Healthcare Patients Research Articles

Excess mortality and life-years lost in people diagnosed with depression: A 20-year population-based cohort study of 126,573 depressed individuals followed for 1,139,073 persons-years

Depression is associated with premature mortality, but evidence is mainly derived from Western countries. Very limited research has evaluated shortened lifespan in depression using life-years-lost (LYLs), a recently developed mortality metric taking into account the illness onset for life expectancy estimation. Temporal trends of differential mortality gap are understudied. This population-based cohort study, which utilized a territory-wide medical-record database of public inpatient and outpatient healthcare services in Hong Kong, evaluated the extent of premature mortality in 126,573 individuals with depression (persons-years=1,139,073) between January 2002 and December 2021 regarding the standardized mortality ratio (SMR) and excess LYLs. Trends in annual SMRs over 20 years were assessed by joinpoint analyses. The results showed that individuals with depression exhibited significantly higher all-cause (SMR=1.84 [95% CI=1.82–1.88]), natural-cause (1.69 [1.66–1.72]), and unnatural-cause (5.24 [4.97–5.51]) mortality rates than the general population. Suicide-specific SMR was markedly elevated (7.92 [7.47–8.38]), particularly in the 15–34 year-olds (12.75 [10.87–14.79]). Respiratory diseases, cardiovascular diseases and cancers accounted for the majority of deaths. Excess LYLs extended to men (5.67 years, 95% CI = 5.45–5.90) and women (4.06 years, 95% CI = 3.89–4.23). Overall and natural-cause mortality rates improved over time, but unnatural-cause and suicide-related mortality gaps persisted. Taken together, this study indicates that depression is associated with increased premature mortality and reduced lifespan in a predominantly Chinese population, mainly attributed to natural causes. Relative suicide-specific mortality is substantially elevated, especially among young people. The pronounced mortality gap underscores an urgent need for effective interventions targeting improved physical health and suicide risk reduction in individuals with depression.

Abstract 4135899: Large-Scale Investigation on the Outcomes of Atrial Fibrillation Ablation in Liver Cirrhosis Patients

Background: Catheter-based atrial fibrillation(AF) ablation is amongst the most commonly done EP procedures that have evolved over decades, improving patient outcomes and quality of life. Atrial fibrillation is seen in 5% of patients with cirrhosis and studies have shown AF in cirrhosis to be associated with increased mortality and adverse hospital outcomes. Aim: There is scarce literature on the outcomes of AF ablation in patients with cirrhosis. Our study aimed to study the safety and efficacy of catheter-based AF ablations in this population group and to ascertain if there is a difference compared to the general patient population. Methods: We used the Nationwide Inpatient Sample Database 2016-2020, the largest openly accessible inpatient healthcare database in the United States. Patients with a primary diagnosis of AF were identified using ICD-10 codes. We excluded patients with a secondary diagnosis of other arrhythmias, missing demographics, mortality, or age<18. The study population was divided into patients with and without cirrhosis. Information was collected regarding various patient demographic characteristics and comorbidities (comorbidity burden captured via Elixhauser Comorbidity Index). The primary endpoint was in-hospital mortality. The secondary endpoints were total complications, length of stay, and hospitalization charges. Results: A total of 23,905 patients underwent ablation, with 23,800 being non-cirrhotic, and only 105 presenting with cirrhosis. This signifies a relatively low proportion of cirrhotic patients undergoing ablation procedures, approximately 0.6% (105 out of a total of 17,600 cirrhotic patients). Additionally, the Elixhauser comorbidity index is significantly higher in cirrhotic patients (6.62) compared to non-cirrhotic patients (3.65) with a p-value <0.001, indicating a higher burden of comorbidities in the cirrhotic group. Patients with cirrhosis undergoing ablation procedures exhibit a notably higher risk of major bleeding compared to those without cirrhosis (14.3% vs. 4.06%, p-value = 0.02). Furthermore, the incidence of bleeding requiring transfusion is significantly elevated in cirrhotic patients (4.8%) in contrast to non-cirrhotic patients (0.2%) (p-value < 0.001). Conclusion: Although the risk of major bleeding is high, overall mortality and other complications are comparable to those without cirrhosis. We believe that this can be mitigated by carefully selecting the patients with cirrhosis for this procedure.

