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Models of integrated care for young people experiencing medical emergencies related to mental illness: a realist systematic review.
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- المؤلفون: Otis M;Otis M;Otis M;Otis M; Barber S; Barber S; Barber S; Barber S; Amet M; Amet M; Nicholls D; Nicholls D; Nicholls D; Nicholls D
- المصدر:
European child & adolescent psychiatry [Eur Child Adolesc Psychiatry] 2023 Dec; Vol. 32 (12), pp. 2439-2452. Date of Electronic Publication: 2022 Sep 24.- نوع النشر :
Systematic Review; Journal Article- اللغة:
English - المصدر:
- معلومة اضافية
- المصدر: Publisher: Country of Publication: Germany NLM ID: 9212296 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1435-165X (Electronic) Linking ISSN: 10188827 NLM ISO Abbreviation: Eur Child Adolesc Psychiatry Subsets: MEDLINE
- بيانات النشر: Publication: 2010- : Heidelberg : Springer Medizin
Original Publication: Toronto ; Lewiston, NY : Hogrefe & Huber, [1992- - الموضوع:
- نبذة مختصرة : Mental illness heightens risk of medical emergencies, emergency hospitalisation, and readmissions. Innovations for integrated medical-psychiatric care within paediatric emergency settings may help adolescents with acute mental disorders to get well quicker and stay well enough to remain out of hospital. We assessed models of integrated acute care for adolescents experiencing medical emergencies related to mental illness (MHR). We conducted a systematic review by searching MEDLINE, PsychINFO, Embase, and Web of Science for quantitative studies within paediatric emergency medicine, internationally. We included populations aged 8-25 years. Our outcomes were length of hospital stay (LOS), emergency hospital admissions, and rehospitalisation. Limits were imposed on dates: 1990 to June 2021. We present a narrative synthesis. This study is registered on PROSPERO: 254,359. 1667 studies were screened, 22 met eligibility, comprising 39,346 patients. Emergency triage innovations reduced admissions between 4 and 16%, including multidisciplinary staffing and training for psychiatric assessment (F(3,42) = 4.6, P < 0.05, N = 682), and telepsychiatry consultations (aOR = 0.41, 95% CI 0.28-0.58; P < 0.001, N = 597). Psychological therapies delivered in emergency departments reduced admissions 8-40%, including psychoeducation (aOR = 0.35, 95% CI 0.17-0.71, P < 0.01, N = 212), risk-reduction counselling for suicide prevention (OR = 2.78, 95% CI 0.55-14.10, N = 348), and telephone follow-up (OR = 0.45, 95% CI 0.33-0.60, P < 0.001, N = 980). Innovations on acute wards reduced readmissions, including guided meal supervision for eating disorders (P = 0.27), therapeutic skills for anxiety disorders, and a dedicated psychiatric crisis unit (22.2 vs 8.5% (P = 0.008). Integrated pathway innovations reduced readmissions between 8 and 37% including family-based therapy (FBT) for eating disorders (X 2 (1,326) = 8.40, P = 0.004, N = 326), and risk-targeted telephone follow-up or outpatients for all mental disorders (29.5 vs. 5%, P = 0.03, N = 1316). Studies occurred in the USA, Canada, or Australia. Integrated care pathways to psychiatric consultations, psychological therapies, and multidisciplinary follow-up within emergency paediatric services prevented lengthy and repeat hospitalisation for MHR emergencies. Only six of 22 studies adjusted for illness severity and clinical history between before- and after-intervention cohorts and only one reported socio-demographic intervention effects.
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- الموضوع: Date Created: 20220923 Date Completed: 20231128 Latest Revision: 20231128
- الموضوع: 20231215
- الرقم المعرف: PMC9510153
- الرقم المعرف: 10.1007/s00787-022-02085-5
- الرقم المعرف: 36151355
- المصدر:
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