The effect of individual, program, and neighborhood variables on continuity of treatment among dually diagnosed individuals

This study reviewed the medical charts of 271 patients diagnosed with co-morbid mental health and substance-use disorders who were discharged from a hospital acute inpatient unit to various outpatient treatment programs in Philadelphia. Geographic Information Systems (GIS) technology and logistic regression modeling were employed to investigate the effects of individual, neighborhood, and program-level variables on arrival to the first treatment appointment within 30 days of discharge. Four models are presented. The results of the study suggest that having had three or more treatment episodes prior to inpatient hospitalization, and living in a neighborhood in which temporary or transitional, and presumably, other low income housing is located, increased the likelihood of patients continuing with treatment in the community. Discharge to the preadmission address, a chief complaint of bizarre behavior, close proximity of two or more liquor and/or beer stores, a high density of narcotics anonymous (NA) and/or alcoholics anonymous (AA) meetings within the neighborhood, an axis I diagnosis of substance-induced mood disorder, and a urine drug screen positive for heroin reduced the likelihood of attending outpatient treatment. We conclude that geographic and community variables as they relate to substance abuse may add an important dimension to our understanding of patient functioning and well being in the community following inpatient treatment.     

Patient evaluation of otolaryngology department service at Christchurch Hospital

One hundred and four consecutive patients seen in the ENT department for consultation and inpatient treatment completed a structured questionnaire at their first postoperative (or posttreatment) outpatient clinic appointment. The aims of the survey were to ascertain the patients opinions and perceptions regarding the ENT department service in a variety of areas. Satisfaction was high in areas of medical and nursing care and with the information given regarding treatment. The major area of dissatisfaction was with waiting times, particularly waiting times at appointments during ENT outpatient clinics.     

文拉法辛治疗抑郁症住院和门诊模式效果比较

摘要： 目的 评价采用住院和门诊模式使用文拉法辛治疗抑郁症的效果。方法 72 例抑郁症患者中住院治疗 36 例 （住院组）, 同期门诊治疗 36 例 （门诊组）, 分别使用文拉法辛 （商品名： 怡诺思） 对其治疗, 于治疗前及治疗 1、 2、 4 及 8 周后, 采用汉密顿抑郁量表（HAMD24）评分对 2 组患者的抑郁症状进行评定并比较 2 组疗效。结果 观察结束时, 住院组无脱落, 门诊组脱落 2 例; 住院组从第 2 周开始直到第 8 周末 HAMD24评分明显下降, 显著低于门诊组,差异有统计学意义; 临床疗效比较, 住院组总有效率 80.6％, 门诊组 64.7％, 差异无统计学意义。结论 文拉法辛治疗抑郁症住院模式比门诊模式具有更高的治疗价值并可获得更好的临床结局。     

Pain among drug users completing an inpatient detoxification program

We determined the prevalence of persistent pain among illicit drug users who have completed inpatient clonidine detoxification and are returning to the community. We found that 17% of drug users have substantial unexplained pain at discharge, and that drug injectors have significantly more pain than non‐injectors. Drug users with substantial pain reported worse self‐perceived health, interference with daily activities and sleep than pain‐free drug users. Our findings suggest that assessing pain at the first outpatient primary care appointment after drug treatment may be an important aspect of the longitudinal care of this population.     

The influence of distance on utilization of outpatient mental health aftercare following inpatient substance abuse treatment

This study examined whether substance abuse patients who live farther from their source of outpatient mental health care were less likely to obtain aftercare following an inpatient treatment episode. For those patients who did receive aftercare, distance was evaluated as a predictor of the volume of care received. A national sample of 33,952 veterans discharged from Department of Veterans Affairs (VA) inpatient substance abuse treatment programs was analyzed using a two-part choice model utilizing logistic and linear regression. Patients living farther from their source of outpatient mental health care were less likely to obtain aftercare following inpatient substance abuse treatment. Patients who traveled 10 miles or less were 2.6 times more likely to obtain aftercare than those who traveled more than 50 miles. Only 40% of patients who lived more than 25 miles from the nearest aftercare facility obtained any aftercare services. Patients who received aftercare services had fewer visits if they lived farther from their source of aftercare. Lack of geographic access (distance) is a barrier to outpatient mental health care following inpatient substance abuse treatment, and influences the volume of care received once the decision to obtain aftercare is made. Aftercare services must be geographically accessible to ensure satisfactory utilization.     