Economic burden of inpatient hospitalizations for pediatric chronic kidney disease in the US.

Children with chronic kidney disease (CKD) face extensive healthcare needs, leading to substantial financial strain on both families and healthcare systems due to costly kidney replacement therapies and associated comorbidities. Limited research on inpatient healthcare utilization is available for the individual stages of pediatric CKD. This retrospective cohort study included inpatient encounters for pediatric patients (≤ 18years) using the Pediatric Health Information System Database (PHIS) between January 2016 and December 2022, with an ICD-10 code for any CKD stage (1-5). Hospitalization cost, length of stay (LOS), morbidity, and mortality data were collected. We identified 23,980 pediatric CKD cases [stage 1: 5,059, stage 2: 6,763, stage 3: 7,012, stage 4: 3,102, and stage 5: 2,044] across 49 different children's hospitals in the United States. Mortality rates were observed to increase with increasing CKD severity, but no clear trend was observed for surgical, medical, and infection rates by CKD stage.The LOS for patients with CKDstage4 and CKDstage5was56% and71% longer relative to the LOS of a typical hospitalization for a patient without CKD, and thebilled chargesfor these hospitalizations were92% and147% higher than those of a typical hospitalization. LOS and hospitalization costs were significantly higher for patients with CKD than for patients without CKD. Furthermore, pediatric patients with stage 5 CKD had significantly higher in-patient costs and all-cause hospitalization LOS compared to those with CKD stages 1-4.

Utilization of Syndromic Vaginitis Diagnostic Testing Reduces 6-Month Follow-Up Outpatient Service Healthcare Costs—A Real-World Data Analysis

Background/Objectives: Vaginitis is a common infection among women of reproductive age. Although various diagnostic methodologies exist, diagnosis without the utilization of available diagnostic tests remains prevalent. This study aimed to assess downstream healthcare utilization and the cost of patients with and without diagnostic testing. Methods: This retrospective, observational study utilized the IQVIA PharMetrics® Plus database from July 2020 to October 2023. Patients with an index claim (ICD-10 code indicating vaginitis) were categorized into two cohorts: those who received a syndromic polymerase chain reaction (PCR) test and those who had no documented test on the index date or within two days. Total and service-specific healthcare resource utilization and costs were assessed for 6 months following the index event. This study was designed to inform how Syndromic Vaginitis PCR testing is used to make treatment decisions and to track outpatient and inpatient healthcare utilization for 6 months post index date represented by cost. Results: Patients who received a Syndromic Vaginitis PCR test had significantly fewer outpatient medical services in the 6 months following initial diagnosis compared to those who received no diagnostic test. This was largely attributed to a substantial decrease in other medical service visits, resulting in mean cost savings of USD 2067 (Syndromic PCR = USD 6675, SD = USD 17,187; No Test = USD 8742, SD = USD 29,894) (p-value 0.0009). Conclusions: Many vaginitis patients do not receive testing, but Syndromic Vaginitis PCR testing may be an effective diagnostic tool for reducing costs associated with vaginitis infections.

