Predictors of Frequent Emergency Department Utilization for Mental Health Reasons

The Journal of Behavioral Health Services & Research - Overcrowding in emergency departments (ED) jeopardizes quality and access to health care, which represents a major issue for service...     

Modeling Relationships Involving Perceived Recovery Orientation of Mental Health Teams Among Quebec Mental Health Professionals

The Journal of Behavioral Health Services & Research - While mental health (MH) services are expected to support client recovery, very little is known about services provided by MH teams in...     

A comparative study of job satisfaction among nurses,psychologists/psychotherapists and social workers working in Quebec mental health teams

Background

This study identified multiple socio-professional and team effectiveness variables, based on the Input-Mediator-Output-Input (IMOI) model, and tested their associations with job satisfaction for three categories of mental health professionals (nurses, psychologists/psychotherapists, and social workers).

Methods

Job satisfaction was assessed with the Job Satisfaction Survey. Independent variables were classified into four categories: 1) Socio-professional Characteristics; 2) Team Attributes; 3) Team Processes; and 4) Team Emergent States. Variables were entered successively, by category, into a hierarchical regression model.

Results

Team Processes contributed the greatest number of variables to job satisfaction among all professional groups, including team support which was the only significant variable common to all three types of professionals. Greater involvement in the decision-making process, and lower levels of team conflict (Team Processes) were associated with job satisfaction among nurses and social workers. Lower seniority on team (Socio-professional Characteristics), and team collaboration (Team Processes) were associated with job satisfaction among nurses, as was belief in the advantages of interdisciplinary collaboration (Team Emergent States) among psychologists. Knowledge sharing (Team Processes) and affective commitment to the team (Team Emergent States) were associated with job satisfaction among social workers.

Conclusions

Results suggest the need for mental health decision-makers and team managers to offer adequate support to mental health professionals, to involve nurses and social workers in the decision-making process, and implement procedures and mechanisms favourable to the prevention or resolution of team conflict with a view toward increasing job satisfaction among mental health professionals.

     

The use of head CT scan in adult trauma victims: an algorithm

INTRODUCTION: The purpose of this study was to identify, through recursive partitioning, clinically relevant criteria which predict the need for acute neurosurgical intervention in a group of patients with mild head injury. MATERIALS AND METHODS: A retrospective cohort of all adult patients, from April 2000 to March 2001, who sustained a blunt trauma and underwent head CT scan, was reviewed. The following inclusion criteria for mild head injury were used: initial Glasgow Coma Scale (GCS) ranging from 13 to 15; no loss of consciousness lasting more than one hour; no obvious skull fracture; a cranial CT scan performed. We collected demographic and trauma related data, interventions and outcome. Univariate and multivariate analyses were undertaken. In parallel, recursive partitioning was carried out using all variables to elaborate a decision algorithm. RESULTS: There were 405 patients in the sample. CT identified lesions in 12% of patients. Twelve patients (3%) required acute neurosurgical intervention. The recursive partitioning analysis identified three significant sequential nodes: deterioration of the GCS; an initial GCS of 13 vs 14 or 15; and the presence of associated injuries or comorbid conditions. CONCLUSIONS: A simple three step rule predicts the need for acute neurosurgical intervention based on clinical findings: a deteriorating GCS; an initial GCS of 13; and the presence of associated injuries or comorbid conditions.     

A simple fall in the elderly: not so simple

BACKGROUND: The goal of this study was to evaluate the burden of falls in the elderly in a Canadian tertiary trauma center. METHODS: Patients admitted to Charles-LeMoyne Hospital with a low velocity fall (LVF) from April 1, 1993 to March 31, 2000 were individually reviewed. Elderly was defined as age 65 years and older. A region was considered to be injured if Abbreviated Injury Scale was greater than or equal to 2. RESULTS: There were 2,333 patients with LVF, 41.4% of all blunt trauma admissions. Median Injury Severity Score was 9 for elderly compared with 5 for young (p < 0.001). Injuries were significantly more frequent to head, face, thorax, and lower limbs in the elderly. Mortality (13.4% versus 0.9%; p < 0.001), length of stay (median = 15 versus 3 days; p < 0.001) and long-term care facility reference (19.3% versus 1.1%, p < 0.001) were significantly higher in the elderly. CONCLUSIONS: LVF is a frequent cause of admission for trauma in the elderly. Despite the apparent benign nature of the mechanism, LVF is associated with more severe injuries and worse outcome.     

Satisfaction with health and community services among homeless and formerly homeless individuals in Quebec,Canada

User satisfaction is a crucial quality indicator in health service provision. Few studies have measured user satisfaction among homeless and formerly homeless individuals, despite the high prevalence of mental health disorders (MHD) in this population. The purpose of this study was to assess overall satisfaction among 455 homeless and formerly homeless individuals who were receiving health and community services, and to identify factors associated with user satisfaction. Data collection occurred between January and September 2017. Study participants were 18 years old or over, with experience of homelessness in the current or recent past. They completed a questionnaire eliciting socio‐demographic information, and data on residential history, service use and satisfaction and health profiles. Multivariate linear analysis was performed on overall satisfaction with health and community services in the previous 12 months. Independent variables were organised as predisposing, enabling and needs factors based on the Gelberg–Andersen Behavioral Model. The mean satisfaction score was 4.11 (minimum: 1; maximum: 5). Variables associated with greater user satisfaction included: older age, residence in permanent housing, common MHD (e.g., depression, anxiety), having a family physician, having a case manager, strong social network, good quality of life and, marginally, male sex and having substance use disorders (SUD). By contrast, frequent users of public ambulatory health services were the most dissatisfied. User satisfaction was more strongly associated with enabling factors. Strategies for improving satisfaction include: promoting more tailored primary care programmes (including family physician) adapted to the needs of this population, better integrating primary care with specialised services including SUD integrated treatment and enhancing continuity of care through the reinforcement of case management services. Further efforts aimed at increasing access to permanent housing with supports, and eliciting more active involvement by relatives and friends may also improve user satisfaction with services, and reduce unnecessary service use.