Community Mental Health Services - economics - organization & administration
Community-Institutional Relations - economics
Denmark
English Abstract
Female
Hospitalization
Housing
Humans
Length of Stay
Male
Mental Disorders - rehabilitation
Abstract
In 1980-1981, two communal housing schemes for young psychiatric patients in the Municipality of Copenhagen were established. The object was to offer these persons a home for a limited period (maximum three years). The object of this investigation is to describe the patients who lived in these communal homes during the period 1.3.1980-28.2.1989, to investigate the duration of hospitalization in psychiatric departments two years before and two years after they stay in the communal home and, on the basis of the experience gained, to discuss the possibilities and limitations of this form of housing. The investigation is retrospective and based on hospital case records. It includes 56 persons: 37 men and 19 women. The average age was 28.7 years. 92% of the residents had a chronic psychiatric disease. They had received psychiatric treatment early and had long histories with prolonged periods of hospitalization. The average duration of hospitalization was 17 months. At the conclusion of the investigation, 33 residents had moved out two or more years ago. The average duration of hospitalization for this group was reduced to approximately 1/3 of the duration of hospitalization prior to the stay in the communal home. The structure outlined here may be employed for a number of the chronic psychiatric patients but a communal psychiatric offer should include a greater spectrum of possibilities for chronic patients to cover their requirements. Establishing an offer of this type demands multidisciplinary cooperation.
PubMed ID
2000649 View in PubMed
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A comparative trial of home and hospital psychiatric treatment: financial costs.

https://arctichealth.org/en/permalink/ahliterature243314
Source
Can J Psychiatry. 1982 Apr;27(3):177-87
Publication Type
Article
Date
Apr-1982
Author
F R Fenton
L. Tessier
A P Contandriopoulos
H. Nguyen
E L Struening
Source
Can J Psychiatry. 1982 Apr;27(3):177-87
Date
Apr-1982
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Ambulatory Care - economics
Bipolar Disorder - rehabilitation
Community Mental Health Services - economics
Cost-Benefit Analysis
Depressive Disorder - rehabilitation
Female
Hospitals, General - economics
Hospitals, Teaching - economics
Humans
Male
Mental Disorders - economics - rehabilitation
Middle Aged
Psychiatric Department, Hospital - economics
Quebec
Schizophrenia - rehabilitation
Abstract
The financial costs of community-based treatment, stressing home treatment, were compared with the cost of hospital-based treatment during one year. Of 155 patients destined to receive inpatient treatment, 76 were randomly assigned to home treatment, 79 to hospital treatment; the two groups were similar as to important social, demographic, and clinical characteristics. The principal differences between the two treatments concerned the focus of treatment, the locale of treatment, the degree to which continuity of treatment was maintained, and the roles of the respective treatment staffs. Manpower and operating costs, measured in dollars, were estimated in two ways. Either way, hospital-based treatment was more expensive during the year: 64.1% more expensive (+3,250 vs. +1,980 per patient) in the first instance, 108.9% more expensive (+6,750 vs. +3,230 per patient) in the second. With two exceptions during the first month of treatment, the proportions of patients and families receiving either treatment who incurred other costs of treatment were low, and the differences between groups were not significantly different. A higher proportion of patients and families receiving home-based treatment defrayed the cost of the patient's psychotropic drugs; second, a higher proportion of families of patients receiving hospital-based treatment defrayed transportation costs. The proportions of patients and families incurring costs of the consequences of illness were low, and the differences between treatment groups were not significant. We compared this study with similar studies, discussed the generalizability of the results of this study and similar studies, and identified issues for future research.
PubMed ID
6807524 View in PubMed
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[Computerized medical records in psychiatry: disturbed relations and double work].

https://arctichealth.org/en/permalink/ahliterature208997
Source
Lakartidningen. 1997 Mar 19;94(12):1045-6
Publication Type
Article
Date
Mar-19-1997

Continuity of care and health care costs among persons with severe mental illness.

https://arctichealth.org/en/permalink/ahliterature172995
Source
Psychiatr Serv. 2005 Sep;56(9):1070-6
Publication Type
Article
Date
Sep-2005
Author
Craig R Mitton
Carol E Adair
Gerry M McDougall
Gisele Marcoux
Author Affiliation
Department of Health Care and Epidemiology, University of British Columbia, Vancouver, Canada. cmitton@exchange.ubc.ca
Source
Psychiatr Serv. 2005 Sep;56(9):1070-6
Date
Sep-2005
Language
English
Publication Type
Article
Keywords
Activities of Daily Living - classification - psychology
Adult
Alberta
Analysis of Variance
Community Mental Health Services - economics
Continuity of Patient Care - economics
Cost Allocation
Cost-Benefit Analysis
Economics
Female
Health Care Costs - statistics & numerical data
Health services needs and demand
Hospitalization - economics
Humans
Male
Middle Aged
Outcome Assessment (Health Care) - statistics & numerical data
Psychotic Disorders - economics - rehabilitation
Quality of Life - psychology
Regression Analysis
Abstract
Although the association between continuity of care and health outcomes among persons with severe mental illness is beginning to be elucidated, the association between continuity and costs has remained virtually unexplored. The purpose of this study was to examine the relationship of continuity of care and health care costs in a sample of 437 adults with severe mental illness in three health regions of Alberta, Canada.
Service use events and costs were tracked through self-reported and administrative data. Associations between continuity and costs were examined by using analysis of variance and regression analysis.
Mean+/-SD total, hospital, and community cost over the 17-month study period were $24,070+/-$25,643, $12,505+/-$20,991, and $2,848+/-$4,420, respectively. The difference in means across levels of observer-rated continuity was not statistically significant for total cost, but improved continuity was associated with both lower hospital cost and higher community cost. Total cost was significantly lower for patients with a higher self-rated quality of life as indicated on the EQ-5D visual analogue scale, although associations did not hold up in the regression analysis. Patients with higher functioning as rated by the Multnomah Community Abilities Scale had significantly lower total and community costs.
The study showed a relationship between continuity of care and both hospital and community costs. The data also indicate that a relationship exists between cost and level of patient functioning. It will be necessary to conduct further studies using experimental designs to examine the impact of shifting resources from hospitals to the community, particularly for high-need patients, on continuity of care and subsequent outcomes.
Notes
Comment On: Psychiatr Serv. 2005 Sep;56(9):1061-916148318
PubMed ID
16148319 View in PubMed
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58 records – page 1 of 6.