A GARANTIA DA SAÚDE MENTAL NO SISTEMA PRISIONAL : DESAFIOS E RESPONSABILIDADES DOS ENTES FEDERATIVOS A PARTIR DA PNAISP

The present study aims to analyze the challenges and responsibilities of federal entities in the implementation of the National Policy for Comprehensive Health Care for Persons Deprived of Liberty (PNAISP), focusing on ensuring mental health care for inmates. It is a bibliographic research that seeks to understand the impacts of this policy in the context of the Brazilian prison system. The methodology involves the selection of scientific articles, legislation, and manuals from the Ministry of Health, available in databases. The results indicate that PNAISP has been implemented slowly and gradually, facing obstacles such as low municipal adherence and insufficient coverage by Family Health Teams, with a predominantly curative focus. It is concluded that, despite significant advances over previous administrations, the full implementation of PNAISP depends on greater coordination among federal entities and active participation of civil society through health councils, in addition to the implementation of concrete actions that ensure access to mental health care in the prison system.

Unplanned 180-day Readmissions and Healthcare Utilization After Immediate Breast Reconstruction for Breast Cancer.

To assess the burden of post-discharge healthcare utilization given by readmissions beyond 30-days following immediate breast reconstruction (IBR) nationwide. Women with breast cancer who underwent mastectomy and concurrent IBR (autologous and implant-based) were identified within the 2010-2019 Nationwide Readmission Database. Cox proportional hazards and generalized linear regression controlling for patient- and hospital-level confounders were used to determine factors associated with 180-day unplanned readmissions and incremental hospital costs, respectively. Within 180 days 10.7% of 100,942 women were readmitted following IBR.. Readmissions tended to be publicly insured (30.8% vs. 21.7%, P<0.001), and multimorbid (Elixhauser comorbidity index >2 31.6% vs. 19.6%, P<0.001) compared to non-readmitted patients. There were no differences in readmission rates amongst types of IBR (tissue expander 11.2%, implant 10.7%, autologous 10.8%; P>0.69). Of all readmissions, 40% occurred within 30 days and 21.7% in a different hospital, and 40% required a major procedure in the operating room. Infection was the leading cause of readmissions (29.8%). In risk-adjusted analyses, patients with carcinoma in situ, publicly insured, low socioeconomic status, and higher comorbidity burden were associated with increased readmissions (all P<0.05). Readmissions resulted in additional $8,971.78 (95% CI: $8,537.72-9,405.84, P<0.001) in hospital costs which accounted for 15% of the total cost of immediate breast reconstruction nationwide. The majority of inpatient healthcare utilization given by readmissions following mastectomy and IBR occurs beyond the 30-day benchmark. There is evidence of fragmentation of care as a quarter of readmissions occur in a different hospital and over one-third require major procedures. Mitigating postoperative infectious complications could result in the highest reduction of readmissions.

Exploring the communication access and participation of a young adult with autism spectrum disorder with limited speech and inpatient nursing staff

This study aimed to describe the nature of interactions between health care professionals and a young adult with autism spectrum disorder with limited speech during an inpatient stay. An observational study was conducted to describe the interactions between a young adult on the autism spectrum and 14 of his inpatient health care providers. Naturalistic video-recordings were taken, and behavioral coding was completed to measure the frequency and type of communication turns taken. The providers took 93% of conversational turns. Most provider turns (76%) were non-obligatory in nature and did not invite the young adult to engage in turn-taking. The young adult only had access to his communication system during one of the 27 interactions (4%); however, when he had access to his system, he demonstrated higher levels of turn-taking. Health care providers should offer patients with limited speech more communicative turns, provide adequate wait time, and ensure communication systems are available during all inpatient interactions.

Telemedicine: Future of the healthcare system and its impact on patient satisfaction: A literature review

