Annual cycles of participatory action research
Paul Thomas in Collaborating for Health, 2017
The three consulting styles require different approaches and different resources: Reactive care: Works thoughtfully from the presenting complaint, using a ‘narrative-based’ style of consulting (Chapter 14). This style allows issues that might impact on health to surface (e.g. other diseases, emotional and social issues, their care plan).Planned care: This follows the care-plan goals, using protocols and patient data.Emergency care: This style solves an immediate threat, e.g. stroke, appendicitis, acute mental illness, child abuse.
Setting the scene
Chris Salisbury, Jeremy Dale, Lesley Hallam in 24-Hour Primary Care, 2018
The heavy reliance on hospital-based services evident in some European systems is said to result in considerably more expensive services. It is difficult to assess the precise impact of this. Emergency departments need to be equipped with expensive, specialised equipment and to have specially trained staff available 24 hours a day. Reducing the number of primary care patients attending could reduce staff costs, but will have little impact on the costs of providing equipment and infrastructure. Primary care patients represent a marginal increase in cost, rather than a pro rata cost. Nonetheless, many countries are trying to move to systems which promote the role of the general practitioner, particularly as a gatekeeper, in order to cut costs. To do this, they must strengthen the infrastructure and organisation of general practice and offer sufficiently attractive remuneration to general practitioners to bring them willingly into a new system. The costs of this have not been quantified and given the growing resistance to 24-hour responsibility among general practitioners who currently hold it, changing from a hospital-based culture of emergency care may not be easily or cheaply accomplished.
Health care and cost containment in Spain
Elias Mossialos, Julian Le Grand in Health Care and Cost Containment in the European Union, 2019
When compared with results currently achieved using the UBA pricing mechanism based on lengths of stay, the results of the above study, outlining efficiency costs and 'prices' for lines of activity, indicate a much higher relative cost for emergencies. The opposite was concluded for ambulatory activity (although this was without any adjustment for case mix). The estimations practically favour the identification of emergency care on one (average) in-patient stay, the third part of these values not reaching the average of ambulatory activity in terms of cost. In conclusion, López and Wagstaff argue that a regulation which bases finance (both for public hospital centres owned by the social security and for contracted centres) on the rate currently established for publicly financed non-public hospitals would save around 17 per cent of current expenditure.
Nursing Staff’s Experiences of Caring for People with Mental Ill-Health in General Emergency Departments: A Qualitative Descriptive Study
Published in Issues in Mental Health Nursing, 2022
Katharina Derblom, Jenny Molin, Sebastian Gabrielsson, Britt-Marie Lindgren
General emergency care is an essential part of the health system worldwide and access to well-organized, safe, and high-quality emergency care can contribute to the reduction of health inequalities (WHO, 2019). People with mental ill-health have more encounters with general emergency departments (ED) than others, related to their physical and psychiatric care needs (Holmberg et al., 2020). Predominately, they report unsatisfying experiences and poor treatment related to stigma and discrimination from staff (Perry et al., 2020), which affects their well-being and recovery (Schmidt & Uman, 2020). Nursing staff in general EDs are often the first point of contact for people with mental ill-health (Morphet et al., 2012). Still, they report lacking knowledge, training, and support to adequately assess and meet the needs of people with mental ill-health (Plant & White, 2013). In this article, “nursing staff” refers to registered nurses (RN), and enrolled nurses (EN) working in direct patient care in general EDs. To tailor suitable interventions that target nursing staffs’ need for support in the provision of optimized acute care for people with mental ill-health, it is crucial to deepen the understanding of their experiences of caring for them, and of the factors influencing the care.
Misallocation of Demand and the Persistent Non-emergent Use of the Emergency Department Post-Healthcare Reform
Published in Hospital Topics, 2020
The theory behind the ACA was that the 32 million Americans who will receive first time health insurance coverage would no longer seek care for non-emergent conditions at hospital emergency departments and instead, would prefer to establish relationships with primary care physicians in order to ensure continuity of care. Many primary care physician practices may be already functioning at capacity and unable to accept new patients, while others may be unwilling to accept the low reimbursements offered by Medicaid. In essence, the continued availability of emergency care is somewhat dependent on the remaining operational emergency departments and the current retail clinics, urgent care centers and primary care providers who are willing to accept lower paying insurance plans. This is an important factor as healthcare providers outside of hospital emergency departments are not bound by the EMTALA law to provide services at no cost. Because of this, it is also becoming increasingly more difficult for patients to coordinate follow-up care after being treated in emergency departments only causing them to return to the ED yet again.
Acute Crisis Care for Patients with Mental Health Crises: Initial Assessment of an Innovative Prehospital Alternative Destination Program in North Carolina
Published in Prehospital Emergency Care, 2018
Jamie O. Creed, Julianne M. Cyr, Hillary Owino, Shannen E. Box, Mia Ives-Rublee, Brian B. Sheitman, Beat D. Steiner, Jefferson G. Williams, Michael W. Bachman, Jose G. Cabanas, J. Brent Myers, Seth W. Glickman
Emergency medicine addresses a broad spectrum of patient care and is impacted by high patient volumes in the United States (US) with an estimated 136 million emergency visits every year (1). North Carolina (NC) had 4.8 million emergency department (ED) visits in 2012 (2). Addressing emergency mental health care is critical due to the increasing prevalence of mental illness and its resulting impact on ED patient volumes. The total US adult population in 2014 suspected to suffer from any mental illness and serious mental illness was 18.1% and 4.1%, respectively (3). Rates of mental illness in NC have been comparable to national rates (4). Patients suffering from acute mental health crises often seek treatment in EDs and represent an increasingly significant portion of ED patients. Visits with a primary mental health diagnosis, excluding substance abuse, accounted for approximately 10% of all NC ED visits in 2012 (2). NC ED visits with a mental health diagnosis increased by 18% from 2008 to 2010, while all NC ED visits increased by only 5% (5).
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