The prevalence of cigarette smoking in an acute inpatient physical medicine and rehabilitation population

The purpose of this study was to determine the prevalence of cigarette smoking among patients before and after discharge from an acute inpatient physical medicine and rehabilitation unit and. to assess smokers’ interest in and desire for smoking cessation. A consecutive sample of inpatients (n = 233) admitted over a 5‐month period to a regional rehabilitation inpatient center for acute rehabilitation treatment was surveyed for their smoking patterns. Ten percent of patients admitted to rehabilitation were active smokers prior to their hospitalization. In spite of reporting high motivation to stop smoking, half were not interested in participating in a smoking cessation program if one were offered to them. Following discharge from inpatient rehabilitation, 54% of a small sample of patients who could be contacted had resumed smoking (all within 4 weeks of being home). Given the prevalence of smoking in this population and its adverse consequences on health and quality of life, we suggest that rehabilitation professionals actively address this health problem during the patient's hospitalization.     

Alcohol attentional bias as a predictor of alcohol abusers' treatment outcome

Alcohol abusers' and non-abusers' attentional distraction for alcohol-related, concern-related, and neutral stimuli was assessed with the emotional Stroop paradigm. Alcohol abusers (n=14) were tested on admission to inpatient treatment and immediately before discharge, 4 weeks later; non-abusers (n=16) were also tested twice, with a 4-week intervening interval. Alcohol abusers were assessed for alcohol use 3 months after discharge. Unlike control participants and alcohol abusers whose treatment was successful, alcohol abusers whose treatment was unsuccessful (who relapsed or did not maintain post-discharge outpatient contact) had a significant increase in attentional distraction for alcohol stimuli during the 4 weeks of inpatient treatment. Compared to control participants and alcohol abusers who completed the 4 weeks of treatment, those who did not complete treatment (n=9) were highly distracted by concern-related stimuli at treatment admission. The results have implications for understanding the cognitive and motivational processes underlying successful treatment for alcohol abuse.     

Using naltrexone in inpatient alcoholism treatment

Naltrexone has been used successfully in outpatient settings as an adjunct to alcoholism treatment. This study examines the efficacy of using naltrexone in an inpatient treatment setting. Sixty-three alcohol-dependent patients who volunteered for a double-blind, placebo-controlled study were followed over the course of their 20 days in treatment and six months follow-up. A comparison group of 59 patients who did not volunteer were also studied over the same period of time. Patients in the study group were randomly assigned to receive naltrexone or placebo. Information was gathered daily on alcohol craving, drug craving and moods on self-reporting forms from the naltrexone and placebo groups, and from the comparison group. Follow-up data was gathered through self-report and through Washington State's TARGET management information system. No significant differences were found in craving scores while in treatment, nor in recidivism after treatment.     

Outpatient treatment engagement and abstinence rates following inpatient opioid detoxification

Many patients with chronic opioid dependence are referred to drug-free outpatient treatment following inpatient detoxification even though successful outpatient treatment engagement and abstinence from opioids occur only in a minority of cases. This retrospective cohort analysis of medical records documents the post-discharge outcome in a treatment setting that maximizes the support during transition to abstinence-oriented outpatient care, with comprehensive social, medical and mental health services, including the availability of naltrexone. Participants were male veterans (N = 112) admitted at an urban VA medical center. Most patients (78%) successfully completed acute detoxification, 49% initiated naltrexone, and 76% accepted a VA aftercare plan. At 90-day follow-up, only 22% remained in aftercare, and < 3% had toxicology-verified abstinence from opioids. At one-year follow-up, 1 out of 5 had been readmitted for detoxification and 4.5% had died. Most patients successfully detoxified from opioids, but very few remained engaged and stabilized in abstinence-oriented outpatient treatment.     

Opening the black box. The impact of inpatient treatment services on client outcomes

This study examined the effects of specific services provided in therapeutic communities (TCs) to treatment outcomes. Findings are compared to prior analyses of treatment outcomes from the District of Columbia Treatment Initiative (DCI) that did not utilize the treatment service information. A subsample of DCI clients randomly assigned to two TC programs, who had remained in inpatient treatment for at least 60 days, were included in the analyses (n = 371). Logistic regression results illustrated that the level of vocational education services received was positively associated with completing treatment, and participation in group services was associated with decreases in postdischarge arrest. In addition, clients who received a greater number of all inpatient services were more likely to complete treatment and were less likely to be arrested after discharge. Findings suggest that TC programs should consider offering more vocational education and group treatment services to enhance prosocial behavior following treatment discharge.     

