Outpatient Care Research Articles

Utilizing pharmacy technicians for medication adherence patient outreach in an ambulatory care setting.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. This publication outlines the development and implementation of a telephone-based adherence call program for pharmacy technicians at Community Health Network (CHNw). This program aims to improve medication adherence rates for contracted Medicare Advantage plans. As healthcare systems look for ways to improve patient care, Medicare reimbursement can guide ideas for initiatives. To improve medication adherence rates, the ambulatory care pharmacy team at CHNw developed a telephone-based adherence call system to better improve clinical outcomes and lower overall healthcare utilization and costs. Initially developed as a pharmacy student-driven service, the program has progressed to be run by clinical pharmacy technicians. Once patients are identified as candidates for outreach, the pharmacy technicians contact them to discuss medication adherence and coordinate with their primary care provider and embedded clinic pharmacist to ensure medication accessibility and overcome potential barriers to adherence. Utilizing pharmacy technicians to complete medication adherence outreach calls has proven to be a success, as evidenced by improvement in star ratings in all 3 CMS medication adherence measures. This has resulted in work off-loaded from the clinical pharmacist, financial gain for the network, and improved medication adherence for patients. With this success, we can financially justify having the technicians on the ambulatory pharmacy team and plan to expand their roles into other pharmacy initiatives soon. This program helps show that expanding the pharmacy technician role may further benefit the healthcare system.

Outpatient total hip arthroplasty: robotic assistance reduces 90-Day postoperative events and optimizes outpatient care.

The adoption of robotic-assisted total hip arthroplasty (THA) is increasingly widespread, yet its influence on outcomes in outpatient surgery remains uncertain. This study aimed to evaluate whether robotic assistance reduces the rate of 90-day postoperative events in patients undergoing outpatient THA, compared to those in inpatient procedures. This historical-prospective cohort study analyzed 706 primary THA cases performed between January 2017 and January 2023 by three senior surgeons. Patients were grouped into outpatient (n = 132) and inpatient (n = 576) cohorts. From December 2019, robotic-assisted THA using the MAKO™ system was implemented. Propensity score matching was used to minimize baseline differences between groups. The primary outcome was the occurrence of any event within 90 days post-surgery, including readmissions, reoperations, and other complications. Secondary outcomes included functional scores, length of hospital stay, and intraoperative factors such as blood loss and Operative Room (OR) time. No significant differences were found between inpatient and outpatient groups in terms of gender, age, BMI, ASA score, or surgeon. The 90-day event rates were similar between the two groups (8.59% vs. 9.38%, p > 0.999). However, outpatient THA was associated with lower blood loss (p = 0.02) and shorter hospital stays (p < 0.001). Multivariate analysis identified prolonged OR time (> 2h), BMI ≥ 25, and manual surgical techniques as significant risk factors for 90-day events. Robotic-assisted surgery, although not statistically significant (p = 0.105), showed a trend towards reducing complications in outpatient THA. Outpatient THA is a safe alternative to inpatient surgery, with no significant difference in 90-day postoperative events. Robotic-assisted surgery appears to reduce complications, particularly in the outpatient setting, and may optimize outpatient care pathways. Further research is needed to confirm these findings and explore long-term outcomes. III.

Bridging the continuity: Practice-enhancing publications about the ambulatory care medication-use process in 2023.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. This article identifies, summarizes, and prioritizes published literature on the ambulatory care medication-use process (ACMUP) from 2023 that can describe ambulatory pharmacy practice. The medication-use process is the foundational system that provides the framework for safe medication utilization within the healthcare environment. The ACMUP is defined in this article as having the following components: transitions of care, prescribing, access, dispensing, adherence, and evaluating. Articles evaluating at least one step of the ACMUP were assessed for their usefulness toward practice improvement. A PubMed search was conducted in January 2024 for the publication year 2023 using targeted Medical Subject Headings (MeSH) keywords and the table of contents of selected pharmacy journals, providing a total of 2,903 articles. A thorough review identified 52 potentially practice-enhancing articles: 6 for transitions of care, 11 for prescribing, 5 for access, 6 for dispensing, 8 for adherence, and 16 articles for evaluating. Trends gleaned from the highest-impact articles are described. It is important to routinely review the published literature and to incorporate significant findings into daily practice. This article continues a series of articles defining and evaluating the currently published literature around the ACMUP. As healthcare continues to advance and care shifts to ambulatory settings, the ACMUP will continue to be a crucial process to evaluate.

