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Fleury MJ, Imboua A, Grenier G. Barriers and Facilitators to High Emergency Department Use Among Patients with Mental Disorders: A Qualitative Investigation. Community Ment Health J 2024; 60:869-884. [PMID: 38383882 DOI: 10.1007/s10597-024-01239-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 01/17/2024] [Indexed: 02/23/2024]
Abstract
This qualitative study explored reasons for high emergency department (ED) use (3 + visits/year) among 299 patients with mental disorders (MD) recruited in four ED in Quebec, Canada. A conceptual framework including healthcare system and ED organizational features, patient profiles, and professional practice guided the content analysis. Results highlighted insufficient access to and inadequacy of outpatient care. While some patients were quite satisfied with ED care, most criticized the lack of referrals or follow-up care. Patient profiles justifying high ED use were strongly associated with health and social issues perceived as needing immediate care. The main barriers in professional practice involved lack of MD expertise among primary care clinicians, and insufficient follow-up by psychiatrists in response to patient needs. Collaboration with outpatient care may be prioritized to reduce high ED use and improve ED interventions by strengthening the discharge process, and increasing access to outpatient care.
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Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada.
- Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada.
| | - Armelle Imboua
- Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
| | - Guy Grenier
- Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
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Chen WH, Hsieh MH, Liao SC, Liu CC, Liu CM, Wu CS, Lin YT, Hwang TJ, Chien YL. A quarter of century after: The changing ecology of psychiatric emergency services. Asia Pac Psychiatry 2022; 14:e12487. [PMID: 34510765 DOI: 10.1111/appy.12487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 08/25/2021] [Accepted: 08/31/2021] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Previous studies demonstrated a trend of increasing common mental disorders among the Emergency Department (ED) visitors in Western countries. Little is known about the current conditions of the emergency psychiatric services in Asian countries. This study aims to survey the current epidemiology and the changing ecology of emergency psychiatry services in Taiwan. METHODS A total of 804 psychiatry consultations were initiated at the ED during the 1-year period from July 1, 2014 to June 30, 2015 in a medical center in northern Taiwan. Clinical data of gender, age, chief complaints, tentative diagnoses, dispositions, and ED staying hours were compared to a previous report in the same hospital in 1988. RESULTS Psychiatry consultation was initiated in 0.72% of all ED visits (804/111,923). Among these visits, females were 1.73 times of the males. The most common chief complaints were psychosis/mania (33.5%) and suicide/self-harm (33.2%), followed by homicide/violence (12.8%) and anxiety/depression (10.3%). Top tentative diagnoses were schizophrenia spectrum and other psychotic disorders (31.3%), trauma- and stressor-related disorders (17.5%), bipolar disorders (15.9%), and depressive disorders (14.2%). Compared to 1988, there are three major changes: (1) over-representation of female patients, (2) an increase of "neurosis" patients, and (3) an increase of suicide/self-harm as chief problem. DISCUSSION This study portrays the current epidemiology and changing ecology of psychiatric emergency in Taiwan. The increase of neurotic and suicide/self-harm patients requires more services and clinical training in managing common mental disorders and suicide in the ED.
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Affiliation(s)
- Wen-Hao Chen
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming H Hsieh
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shih-Cheng Liao
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chen-Chung Liu
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chih-Min Liu
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chi-Shin Wu
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Ting Lin
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tzung-Jeng Hwang
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Ling Chien
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
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Emergency psychiatric management of borderline personality disorder: Towards an articulation of modalities for personalised integrative care. Encephale 2020; 46:463-470. [PMID: 32571544 DOI: 10.1016/j.encep.2020.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 03/27/2020] [Accepted: 04/07/2020] [Indexed: 11/20/2022]
Abstract
Building on existing literature, the authors draw the landscape of psychiatric emergencies, and focus on borderline personality disorder, frequently encountered, and strongly linked to death by suicide. A review of knowledge in terms of diagnosis, prognosis, etiology, and treatment, as well as their own experiences, lead them to propose areas of progress that would secure the patient's care pathway. The evolution of society has led psychiatric emergency departments to play the role of a safety net and an entry point to the mental health system. Borderline personality disorder is one of the most common pathologies encountered in psychiatric emergencies. It represents a major concern, long characterized by an often dramatic evolution, and by the human and economic stress it generates. However, since the 1990s, knowledge of this disorder has been refined, and today there are various means of evaluation, good clinical practices and psychotherapeutic treatments, thanks to which significant and lasting improvement is possible. Recent studies highlight the crucial role of hospital caregivers, and the benefit of consolidating their skills by providing them with the knowledge and tools specific to this disorder. They also converge on the interest of setting up specific emergency treatment modalities, particularly highly structured, safe and empowering for the patient, in order to improve their effectiveness. The authors suggest that a case formulation model for persons with borderline personality disorder in emergency would make it possible to activate these two levers of progress, while improving collaboration between hospital and outpatient care. This would also address their main concern of optimizing the patient's therapeutic pathway and reinforcing adherence to treatment that could bring remission, and should be supported by data from empirical research.
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Schmidt M, Garmy P, Stjernswärd S, Janlöv AC. Professionals' Perspective on Needs of Persons Who Frequently Use Psychiatric Emergency Services. Issues Ment Health Nurs 2020; 41:182-193. [PMID: 31930924 DOI: 10.1080/01612840.2019.1663565] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study explores how professionals experience persons who frequently use psychiatric emergency services (PES) in terms of their needs in Sweden. The data comprise 19 semi-structured individual interviews and one focus group interview with healthcare professionals (i.e., assistant nurses, psychiatric nurses, intern physicians, and resident physicians), which are analyzed using qualitative content analysis. The overall findings suggest that persons who frequently use PES suffer from illness, unfavorable life circumstances, and inadequate care, which together emphasize the need for more sustainable support. The findings indicate that the professionals saw beyond illness-related needs and could also acknowledge patients' needs originating from social, existential, and care- and support-related aspects of life.
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Affiliation(s)
- Manuela Schmidt
- Faculty of Health Science, Kristianstad University, Kristianstad, Sweden.,Department of Health Sciences, Lund University, Lund, Sweden
| | - Pernilla Garmy
- Faculty of Health Science, Kristianstad University, Kristianstad, Sweden.,Department of Health Sciences, Lund University, Lund, Sweden
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Schmidt M, Ekstrand J, Tops AB. Self-Reported Needs for Care, Support and Treatment of Persons Who Frequently Visit Psychiatric Emergency Rooms in Sweden. Issues Ment Health Nurs 2018; 39:738-745. [PMID: 30111203 DOI: 10.1080/01612840.2018.1481471] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
AIM To investigate self-reported needs for care, support and treatment among persons who frequently visit psychiatric emergency rooms (PERs). DESIGN A cross-sectional design. Qualitative and quantitative data were collected using an interview-based manual. Qualitative data were analysed using content analysis, whereas quantitative data were analysed using descriptive, non-parametric statistical tests. RESULTS Persons who frequently visit PERs self-reported unmet needs for care, support and treatment in life domains such as health, socialisation, daytime activities, and emotional and financial security. CONCLUSION To meet the needs of persons who frequently visit PERs, close cooperation between concerned welfare actors should be implemented.
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Affiliation(s)
- Manuela Schmidt
- a Faculty of Health Science , Kristianstad University , Kristianstad , Sweden.,b Department of Health Sciences , Lund University , Lund , Sweden
| | - Joakim Ekstrand
- c Faculty of Business , Kristianstad University , Kristianstad , Sweden
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