ABSTRACT Background and Objectives: The utilization of telemedicine has increased dramatically since the onset of the COVID-19 pandemic. In this review, we examined studies published within the past five years that investigated the impact of telemedicine on patient satisfaction. Methods: Four investigators utilized PubMed and Google Scholar to find studies published within the past five years that assessed patient satisfaction with telemedicine in the field of adult primary care, using either the Press Ganey or CAHPS surveys. Studies that compared cost and quality of care between telemedicine and in-patient healthcare were also included to address the secondary aims of this study. Results: A total of 11 studies out of the 405 that were investigated were selected for this review. Five studies found no significant difference in patient satisfaction between telemedicine and in-person medicine, with one of those showing a patient preference for telemedicine. One study demonstrated significantly higher satisfaction with in-person medicine vs. telemedicine. Another study found that most physicians and patients reported no perceived difference in quality of care between telemedicine and in-person visitation. One study found no difference in patient satisfaction with telemedicine between immigrants and non-immigrants. Another study showed that patients have higher satisfaction when using telemedicine with their PCP vs. an unfamiliar provider. Two studies found telemedicine to be cost-effective. Conclusions: Our review concludes that patient satisfaction with telemedicine is not inferior to that with in-person visits. However, further research should be conducted to determine various factors that may affect patient perception and satisfaction.

Inpatient Falls: Epidemiology, Risk Assessment, and Prevention Measures. A Narrative Review.

Background Patient falls are a common inpatient dilemma and comprise the largest category of preventable adverse events in hospitalized patients. These events place a clinical burden on the patient, such as increased morbidity and reduced quality of life, in addition to an economic burden on the hospital system. Fall prevention strategies have the opportunity to decrease inpatient health care costs and length of stay. Several risk factors have been identified that contribute to inpatient falls and several strategies have been identified to minimize this risk. These risk factors are typically characterized as intrinsic and extrinsic factors. Intrinsic factors include characteristics such as age, gender, impaired mobility, and physiological factors (eg, co-morbidities, low muscular strength, visual impairment, poor reaction time, and movement disorders). Extrinsic factors are related to characteristics in the environment, such as slippery surfaces, footwear, bad lighting, and the influence of medications. Risk assessment tools, such as the Hendrich II Fall Risk Model, Morse Fall Scale, and STRATIFY, were developed to help identify those at risk. In utilizing these models and our understanding of predisposing risk factors, prevention strategies may be utilized to mitigate these risks. These strategies are often generalized actions including patient education; however, targeted interventions (ie, patient education) also improve outcomes by interrogating specific risk factors.

Analysis of Transparency and Accountability of the Health Operational Assistance (BOK) Budget at Sirombu Inpatient Health Center

Health Operational Assistance (HOA) is a fund that is used to ease the public burden on financing the health sector, especially service in community health centers, reduction in maternal mortality, infant mortality and malnutrition. Puskesmas Sirombu as a health service unit is used as a medical center for the welfare of the community, but in reality the Puskesmas Sirombu has not been optimal in realizing the budgeted funds. This study aims to determine the transparency and accountability of budget execution Bantuan Operasional Kesehatan (BOK) at Puskesmas Rawat Inap Sirombu in 2021. The research sample was taken using the method purposive sampling (specific goals or criteria). The data analysis technique used is triangulation method which combines in-depth interviews and document searches and triangulation of sources using different information to do cross check information from several sources, to improve the results of the data obtained when getting different data. Based on the research results, it can be concluded that the Puskesmas Sirombu has implemented its transparency and accountability well but has not been optimal in managing the budget for transportation assistance for Health Operational Officers (BOK), this can be seen from the fact that some of the budget was not realized.

Virtual Hospitals and Patient Experience: Protocol for a Mixed Methods Observational Study.

Virtual care is increasingly incorporated within routine health care settings to improve patient experience and access to care. A patient's experience encompasses all the interactions an individual has with the health care system. This includes a greater emphasis on actively involving carers in the decisions and activities surrounding a patient's health care. This study aimed to investigate the variety of health care delivery challenges encountered in a virtual hospital and explore potential ways to improve the patient experience. Focusing on acute respiratory, this protocol outlines a mixed methods study exploring the patient experience of a virtual hospital in Australia, Royal Prince Alfred Virtual Hospital (rpavirtual). We will use an exploratory mixed methods approach comprising of secondary data analysis, observations, interviews, and co-design focus groups. Participants will include patients, their carers, and health care workers who are involved in the acute respiratory virtual hospital model of care. Together, the data will be triangulated to explore views and experiences of using this model of care, as well as co-designing recommendations for further improvement. Findings from this study will identify current barriers and facilitators to implementing virtual care, such as work-as-done versus work-as-imagined, equity of care, the role of carers, and patient safety during virtual care. As of August 2024, a total of 25 participants have been interviewed. This protocol outlines a mixed methods case study on the acute respiratory model of care from Australia's first virtual hospital, rpavirtual. This study will collect the experiences of patients, carers, and health care workers to co-design a series of recommendations to improve the patient experience. DERR1-10.2196/58683.