Emergency medicine transformation to improve hospital admissions and patient outcomes: Emergency ambulatory care model in Hong Kong

Emergency medicine transformation to improve hospital admissions and patient outcomes: Emergency ambulatory care model in Hong Kong

Outpatient Palliative Care and End-of-Life Care Intensity: Linking Massachusetts Cancer Registry with All-Payer Claims.

Early palliative care is associated with better outcomes for patients with advanced-stage cancers. Using a novel data linkage, we assessed outpatient palliative care use before death and its association with end-of-life care intensity and variation across eight provider networks. We linked Massachusetts Cancer Registry and the All-Payer Claims Database for individuals with commercial insurance, Medicaid or Medicare Advantage diagnosed with colorectal, lung, prostate, and breast cancers from 2010 through 2013 who died by December 31, 2014. We characterized outpatient palliative care visits in the 6 months before death and identified end-of-life hospitalizations, emergency department visits, intensive care unit admissions, chemotherapy, no/late hospice enrollment, and in-hospital deaths. We used logistic regression to assess factors associated with outpatient palliative care and ordinal logistic regression with provider network fixed effects to assess the association of palliative care with a composite measure summing individual end-of-life intensity measures. Among 6,279 decedents, 11.3% had at least one outpatient palliative care visit. Palliative care use varied across provider networks from 6.0% to 19.3%. In adjusted analyses, younger age, longer duration from diagnosis to death, death in 2012-2014 vs. 2010, and provider network were associated with palliative care visits (all P < 0.05). End-of-life care intensity varied across provider networks. Patients with palliative care visits had lower adjusted odds of receiving intensive end-of-life care (adjusted odds ratio (OR) 0.62 per additional measure of end-of-life intensity, 95%CI 0.53, 0.72). Outpatient palliative care use varied substantially among regional provider networks and was associated with less intensive end-of-life care.

Standardized Reporting of HCC with LI-RADS and mRECIST: Update on the Situation in Germany.

Online survey about the current status of CT protocols in hepatocellular carcinoma (HCC) in the year 2023/2024. Moreover, the usage of structured reporting using LI-RADS and mRECIST was surveyed and the results were compared with a survey from 2020.Radiologists working in outpatient or inpatient care in Germany were invited. The survey was conducted between 10/2022 and 06/2023 and between 06/2024 and 08/2024. HCC-related questions were asked regarding the commonly used imaging modalities, body coverage, and contrast phases in CT, as well as the usage of structured assessment and treatment response using mRECIST and LI-RADS.More than half of the participants stated that they "frequently" perform imaging of HCC. In the CT protocol, acquisition of a pre-contrast phase was widespread. While a late arterial and a portal venous contrast phase was acquired in most cases, a delayed phase was used much less frequently (at small and medium-sized hospitals only in 26.5%). For staging, LI-RADS was used in structured reports in only 13%; for response monitoring mRECIST was used at university hospitals in only 26.5% and LI-RADS in 14.7%, whereas these have been almost never used in routine practice at all other sites. The main reasons given for the lack of application were the expenditure of time, the lack of reporting templates, problems with integration into the IT infrastructure and a lack of reimbursement.The recommendation of a three phase CT examination in late arterial, portal venous, and delayed phase for HCC diagnostics according to LI-RADS is only partially implemented in Germany. Structured reporting for staging and response monitoring using LI-RADS and mRECIST was at a similarly low level in Germany in 2023 compared to 2020. Possible solutions include the development and distribution of online educational resources, structured reporting templates, and inexpensive IT solutions. · The CT protocols in HCC diagnostics in Germany differ considerably with regard to the contrast phases acquired.. · Definition of a late arterial (approx. 15-20s p.i.; 5-15s after aortic peak), portal venous (approx. 60-80s p.i.) and delayed phase (2-5min p.i.) as well as a pre-contrast phase only after TACE may improve quality of CT diagnostics of HCC.. · The use of structured reporting using LI-RADS, LR-TR and mRECIST in HCC remained low in 2023/2024, similar to 2020.. · The use of LI-RADS and mRECIST could be improved by providing online educational resources, structured reporting templates, and inexpensive IT solutions.. · Nelles C, Ristow I, Juchems MS et al. Standardized Reporting of HCC with LI-RADS and mRECIST: Update on the Situation in Germany. Rofo 2025; DOI 10.1055/a-2438-1670.

Nurse-Led Service Model for Outpatient Pain-Free Management Under Anesthesiologist Supervision: A Single Center, Observational Study in China.

