Management and Financing of Emergency Medical Services

Hatley, Todd; Patterson, P. Daniel

doi:10.18043/ncm.68.4.259

Cited by 2 publications

(1 citation statement)

References 3 publications

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“…Tapping into Mary’s latent potential also led to a considerable savings in medical costs 8 . Based on the average cost of an ambulance transport ($415; Hatley & Patterson, 2007), cost per inpatient hospital day for individuals with schizophrenia ($850; Stensland, Watson, & Grazier, 2012), and length of hospital stay for individuals with schizophrenia (11 days; Stensland et al, 2012), 9 we estimate that 10 hospitalizations over the 2-year period would have cost at least $97,650. For comparison sake, we also estimated the cost of 70 outpatient psychotherapy sessions in the community ($94.59 per hour; Olfson & Marcus, 2010) as $6,621.…”

Section: Follow-up and Discussionmentioning

confidence: 99%

Successfully breaking a 20-year cycle of hospitalizations with recovery-oriented cognitive therapy for schizophrenia.

Grant

Reisweber

Luther

et al. 2014

Psychological Services

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Individuals with severe and persistent schizophrenia can present challenges (e.g., difficulties sustaining motivation and conducting information processing tasks) to the implementation of recovery-oriented care. We present a successful application of recovery-oriented cognitive therapy (CT-R), a fusion of the spirit and principles of the recovery movement with the evidence base and know-how of cognitive therapy, that helped an individual with schizophrenia move along her recovery path by overcoming specific obstacles, including a 20-year cycle of hospitalizations (five per year), daily phone calls to local authorities, threatening and berating "voices," the belief that she would be killed at any moment, and social isolation. Building on strengths, treatment included collaboratively identifying meaningful personal goals that were broken down into successfully accomplishable tasks (e.g., making coffee) that disconfirmed negative beliefs and replaced the phone calling. At the end of treatment and at a 6-month follow-up, the phone calls had ceased, psychosocial functioning and neurocognitive performance had increased, and avolition and positive symptoms had decreased. She was not hospitalized once in 24 months. Results suggest that individuals with schizophrenia have untapped potential for recovery that can be mobilized through individualized, goal-focused psychosocial interventions.

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Section: Follow-up and Discussionmentioning

confidence: 99%

Successfully breaking a 20-year cycle of hospitalizations with recovery-oriented cognitive therapy for schizophrenia.

Grant

Reisweber

Luther

et al. 2014

Psychological Services

View full text Add to dashboard Cite

show abstract

Pain, distress, and anticipated recovery for older versus younger emergency department patients after motor vehicle collision

et al. 2014

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BackgroundMotor vehicle collisions (MVCs) are the second most common injury mechanism resulting in emergency department (ED) visits by older adults. MVCs result in substantial pain and psychological distress among younger individuals, but little is known about the occurrence of these symptoms in older individuals. We describe the frequency of and characteristics associated with pain, distress, and anticipated time for physical and emotional recovery for older adults presenting to the ED after MVC in comparison to younger adults.MethodsIn-person interviews were conducted for adults presenting to one of eight EDs after MVC without an obvious fracture or injury requiring admission as part of two prospective studies. Pain severity was assessed using a 0–10 verbal scale. Distress was assessed using the Peritraumatic Distress Inventory (range 0–52). Patients were asked to estimate their expected time for physical and emotional recovery; these responses were dichotomized to <30 or ≥30 days. ED pain and distress and associations between patient and collision characteristics and ED pain and distress were examined for patients age 65 years and older and patients age 18 to 64.ResultsOlder (n = 96) and younger (n = 943) adults had the same mean pain scores (5.5, SD 2.5 vs. 5.5, SD 2.4). Distress scores were lower in older than in younger adults (15.5, SD 9 vs. 19.2, SD 10). A higher percentage of older adults than younger adults had an anticipated time to physical recovery ≥30 days (41%, 95% confidence interval [CI] 28%-55% vs. 11%, 95% CI 9%-13%). Similarly, older adults were more likely to have an anticipated time for emotional recovery ≥30 days (45%, 95% CI 35%-55% vs. 17%, 95% CI 15%-20%). Older adults were less likely than younger adults to have moderate or severe neck pain (score ≥4) (25%, 95% CI 23% to 41% vs. 54%, 95% CI 48% to 60%) or back pain (31%, 95% CI 23% to 46% vs. 56%, 95% CI 51 to 62%) but more likely to have moderate or severe chest pain (42%, 95% CI 32% to 50% vs. 20%, 95% CI 16 to 23%). Pre-MVC depressive symptoms and pain catastrophizing were positively associated with pain and distress in both older and younger adults.ConclusionsIn our cohort, older adults who presented to the ED after MVC experienced similar pain severity as younger patients and less distress but were more likely to estimate their times for physical and emotional recovery to be 30 days or more. Increased emergency provider awareness of acute pain and distress symptoms among older patients experiencing MVC may improve outcomes for these patients.

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Management and Financing of Emergency Medical Services

Cited by 2 publications

References 3 publications

Successfully breaking a 20-year cycle of hospitalizations with recovery-oriented cognitive therapy for schizophrenia.

Successfully breaking a 20-year cycle of hospitalizations with recovery-oriented cognitive therapy for schizophrenia.

Pain, distress, and anticipated recovery for older versus younger emergency department patients after motor vehicle collision

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