Patients’ experiences of racism in German inpatient healthcare

Abstract Background Racism is recognised as a social determinant of health. An evolving concern in research and policymaking has been the impact of racism in the healthcare system, particularly regarding the quality of healthcare and barriers for healthcare. Little is known about patients’ experiences of racism in hospitals and rehabilitation facilities in Germany and their coping strategies in dealing with racism. Methods As part of a joint project on racism in healthcare (RiGeV) funded by the Federal Ministry of Education and Research, twenty qualitative interviews and two group discussions with patients and their next of kin about their experiences in hospitals and rehabilitation facilities were conducted and analysed using the documentary method. Ethical approval for this study was obtained from the Ethics Committee of Fulda University of Applied Sciences. Results Interviews with patients and their next of kin revealed that the most significant experiences of racism in hospitals are attributions of dramatisation and exaggeration of pain, embedded in a general perception of not being taken seriously and/or being ignored. Patients try to avoid such experiences that compromise their trust and sense of security, as well as the quality of treatment they receive. Healthcare for refugees is impacted by structural barriers (AsylBLg) which jeopardise the healing process and represent a considerable psychosocial burden. Conclusions Recommendations for policies and practice include a mission statement for non-discriminatory treatment and the sanctioning of racism within healthcare institutions. A complaints office should manage implementation and offer support for affected patients. The topic of racism must be addressed in the training and further education of doctors and healthcare professionals. Patient trust in a safe and high-quality form of healthcare should be strengthened by addressing their complaints. Health care for refugees has to be improved. Key messages • Racism in German inpatient healthcare represents a considerable psychosocial burden for patients and impairs the quality of treatment they receive. • Policies for reducing racism inpatient healthcare have to be implemented.

Trends and patterns in pulmonary arterial hypertension-associated hospital admissions among methamphetamine users: a decade-long study.

Pulmonary arterial hypertension (PAH) is a rare, chronic, progressive form of pulmonary hypertension in which increased arterial pressure causes remodeling of the arterial system and is associated with heart failure. Methamphetamine is a stimulant that has recently become a focus in PAH research, but the recent trends and demographics of this cohort of patients are not known. The study aimed to analyze the overall trends and demographics of PAH patients with and without concurrent methamphetamine usage. The study used the National Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), and Agency for Healthcare Research and Quality (AHRQ) from 2008 to 2020 to calculate nationally weighted estimates for both conditions by ICD-9 and ICD-10 diagnosis codes. We used several statistical measures, including descriptive statistics with design-based chi-square and t-tests, trend analysis with Cochran-Armitage test, generalized linear models, and other data preprocessing measures. A significant increase was evident in patients with pulmonary arterial hypertension (PAH) and concurrent methamphetamine use (9.2-fold). Most of the hospitalized patients were males (59.16%), aged 41-64 (45.77%), White (68.64%), from the West (53.09%), with Medicaid (50.48%), and with median income <$25,000. The rate of increase over the period was higher for males (11.8-fold), race (not sure which race; please check and modify), aged 41-64 (11.3-fold), and in the South (15.1-fold). An overall adjusted prevalence ratio (PR) for PAH hospitalizations among concurrent methamphetamine users was 32.19 (CI = 31.19-33.22) compared to non-users. With respective reference categories, the significantly higher PR was evident for males, patients aged 41-64, White, with Medicare, median income <$25,000, all regions compared to Northeast, length of hospital stays, and conditions, including chronic pulmonary disease, diabetes, hypertension, obesity, and peripheral vascular disorders. This study reveals a national overall and demographic-specific trend of increasing PAH with concurrent methamphetamine usage and associated factors. The findings may help to understand the current patterns and identify the vulnerable sociodemographic cohorts for further research and to take appropriate policy measures.