The efficacy of establishing an intensification outpatient center for diagnostic and treatment endoscope services has been documented, but its practical implementation remains limited. Presently, there are two models for outpatient endoscope care services: the clinical specialty-based model and the solitary outpatient model. However, each model has its limitations. In this study, we introduce a nurse-led service model that offers comprehensive care throughout the entire journey for patients undergoing painless endoscopic treatment procedures outside the operating room overseen by anesthesiologist and report its implementation in an university-affiliated hospital. A single-center observational study. Data was collected all of 2013 and 2022 at a tertiary medical hospital center. A total of 168,100 patients undergoing endoscopic anesthesia were included in the analysis. Patients receiving endoscopic diagnosis and treatment were divided into two groups: the Model-2013 (clinical specialty endoscopy service model, from January to December 2013) and the Model-2022 (nurse-led service model under the supervision of anesthesiologists, from January to December 2022). We conducted a retrospective analysis of workload data and compared the nursing quality management index of endoscopy center between Model-2013 and Model-2022. In 2013, the workload for digestive endoscopy was 28,864 procedures, while in 2022, it had significantly increased to 139,236 procedures. Patient satisfaction had risen from 93.99% to 95.25%, and the satisfaction of the collaborative team increased from 91.77% to 98.10%. The endoscopic cancellation rate dropped from 13.56% to 8.75%. The quality indicators for anesthesia nursing and endoscopy nursing had improved significantly without an increase in equipment and nursing costs (p < .05). The nurse-led service model for patients undergoing painless endoscopic procedures outside the operating room can enhance service efficiency and patient safety and satisfaction, and can serve as a viable alternative to the traditional models based on clinical specialty and independent single endoscopy department.

Timely access to specialist outpatient care: can applying systems thinking unblock our waiting lists?

BackgroundThe purpose of this qualitative study was to focus on review and repeat review outpatients and the structural role they play in exacerbating waitlists for Specialist Outpatient (SOP) services in Queensland. Waitlists, which record the number of patients waiting for an initial consultation (new appointment), are an indicator of a health system under strain. Waiting too long to access SOP can have a detrimental effect on people’s health outcomes. Not tackling the structural drivers of waitlists can result in non-systemic, non-sustainable fixes that perpetuate waitlists and detrimental outcomes. Patients should be discharged from specialist care when the episode of care is completed, provided appropriate care is available. When review patients remain in the SOP system, they impact the number of new appointments available.MethodsThis paper uses a feedback systems approach to make transparent the touchpoints, dynamics and impact of review and repeat review appointments on waitlists. The evidence used to construct the causal loop diagrams (CLD) in this paper was an output of Group Model Building (GMB). Two facilitated half-day participatory workshops were held in April and June 2023. The project brought together researchers, consumers, hospital and health services (HHS) specialty clinical leads, General Practitioners (GPs), Executive sponsors, HHS outpatient service managers and analysts to provide hospital and healthcare expert stakeholders an opportunity to translate their collective mental models into meaningful system diagrams which communicated how the outpatient system was working.ResultsThe CLD provided a cross-boundary visual of how the review and repeat review appointment contributes to the waitlist. It shows that the review and repeat review outpatients are a hidden feedback loop contributing to growing waiting lists. In the absence of a discharge planning intervention, they have the potential to become a vicious cycle that grows review appointment demand, consuming the availability of new appointments.ConclusionsA feedback systems approach can enhance SOP system understanding, ultimately shifting policy response in health away from local “firefighting” fixes towards more sustainable systemic solutions which promote timely outpatient access. The results suggest that the review patient process impacts the waitlists and should be viewed as a leverage point in the management of growing specialist outpatient waitlists.

Barriers and facilitators to the implementation of PHAROS, a perioperative pharmaceutical management intervention for older adults – a qualitative interview study from the perspective of healthcare providers

