Suchergebnisse

Publicly available costs data for child and adolescent psychiatric inpatient services do not allow links to be made with patients' needs and outcomes. Without this information commissioners may reduce the role of inpatient services on the basis of budgetary impacts alone. This study estimates the support costs before, during and after an inpatient admission and explores the associations between costs, needs and outcomes. A detailed prospective cohort study of eight child and adolescent units was undertaken in which participants were assessed at referral, admission, decision to discharge and 1 year later. Mean admission costs were £24,120, although the range was wide. Associations were found between costs and patients' global impairment, age and exclusion status. Support costs after admission were similar to pre-admission costs, but there was some evidence to suggest that services were better targeted. Moves in England to develop national tariffs for inpatient psychiatric episodes should be based on the likely cost of the episode of treatment rather than costs per day, and good commissioning requires more information on the predictors of such costs.

Forty women meeting the criteria for either Major Depression or Major Depression plus Dysthymia received a 2-week, multifaceted, cognitive-behavior-based, inpatient intervention plus antidepressant medication. Patient scores on the Beck Depression Inventory, the Automatic Thoughts Questionnaire, and the Hamilton Rating Scale for Depression at admission, indicated significant improvements at the time of discharge from the hospital and at follow-up. The rate of change on the three scales was comparable for both patient groups, further supporting the potential of a short-term, combined intervention approach for patients meeting the criteria for Major Depression and Major Depression plus Dysthymia.

Objective: To identify clinical variables influencing the length of stay (LOS) of inpatient treatment for anorexia nervosa (AN). Method: We analyzed structured clinical charts of 300 consecutive hospitalizations for AN in a specialized eating disorder unit. The sample included patients from 12 to 22 years old. Factors related to the patient and events occurring during the stay were investigated as possible predictors of LOS. Results: Mean LOS was 135 days. The best model of linear regression revealed that the following factors were significantly related to LOS: duration of AN at admission, use of tube feeding during the stay, accomplishment of the therapeutic weight contract and presence of a comorbid disorder. Conclusions: The identification of factors influencing duration of stay, both at the outset and during the hospitalization, could help clinicians to optimize and individualize treatments, as well as increase patient and family compliance.

Severely malnourished children need special care. This book provides simple, practical guidelines for treating these children successfully and takes into account the limited resources of many hospitals and health units in developing countries. It is intended for doctors, nurses, dietitians and other health workers with responsibility for the medical and dietary management of severely malnourished children, and for their trainers and supervisors. The guidelines are authoritative and hospitals using them report substantial reductions in mortality. For example, mortality rates of 30-50% have fall

AbstractThe inpatient treatment of severe personality disorders requires a multidisciplinary clinical approach based on an understanding of the patient's personality organization, predominant personality traits, and comorbid psychiatric disorders.

OBJECTIVES: To mitigate the economic burden of tuberculosis (TB), it is important to fully understand the costs of TB treatment from the patient perspective. We therefore sought to quantify the patient-incurred cost of TB treatment in rural Malawi, with specific focus on costs borne by patients requiring inpatient hospitalization. METHODS: We conducted a cross-sectional survey of 197 inpatients and 156 outpatients being treated for TB in rural Malawi. We collected data on out-of-pocket costs and lost wages, including costs to guardians. Costs for inpatient TB treatment were estimated and compared to costs for outpatient TB treatment. We then explored the equity distribution of inpatient TB treatment cost using concentration curves. RESULTS: Despite free government services, inpatients were estimated to incur a mean of $137 (standard deviation: $147) per initial TB episode, corresponding to > 50% of annual household spending among patients in the lowest expenditure quintile. Non-medical hospitalization costs accounted for 88% of this total. Patients treated entirely as outpatients incurred estimated costs of $25 (standard deviation: $15) per episode. The concentration curves showed that, among individuals hospitalized for an initial TB episode, poorer patients shouldered a much greater proportion of inpatient TB treatment costs than wealthier ones (concentration index: −0.279). CONCLUSION: Patients hospitalized for TB in resource-limited rural Malawi experience devastating costs of TB treatment. Earlier diagnosis and treatment must be prioritized if we are to meet goals of effective TB control, avoidance of catastrophic costs, and provision of appropriate patient-centered care in such settings.