Experiences with paediatric hospital health care: a cross-sectional study among paediatric patients

Abstract Background The measurement of patient experiences is gaining importance in many healthcare systems, including the Slovenian one. The need for a national survey on patient experiences in the paediatric inpatient settings emerged recently. Methods The survey took into account various aspects of inpatient healthcare such as admission, hospital staff, safety, food and discharge from hospital. As part of the study, children/parents were able to give praise and suggestions for improvements. We used three different questionnaires adapted to the cognitive abilities of children - a child questionnaire for the age group 9-13 years in paper form, an online adolescent questionnaire for the age group 14-18 years, and an online parent questionnaire for the age group 0 (1 month)-8 years. The questionnaires were cognitively tested and piloted before national rollout. Results The national survey was conducted between September 2023 and March 2024 and included paediatric patients who spent at least one night in an acute paediatric hospital ward. The survey included 25 paediatric wards and totally 1965 questionnaires were valid for analysis. The rough response rate was 17,6 %. The first preliminary results of the qualitative analysis suggest that surveyed paediatric patients and their parents rate highly inpatient health care services received, however they point out also to areas that need improvement such as environmental factors (noise, temperature), food, infrastructure (outdated facilities &amp; equipment) and in some cases attitude of hospital staff. Conclusions National institute of public health carried out the first national survey on paediatric patient reported experience measures in acute hospitals in Slovenia. The results of this survey will be used to improve the quality of inpatient health care services in paediatric wards, as well renew focus on the requirements of European charter of children rights and United Nations Convention on the Rights of the Child. Key messages • National institute of public health carried out the first national survey on paediatric patient reported experience measures in hospitals in Slovenia. • The results of this survey will be used to drive hospital quality improvements.

Development of health care expenditures in Finland up to 2040

Abstract Background Increasing health care expenditures are threatening public health by complicating the supply of adequate health services. Exploration of possible future developments of the expenditures is needed to understand how to prepare for future or to change an unwanted course of development. We provided projections by health care sectors taking into account demographic and other developments. Methods We used national data on the realized expenditures per capita by age group, sex and health care sectors from 2017 to 2020, and official forecasts of the population in Finland up to 2040. Future per capita expenditures were projected with Bayesian linear regression models incorporating a priori dependency structure for the slope parameters of the age groups such that the time trends of adjacent groups would be more similar than other groups. These projections were then combined with the population forecasts to estimate the total expenditures. Results The greatest increase (164%) was estimated for the total costs of the primary outpatient healthcare: from 2153 to 5677 million euros in 2020-2040, such that 7% of the growth was attributed to demographic developments. The estimated growths were 68% for the primary inpatient healthcare, 14% for the specialised somatic healthcare, and 52% for the urgent and emergency health services, of which 91%, 98% and 21% were attributed to demographic developments, respectively. Conclusions Notable increases in expenditures are expected in all considered health care sectors, but there are great differences in the proportions of the growth attributed to demographic developments. Due to the limited role of demographic changes, it is worth focusing on controlling the impacts of other developments by, e.g., improving the population health and the efficiency of the health care system. Key messages • Notable increases are expected in health care expenditures up to 2040. • Impacts of demographic changes varies markedly between health care sectors.