Severe alcoholism in the mental health sector: I. A cost analysis of treatment

In a country in which the public mental health sector provides services to alcoholics, the costs of direct care to alcoholics were compared with those of other mental health patients. Costs were developed for a 1-yr cohort of patients who had received inpatient care but who had recently come from the community and returned to the community. The costs were based on inpatient and outpatient utilization within 2 yr of follow-up, commencing at discharge from inpatient care. Alcoholics represented the largest single diagnostic group in the cohort (39%), although their cost of care was only 22% of total costs. This is so despite the facts that similar percentages of alcoholics and nonalcoholics required rehospitalization in the 2 yr of follow-up and both groups exhibited similar patterns in the number of readmissions. Alcoholics have lower costs than other patients because they use cumulatively fewer inpatient days and receive fewer days of the most expensive outpatient service of full-day treatment. On the average, the cost to serve alcoholic patients is less than half the cost to serve nonalcoholic patients.     

医院门诊候诊时间量化分析和研究

目的 通过对门诊患者候诊时间的量化统计和分析,发现影响候诊时间的关键因素以优化门诊就诊流程,缩短候诊时间.方法 通过信息系统,采集北京大学肿瘤医院2013年11月4-29日上午门诊就诊患者的候诊时间,按患者性别、年龄、医保类型和挂号号源类型进行统计分析.结果 门诊患者平均候诊时间为36.3（10.6,81.5） min,主任医师、副主任医师和主治医师号源的候诊时间分别为54.1（19.1,106.8）、34.0（10.3,74.7）、26.4（7.8,66.5） min,差异有统计学意义（P＜0.05）;34.7％ （3 984/11 471）的患者候诊时间超过60 min,外地医保就诊患者候诊时间[42.5（12.1,90.4） min]明显高于北京本地医保就诊患者[在职：33.8（9.8,77.3） min;离退：30.5（9.9,68.4） min].结论 候诊时间可作为门诊流程管理的监测指标,预约诊疗和流程优化有助于缩短候诊时间.     

Effects of 12-step mutual support and professional outpatient services on short-term substance use outcomes among adults who received inpatient treatment

BackgroundContinuing care is increasingly prioritized in the treatment of substance use disorders (SUDs). Ongoing engagement in continuing care, including mutual support (e.g., 12-step groups) and/or professional outpatient services, may enhance treatment outcomes and facilitate recovery.ObjectiveThis study investigates how engagement in 12-step mutual support and professional outpatient services is associated with short-term substance use outcomes in a sample of patients who completed inpatient SUDs treatment.MethodsAs part of the Recovery Journey Project – a longitudinal cohort study – participants completed questionnaires upon admission to an inpatient SUDs treatment program, and at 1- and/or 3-months post-discharge (n = 379). Baseline data were collected by self-administered, electronic questionnaires. Follow up data were collected by phone or email. Analyses involved multivariate Generalized Estimating Equations separately modelling self-reported abstinence and percent days abstinent (PDA) over the three time periods.ResultsOverall, rates of self-reported abstinence and PDA increased significantly from baseline to 1- and 3-months follow up. Engagement in 12-step activities (i.e., attended 30 meetings in 30 days, had a home group, had a sponsor, did service work) and professional outpatient substance use support were each significantly associated with abstinence and PDA. Participants who reported a higher degree of 12-step involvement (defined as engagement in more 12-step activities) were also more likely to report being abstinence and greater PDA.ConclusionsEngagement in continuing care, including 12-step activities and professional outpatient substance use support, was highly associated with substance use. Clinical teams should encourage participation in such activities to optimize treatment outcomes.     

Coronavirus 2019 work-from-home productivity of inpatient and infusion pharmacists at a comprehensive cancer center

PurposeTo evaluate inpatient and infusion pharmacist order verification productivity when working from home and to report their perceptions of a flexible workplace setting.MethodsOrder verification data were pulled from the electronic medical record from April 27, 2020, to June 30, 2020, matched to the pharmacist schedule on the basis of work setting and reported as average orders verified per day. Pharmacist perceptions were gathered via a survey to evaluate practice setting background, workplace setting preference, and perceived changes in workflow and their productivity.ResultsThere was an overall increase in order verification productivity when working from home. Inpatient pharmacists, on average, verified 152 orders per day from home and 133 orders per day onsite. Infusion pharmacists, on average, verified 144 orders per day working from home and 117 orders per day working onsite. Fifty-nine percent of pharmacists reported preferring the mix of onsite and home workplace setting and noted little change in workflow. In addition, 57% of the pharmacists perceived themselves as being more productive, 32% as maintaining the same level of productivity, and 10% felt that they are less productive when working from home. The order verification data showed a greater increase in productivity for infusion shifts worked from home than inpatient shifts.ConclusionThe coronavirus 2019 pandemic prompted pharmacy departments to re-evaluate their ability to provide an option for a flexible workplace for pharmacists. Our study demonstrates that pharmacists, on average, verified more orders when working from home, and they also perceive themselves as being more productive. The results of this study support long-term applicability of a flexible work schedule for inpatient and infusion pharmacists.     