BackgroundNumber of drugs are increasing with older age and present a risk factor for various adverse health outcomes. A comprehensive medication therapy management (MTM) before admission for elective surgery may help reduce unnecessary and potentially inadequate medications (PIM) and thus improve patient health. Our goal was to evaluate the implementation of PHAROS, a perioperative MTM intervention study, from the perspective of health care providers. The PHAROS intervention aimed to improve medication appropriateness in older inpatients at the outpatient / inpatient interface.MethodsWe performed a qualitative interview study within a pilot intervention study comparing a comprehensive MTM with standard care in older inpatients (≥ 65 years) in Germany. Semi-structured interviews with health care professionals were performed from March to July 2021. The Consolidated Framework for Implementation Research (CFIR) was used to guide development of interview guide, data coding, analysis, and reporting of findings.ResultsTen health care professionals involved in the implementation of PHAROS were interviewed. Based on CFIR-constructs, facilitators included need for and meaningfulness of the intervention as well as positive and supportive cooperation within the project team. Implementation of MTM at the interface of inpatient to outpatient care before elective surgery was hampered by personal and organizational barriers as well as barriers resulting from broader health care structures in Germany. In particular, lack of documentation standards, missing compatibility with clinical workflow, difficulties in stakeholder engagement, as well as communication barriers between outpatient and inpatient care interfaces hindered implementation of the intervention.ConclusionsFurther studies should consider focusing on facilitators to pharmaceutical implementations such as transparent and clear communication structures between stakeholders, standardization of medication documentation, and intervention structures that are adapted to hospital workflows.Trial registrationhttps://drks.de Identifier: DRKS00014621, this study was part of the PHAROS study.

Diabetes mellitus and obesity: risk optimization before surgical interventions

The prevalence of obesity has increased significantly in recent years and is acausal risk factor for the development of type2 diabetes. Moreover, chronic degenerative joint diseases are also triggered by obesity. Both obesity-related secondary diseases-type2 diabetes and chronic degenerative joint disease-can be prevented or at least delayed by lifestyle intervention aimed at weight reduction. The progression of these diseases can also be favourably influenced by radical weight loss. Diets with areduction in carbohydrates-aso-called "low-carb" or ketogenic diet-appear to be superior to alow-fat diet. If joint replacement surgery is necessary, preoperative and perioperative interdisciplinary care by ateam of experienced therapists from the fields of orthopaedics and obesity/type2 diabetes is required. The Düsseldorf TeDia model in the network of Catholic hospitals in Düsseldorf takes these requirements into account by providing interdisciplinary care for such patients at the orthopaedic centre at St. Vinzenz Hospital Düsseldorf and the West German Diabetes and Health Centre (WDGZ). Patients with pronounced obesity or diabetes mellitus are presented preoperatively at the WDGZ on an outpatient basis, and weight reduction therapy or optimization of the diabetic metabolic situation is initiated. If joint problems persist despite weight reduction or pronounced degenerative changes that require surgery, the WDGZ provides inpatient diabetology care in the orthopaedic clinic with the option of further outpatient follow-up care.

Transfer from long-term care to acute care and risk of new permanent cognitive or physical disability among long-term care residents in Canada: protocol for a retrospective cohort study

IntroductionLong-term care (LTC) residents are frequently transferred to acute care hospitals. Transfer decisions should align with residents’ wishes and goals. Decision to transfer to hospital, when not aligned with the...

Firearm injury survivors report extreme high risk for poor physical and mental health outcomes early after hospital discharge necessitating multidisciplinary care

BackgroundUp to 20–40% of survivors of any traumatic injury develop post-traumatic stress disorder (PTSD) or depression after injury. Firearm injury survivors may be at even higher risk for adverse outcomes....

Neighbourhood socioeconomic conditions and emergency admissions for ambulatory care sensitive conditions in children: a longitudinal ecological analysis in England, 2012–2017

BackgroundAmbulatory care sensitive conditions (ACSCs) are those for which hospital admission could be prevented by interventions in primary care. Children living in socioeconomic disadvantage have higher rates of emergency admissions...

Comparison of health-related quality of life in atopic dermatitis, hidradenitis suppurativa, pemphigus and psoriasis

This study aims to explore the measurement agreement between direct and indirect health utility measures in four chronic dermatological conditions (atopic dermatitis, hidradenitis suppurativa, pemphigus, psoriasis). Outpatients survey data collected between 2015 and 2021 were analysed. Health-related quality of life (HRQoL) outcome measures included time trade-off (TTO), EQ-5D-5L and Dermatology Life Quality Index (DLQI). Descriptive statistics were computed for the pooled sample and four diseases. Mean, standard deviation (SD), median, interquartile range (IQR), ceiling and floor effects were calculated for TTO, EQ-5D-5L and DLQI utilities. Bland‒Altman plots and intraclass correlation coefficients (ICC) were applied to investigate the agreement between health utility measures. Sociodemographic characteristics (age, sex, educational level, employment status) and health-related information (disease duration, outpatient care visits in the past 3 months and disease severity) impact on utilities was investigated by Tobit regressions. The sample includes N = 765 patient responses with a mean age of 41.5 (SD = 16.2), majority being males (52.7%). Total sample mean utilities were the highest according to TTO (0.83), followed by EQ-5D-5L and vDLQI (0.81 and 0.81) and lowest in mDLQI (0.77). Measurement agreement was found only between TTO and EQ-5D-5L. Skin-disease severity impacted all health state utilities, though only TTO differentiated utility values according to disease type. The discrepancies between the TTO and DLQI warn to compare DLQI-based utilities in different dermatological conditions with extreme caution.