Racism in inpatient settings in Germany: professionals’ perspectives

Abstract Background Experiences of racial discrimination during healthcare encounters have increasingly been recognised as a source of health inequity. Narrative accounts by racialised healthcare users have dominated research in the field but it is equally important to capture the perceptions and practices of professionals to understand how racism operates in healthcare provisioning. This presentation asks: how does racism manifest in the German inpatient healthcare system (hospitals, rehabilitation facilities), and are there areas or phases of healthcare provisioning where racism is observed more frequently? Methods Problem-centred expert interviews (Döringer 2021) with 20 healthcare professionals from medicine, nursing, and therapeutic professions working in hospitals or rehabilitation facilities across three German federal states. Data were analysed using documentary method (Bohnsack 2002). Results Racism occurs widely in German inpatient settings. It manifests both structurally, e.g. in the absence of professional translators for healthcare users with limited German skills, and interpersonally, e.g. in the form of microaggressions and stereotyping but also the witholding of treatment and verbal abuse. Targets of racism are both patients and staff, especially internationally recruited healthcare workers. Respondents thereby identify night shifts, psychiatric settings and the emergency ward as contexts where racism is more likely to occur. The hierarchical nature of and pervasive power asymmetries in hospitals thereby prevent effective interventions against racial discrimination. Conclusions Racism in German healthcare institutions requires multiscalar public health interventions, particularly at the level of the institutions themselves. These include the establishment of a robust and low-threshold complaints structure, spaces for self-reflection for professionals, and mandatory anti-racism training rather than a focus on diversity-sensitive competence. Key messages • In future research approaches, structurally determined reproductions of racism should be investigated using a multi-method approach. • Experiences of powerlessness are reported by both those affected by racism and those professionals who observe racism and should be addressed by the institutions.

Determinants of acute psychiatric inpatient length of stay in Ireland.

Ireland has had an historic over-reliance on inpatient mental health care accompanied by poorly resourced community provision. There has been an increasing policy focus on provision of mental health care in the community to facilitate diversion from, or shorten stays in, inpatient care. However, little is known about the determinants of psychiatric inpatient length of stay (LOS) to allow for the targeting of community services. To use a large cross-sectional national dataset to examine the determinants of psychiatric inpatient LOS in the Irish context. Using information on 60,607 discharges from adult acute psychiatric units in Ireland between 2015 and 2019, the study employs both descriptive and regression analysis. Using negative binomial regression models, we control for patient demographic, socioeconomic, and clinical characteristics. In addition, as LOS may be related to provision of non-acute services in the patient area of residence, the analysis also controls for aspects of community service provision. The study finds that longer LOS is associated with older age, being female, and having an involuntary admission. Clinical diagnosis significantly impacts LOS, with diagnoses such as schizophrenia being associated with longer LOS. There is also significant variation in LOS across region of residence, with discharges from some regions staying up to 5days longer. The regional variation observed in inpatient LOS supports the assumption that increased provision of community services diverts or reduces the quantum of care required in inpatient settings. However, without substantive improvement in the community data collected and reported, future planning of mental health services, both community and inpatient, will be substantially curtailed.

Reductions in inpatient and outpatient mental health care in germany during the first year of the COVID-19 pandemic - What can we learn for a better crisis preparedness?

During the COVID-19 pandemic, reports from several European mental health care systems hinted at important changes in utilization. So far, no study examined changes in utilization in the German mental health care inpatient and outpatient mental health care system comprehensively. This longitudinal observational study used claims data from two major German statutory health insurances, AOK PLUS and BKK, covering 162,905 inpatients and 2,131,186 outpatients with mental disorders nationwide. We analyzed changes in inpatient and outpatient mental health service utilization over the course of the first two lockdown phases (LDPs) of the pandemic in 2020 compared to a pre-COVID-19 reference period dating from March 2019 to February 2020 using a time series forecast model. We observed significant decreases in the number of inpatient hospital admissions by 24-28% compared to the reference period. Day clinic admissions were even further reduced by 44-61%. Length of stay was significantly decreased for day clinic care but not for inpatient care. In the outpatient sector, the data showed a significant reduction in the number of incident outpatient diagnoses. Indirect evidence regarding the consequences of the reductions in both the inpatient and outpatient sector of care described in this study is ambiguous and direct evidence on treatment outcomes and quality of trans-sectoral mental healthcare is sparse. In line with WHO and OECD we propose a comprehensive mental health system surveillance to prepare for a better oversight and thereby a better resilience during future global major disruptions.