A comparison of disulfiram acceptors and refusers on selected demographic and clinical characteristics

Male problem drinkers who accepted a treatment recommendation to take disulfiram were compared to those who refused the drug therapy. Subjects were drawn from a clinical population presenting to an outpatient alcoholism assessment service over a 3-year period. Both univariate and multivariate analyses were employed to investigate which client variables were associated with compliance to the disulfiram recommendation. The most important variable that distinguished the two groups was the percentage of other treatment recommendations adhered to by the client with the disulfiram acceptors being more likely to accept the other treatment recommendations. In addition, clients agreeing to take disulfiram were slightly younger and had higher scores on the Michigan Alcoholism Screening Test (MAST). Variables such as socio-economic status, previous treatment history, other drug use and drinking pattern were not associated with agreement to take disulfiram. The implications of these findings are discussed, particularly their relevance to research on the therapeutic effectiveness of disulfiram.     

Preliminary Outcomes from a Community Linkage Intervention for Individuals with Co-Occurring Substance Abuse and Serious Mental Illness

Abstract

Objective: Few interventions assist individuals with a mental illness and a co-occurring substance abuse disorder in the transition from hospitalization to outpatient treatment. This change in care is often abrupt, resulting in fragmented treatment that jeopardizes recovery. This article reports on the preliminary outcomes from a new eight-week linkage intervention entitled “Time-Limited Case Management (TLC)” that integrates intensive outreach, Dual Recovery Therapy (DRT), and peer support to facilitate outpatient treatment engagement following discharge from Acute Psychiatry.

Method: This eight-week naturalistic feasibility study included 59 recently hospitalized subjects with a mental illness and substance abuse disorder who were offered the new service. The individuals who agreed to receive TLC (n = 26) formed the treatment group and those who refused (n = 33) made up the comparison group.

Results: The TLC service was successfully implemented into the system and improved the transition from inpatient to outpatient care. The individuals who received the TLC intervention had a higher show rate at the Day Treatment Center intake appointment, attended more days of treatment at the Day Center, had greater pharmacy refill compliance, and were less likely to be lost to follow-up at eight weeks than the comparison group.

Conclusion: TLC represents a promising new approach to maintaining continuity in care following psychiatric hospitalization that may be easily implemented in other systems. We are currently in the process of developing an implementation manual and doing a large randomized controlled trial to determine whether the intervention improves substance abuse and psychiatric outcomes in addition to facilitating treatment engagement.     

Social skills training in groups for alcoholics: one-year treatment outcome for groups and individuals

In an experimental comparison, 24 inpatients at an Alcoholism Treatment Center with the DSM-III diagnosis alcohol dependence (alcoholism) were randomly assigned to a Social Skills Training Group (SSTG) or a Control Group (CG). Both groups received, in addition, the traditional treatment program at the institution. Self-report questionnaires, as well as questionnaires for significant others, were used to get biweekly information after discharge on current drinking habits, working days, and nights slept home. A lottery procedure ensured an extremely high return rate of questionnaires during 1 year follow-up (23 of 24 clients returned all questionnaires). SSTG clients drank on the average 2/3 of the amount of pure alcohol or its equivalent (740 cl, that is 14.2 cl/week) that the CG clients did (1196 cl, that is 23.0 cl/week) during 1 year follow-up after discharge. SSTG clients had twice as many sober days (281 or 77% compared to 116 or 32%) and working days (223 or 97% compared to 104 or 45%). The average length of abstinence period after discharge were 51.6 days for SSTG and 8.3 for CG clients. All SSTG clients had drunk after 143 days, and all CG clients after 31 days. During drinking days, however, SSTG had drunk almost twice as much as CG clients. The average number of nights slept home were 345 (95%) for the SSTG versus 316 (87%) for the CG. In addition to group data, detailed individual data are also presented.