Cost offset from a psychiatric consultation-liaison intervention with elderly hip fracture patients

Article Abstract:

Studies have indicated that psychiatric and psychosocial variables are important factors in the care and treatment of hospital patients. Hospital patients who receive needed psychiatric care appear to respond better to treatment for their medical problem, which may also lead to a reduction in their medical costs. Traditionally, not all patients entering the hospital for medical care undergo psychiatric screening. It is suggested that routine psychiatric screening of all patients entering the hospital may lead to better and earlier detection of psychiatric problems, resulting in better overall care, earlier discharge, and decreased medical costs. At two hospitals, Mount Sinai Medical Center in New York and Northwestern Memorial Hospital in Chicago, elderly patients who underwent surgical repair of fractured hips were evaluated. During one study year (baseline), patients received traditional psychiatric referral; during the next study year (experimental), all patients received psychiatric screening upon admittance to Mount Sinai; at Northwestern, patients admitted to Unit A received screening, while patients admitted to units B or C received traditional referral. The length of the hospital stay, medical costs, and placement of the patient after discharge were assessed in each group of patients. At Mount Sinai, 10 percent of the patients underwent psychiatric consultation during the baseline year, and 79 percent underwent consultation during the experimental year. At Northwestern, 2 percent of the patients from units A, B, and C underwent consultation during the baseline year; 61 percent from unit A, and 6 percent from units B and C received consultation during the experimental year. At Mount Sinai, patients in the experimental group stayed in the hospital an average of 2.2 days less than the patients in the baseline group, a significant difference. At a savings of $647 per day per patient, the amount saved was $178,572. At Northwestern, the unit A patients stayed an average of 1.7 fewer days resulting in an overall savings of $97,361 in the experimental year. There were no differences among the groups in the placement of patients following discharge. These results indicate that psychiatric liaison screening for all elderly patients entering the hospital for hip fracture surgery can result in better diagnosis and treatment of psychiatric disorders, as well as decreases in length of hospital stay and medical costs. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Medical care, Cost of, Health care costs, Identification and classification, Medical screening, Health screening, Hospital patients, Mentally ill aged, Mentally ill elderly

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Effect of a psychiatric liaison program on consultation rates and on detection of minor psychiatric disorders in cancer patients

Article Abstract:

Although 47 percent of cancer patients suffer from psychiatric disorders, only two percent of these individuals ever request psychiatric consultations. The majority of the disorders, 68 percent, are identified as adjustment disorders which are generally responsive to short-term therapy. It was hypothesized that the reason for the lack of referrals is often a result of the inability of the primary care physician to detect minor mental disorders and the physician's belief that psychological intervention would serve no real purpose in helping the patient. A study conducted over a seven-year period at a university hospital gynecological oncology service supports this hypothesis. Data were collected from a group of 1,092 female cancer patients over a four-year period before a psychiatric liaison program was available as well as an experimental group of 1,798 female cancer patients over a three-year period who had a psychiatric liaison intervention program available to them. Nine percent of the patients in the second group utilized psychiatric services, compared to four percent in the other group. It was concluded that the psychiatric liaison program was successful in helping to identify cancer patients who were in need of psychiatric counseling; the program also created a greater awareness of this need in the primary care physicians. Emphasis upon interaction between the oncology and psychiatric staff, along with the identification of the cancer patient's specific needs, is believed to provide optimal care levels and to improve the overall quality of life for these patients.

Case studies, Evaluation, Services, Psychiatric services, Mental health services, Cancer, Cancer patients, Psychiatric consultation

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Expenditures for psychotropic medications in the United States in 1985

Article Abstract:

Psychotropic drugs, drugs used to treat psychiatric conditions such as depression or schizophrenia, are widely used in the US, but have rarely been included in estimates of the costs of mental health services. When their cost has been estimated, it has been through national health surveys rather than surveys of mental health services in particular. The former measure may not be accurate. The present study estimated the costs of prescriptions for psychotropic medications in 1985 from data compiled from the Pharmaceutical Data Service Alpha National Prescription and Sales Audit. The results were compared with a similar estimate derived from a health services survey; the most recent available was for 1977. In 1985, total sales for outpatient psychotropic medication was $1.45 billion; in 1977 the estimate was $513 million. Of the money spent in 1985, $868 million was for antianxiety medications and sedatives, $263 million for antipsychotic medications, $240 million for antidepressants, and $84 million for other types of psychotropic drugs. Psychotropic medications represented a substantial cost to consumers in 1985, and the more commonly used estimate of costs vastly underestimated this expense. It is recommended that estimates be drawn from data more frequently, and that future estimates be based on medication databases. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Economic aspects, Demographic aspects, Psychotropic drugs, Drug utilization, Drug monitoring

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