Malignant Hematologic Oncology Referrals to an Outpatient Palliative Care Clinic at a Tertiary Cancer Center.

Hematological malignancies represent a heterogeneous group of diseases with variable and often unpredictable illness trajectories. Comparisons between hematological and solid tumor malignancy referrals to an outpatient palliative care clinic have not been explored. This study compared characteristics, referral trends, and time from first palliative care clinic visit to death between patients with hematological and solid tumor malignancies. A retrospective review of palliative care clinic referrals at a tertiary cancer center from January 1st, 2018 to December 31st, 2022 was conducted. Clinical and demographic data, symptom burden, performance status, and time from first palliative care clinic visit to death were compared. Of 5230 outpatients, 283 (5.4%) had a hematological malignancy (107 [38%] leukemia, 98 [35%] lymphoma, and 78 [28%] multiple myeloma). Patients with leukemia and lymphoma had similar symptom burden to solid tumor malignancies; patients with multiple myeloma had significantly more pain (P < 0.0001) and constipation (P = 0.005). Patients with hematological malignancies had worse performance status compared with solid tumor malignancies (ECOG ≥3 for 37.9% leukemia, 35.0% lymphoma, and 31.6% multiple myeloma vs. 19.6% solid tumor malignancies, P < 0.0001). At 12-months from first palliative care clinic visit, survival probabilities were 27.6% for leukemia, 42.2% lymphoma, and 69.5% multiple myeloma vs. 39.5% solid tumor malignancies. Patients with hematological malignancies experience at least similar symptom burden to those with solid tumor malignancies referred to a palliative care clinic, and worse performance status, factors that should be considered when designing palliative care clinic interventions for patients with hematological malignancies.

Emerging Healthcare Trends in Prosthetic Treatment of Hand Osteoarthritis.

Background: For many years, advancements in hand joint replacement (JR) were relatively minor compared to those for large joints. However, the caution previously exercised due to high complication rates is gradually being replaced by the expanding use of JR therapies for small joints in the hand. Despite this progress, there is a lack of comprehensive data on the outcomes of hand JR and on the optimal infrastructure required to meet the growing demand for these therapies. Methods: This study examined trends and revision rates of JR for thumb carpometacarpal (CMC-1) and finger (MCP and PIP) joints in both inpatient and outpatient settings in Germany. Data from the Federal Statistical Office of Germany (Destatis) and the Central Institute for Statutory Health Insurance Physicians (ZI) were analyzed, focusing on the incidence, demographics, and outcomes of these procedures. Results: This study found a substantial national increase in prosthetic treatments specifically for CMC-1, with a 2.18-fold rise in the outpatient sector compared to a 1.65-fold increase in inpatient treatments. Despite this shift, 83.7% of JR procedures were still performed in an inpatient setting. Conclusions: The overall complication rates appear to be declining, suggesting that while the management of these procedures is shifting towards outpatient care, the quality remains stable.

Impact of an Oregon health policy aimed at strengthening adolescent linkage to outpatient mental health care from the emergency department.

Oregon introduced a state policy, HB 3090, on October 6, 2017, which increased requirements on emergency departments (EDs) to improve transitions to outpatient mental health care. The objective of this study was to examine the policy's impact among low-income adolescent patients who face severe barriers to follow-up. This was a retrospective cohort study of visits by Medicaid enrollees ages 14-18 presenting to any Oregon ED for a mental health concern between January 1, 2016, and December 31, 2019. We calculated standardized mean differences and used interrupted time series models to evaluate the association of HB 3090 with 14-day mental health follow-up, in-ED services, and inpatient admissions, adjusting for gender, race/ethnicity, primary language, and calendar months. Among 26,071 adolescent mental health-related ED visits, we found an estimated increase of 3.63 percentage points (pp; 95% confidence interval [CI] 0.27 to 6.99) in the adjusted probability of a 14-day outpatient mental health claim postpolicy. However, this effect was attenuated over time, with a slope change of -0.25 pp (95% CI -0.5 to 0) for each month thereafter. The probability of receiving mental health services in the ED or inpatient admission did not change in association with the policy. There was a small increase in short-term outpatient mental health visits after the policy, but the association weakened over time, and other key outcomes did not change. Putting pressure on EDs to perform better in this area is likely to be a minimally effective strategy without accompanying strengthening of mental health resources.