Improving Healthcare in South Texas Rural Communities: An Interprofessional Initiative for Primary Care Dental and Medical Residents.

To enhance primary care dentistry and medicine residents' didactic knowledge, communication skills to address patient's healthcare needs, and collaboration among healthcare professionals, while increasing confidence in integrating primary care skills into their clinical practice. An Interprofessional Education workshop was organized to enhance didactic knowledge and learning of 42 primary care dentistry (PCD) and family and community medicine (FCM) residents on topics including addressing facial and dental trauma in adults, managing patients with alcohol use and abuse, pain control and prescription opioid use in dentistry, and opioid use disorder and treatment. An online survey was administered before and after the workshop to assess changes in knowledge, confidence, and future intentions to incorporate targeted primary care skills learned during the workshop into clinical practice and to elicit residents' perceptions of workshop quality. Overall scale means were assessed by chi-square tests for knowledge scales and analysis of variance for confidence and career intentions scales, significance levels were set at 0.05. Pre-workshop assessments were completed by all attendees while post assessments received a response rate of 83.3%. Both PCD and FCM residents reported an increase in their knowledge (p<0.05) and confidence (p<0.05) in providing care for patients with facial/dental trauma, identifying signs of opioid abuse, addressing alcohol abuse, and understanding the referral processes following the workshop. While an overall increase was noted regarding intentions to incorporate skills learned during the workshop into practice by the PCD (pre-course=4.33, post-course=4.42) and FCM (pre-course=4.55, post-course=4.73) residents, the differences were not statistically significant differences. The interprofessional education workshop for PCD and FCM residents enhanced their knowledge, confidence, and future intentions to incorporate primary care skills into clinical practice and improve patient outcomes.

Ensuring Patient Care Continuity: An Audit of Discharge Letter Completeness in Accordance with National Standards

Abstract Background Discharge letters serve as a crucial communication tool to convey essential patient's healthcare information from hospital teams to general practitioners and step-down institutions. In 2013, the Health Information and Quality Authority (HIQA) introduced the National Standard for Patient Discharge Summary Information guideline. Reference 1. Health Information and Quality Authority. (2013). National Standard for Patient Discharge Summary Information. Retrieved from https://www.hiqa.ie/hiqa-news-updates/hiqa-publishes-national-standard-patient-discharge-summary-information. Methods This audit reviewed the completeness of discharge letters of patients admitted under the geriatric service of a tertiary hospital, covering the period between 1st September and 31st December 2023. Twenty-five variables were selected from the HIQA standards. The discharge letters were audited for completeness based on the inclusion of these recommended variables. An acceptable completeness rate of 80% for each variable was established. Results Of the total 89 discharge letters meeting the inclusion criteria, the average age of patients was 80.75 [SD12.95] years, with males comprising 60%. Seventeen out of 25 selected variables were 100% complete as they were automatically included by the electronic software. All discharge letters also invariably included diagnosis and hospital course information. Over 80% of the discharge letters met the acceptable threshold of including the items: discharge medication and future actions/follow-up. However, documentation of allergic status and inclusion radiological and blood investigations were only found in 27% and 49% of the letters, respectively. Conclusion The audited discharge letters had acceptable rates of completeness regarding inclusion of important items, while documentation of allergic status and inclusion of blood and radiological investigations fell below the acceptable standard. Of note, those that were automatized achieved 100% compliance. Regular auditing of discharge letters should become standard practice to improve completeness and ensure patient care continuity and safety. Consideration should be given to automatization of inclusion of reports of investigations.