Trauma systems: a model for regionalized care

Article Abstract:

Trauma systems may provide a model for patient care for other specialized areas of medicine. Trauma systems are programs designed to coordinate and facilitate care of critically injured patients. They usually operate on a regional basis. Recent evaluation of trauma systems in the U.S. indicates that most systems fail to limit the number of designated trauma centers based on community need. During the development of the trauma systems approach, trauma surgeons emphasized that limiting the number of designated trauma centers was important to maintaining quality patient care and reducing costs. Limiting the number of centers reduces patient mortality by ensuring that health professionals have adequate experience in caring for trauma patients. This standard should also be applied to other areas of medicine such as organ transplantation, high-risk neonatal care and heart surgery.

Editorial, Standards, Community medicine

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Psychoactive substance dependence among trauma center patients

Article Abstract:

All individuals seen by trauma centers should be tested for alcohol or other psychoactive substance dependence, regardless of their blood alcohol status. Currently, only individuals with a positive blood alcohol test or urine drug screen are assessed for substance dependence. Of 45 individuals seen at a Baltimore, MD trauma center between April and July, 1990, 24 had a negative blood alcohol test (BAC-) and 21 had a positive test (BAC+). All of the patients were assessed for substance dependence by a nurse who was unaware of their BAC status. Sixty-nine percent of the patients were diagnosed with a psychoactive substance abuse disorder (PSUD), and the frequency of PSUD was almost as high in the BAC- patients as it was in the BAC+ patients. Seventy-six percent of BAC+ patients were diagnosed with PSUD, and 62% of the BAC- patients were diagnosed with PSUD.

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A computer-administered telephone interview to identify mental disorders

Article Abstract:

Administering a diagnostic test for detecting mental disorders using interactive voice response (IVR) technology appears to be effective. IVR technology involves a patient dialing an 800 telephone number and using a touch-tone telephone to answer questions. The Primary Care Evaluation of Mental Disorders (PRIME-MD) was administered over the telephone by a physician and by IVR to 200 patients. A subset of patients were also interviewed in person. About 60% of the patients were diagnosed with a psychiatric disorder by both techniques. However, the prevalence of alcohol abuse was twice as high when using IVR.

Alcoholism, Mental illness, Psychiatric diagnosis, Audiotex, Audiotext services

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