Not all quad bikers are the same: unsupervised cluster analysis identifying injury risk groups among quad bike riders in Dubai, UAE

ObjectiveQuad bike riders in Dubai (UAE) constitute a highly diverse group with varying driving skills and familiarity with the desert environment. In the absence of evidence on the quad bike...

Assessing the financial burden of multimorbidity among patients aged 30 and above in India

BackgroundMultimorbidity is associated with significant out-of-pocket expenditures (OOPE) and catastrophic health expenditure (CHE), especially in low- and middle-income countries like India. Despite this, there is limited research on the financial burden of multimorbidity in outpatient and inpatient care, and cross-state comparisons of CHE are underexplored.MethodsWe conducted a cross-sectional analysis using nationally representative data from the National Sample Survey 75th Round ‘Social Consumption in India: Health (2017–18)’, focusing on patients aged 30 and above in outpatient and inpatient care in India. We assessed multimorbidity prevalence, OOPE, CHE incidence, and CHE intensity. Statistical models, including linear, log-linear, and logistic regressions, were used to examine the financial risk, with a focus on non-communicable diseases (NCDs), healthcare facility choice, and socioeconomic status and Epidemiological Transition Levels (ETLs).ResultsMultimorbidity prevalence in outpatient care (6.1%) was six times higher than in inpatient care (1.1%). It was most prevalent among older adults, higher MPCE quintiles, urban patients, and those with NCDs. Multimorbidity was associated with higher OOPE, particularly in the rich quintile, patients seeking care from private providers, low ETL states, and rural areas. CHE incidence was highest in low ETL states, private healthcare users, poorest quintile, males, and patients aged 70 + years. CHE intensity, measured by mean positive overshoot, was greatest among the poorest quintile, low ETL states, rural, and male patients. Log-linear and logistic regressions indicated that multimorbidity patients with NCDs, those seeking private care, and those in low ETL states had higher OOPE and CHE risk. The poorest rural multimorbidity patients had the greatest likelihood of experiencing CHE. Furthermore, CHE intensity was significantly elevated among multimorbidity patients with NCDs (95% CI: 19.29–45.79), patients seeking care in private, poorest, and from low ETL states (95% CI: 7.36–35.79).ConclusionsThe high financial burden of OOPE and CHE among multimorbidity patients, particularly those with NCDs, highlight the urgent need for comprehensive health policies that address financial risk at the primary care level. To alleviate the financial burden among multimorbidity patients, especially in low-resource settings, it is crucial to expand public healthcare coverage, incorporate outpatient care into financial protection schemes, advocate for integrated care models and preventive strategies, establish standardized treatment protocols for reducing unnecessary medications linked to polypharmacy, and leverage the support of digital health technologies.

Trends in psychiatric emergency visits: insights from France’s largest psychiatric emergency department

IntroductionPsychiatric emergency departments (EDs) in France have been under pressure from several factors, exacerbated by the COVID-19 pandemic. The pandemic led to an increase in psychiatric disorders, particularly anxiety and depression, with younger people and women being most affected. The aim of this study was to provide a comprehensive description of the trends in the number of visits to the largest psychiatric emergency department in France, with a particular focus on the period preceding and following the advent of COVID-19 pandemic.MethodsThis retrospective study analyzed data from 69,764 visits to the Centre Psychiatrique d’Orientation et d’Accueil (CPOA) in Paris from 2016 to 2023. Patient data, including demographics, reasons for visit, and diagnoses, were collected and analyzed to identify trends over this period.ResultsThe study observed a 28.5% increase in ED visits from 2016 to 2023. The increase was primarily driven by mood and anxiety disorders, which showed increases of 38.6% and 75.4%, respectively. The average age of patients decreased, reflecting a younger population increasingly affected by psychiatric problems. Interestingly, despite the increase in ED visits, hospital admissions decreased by 11.9%, with a notable decrease in involuntary commitment.DiscussionThe findings highlight a paradox where increased psychiatric ED visits are not accompanied by an increase in hospital admissions. This suggests a shift toward outpatient care due to systemic factors, including reduced hospital bed availability and challenges in accessing timely outpatient services. This study underscores the need to strengthen outpatient mental health services to effectively manage the growing demand. Further research, especially multicenter studies, is recommended to validate these findings and inform policy changes.