Predicting time to emergency department re-visits and inpatient hospitalization among adolescents who visited an emergency department for psychotic symptoms: a retrospective cohort study

Amir Soleimani, Rhonda J Rosychuk, Amanda S Newton, Amir Soleimani, Rhonda J Rosychuk, Amanda S Newton

Abstract

Background: Adolescents experiencing psychosis may enter the mental health system by a pathway to care that includes or is initiated at the emergency department (ED). However, a better understanding of the pathway to care involving EDs is required to ensure these patients receive the care they require. This study explores physician-based care factors associated with adolescent ED re-visits and inpatient hospitalization following an index ED visit for psychotic symptoms.

Methods: Using administrative data from Alberta, Canada, we identified a cohort of adolescents aged 13-17 years who were discharged after an ED visit for psychotic symptoms between April 1, 2002 and September 29, 2010. Multivariable models estimated times to ED re-visit and inpatient hospitalization for mental health care in a 90-day period after ED discharge.

Results: The cohort was comprised of 208 adolescents. Reduced times to ED re-visit and inpatient hospitalization were associated with: 1) multiple physician visits after discharge (ED re-visit: hazard ratio [HR] 5.93, 95 % confidence interval [CI] 2.09-16.82; inpatient hospitalization: HR 9.43, 95 % CI 1.24-72.00), and 2) post-ED physician care provided in a hospital-based outpatient clinic (ED re-visit: HR 3.07, 95 % CI 1.77-5.29; inpatient hospitalization: HR 3.48, 95 % CI 1.54-7.88). A follow-up visit to a pediatrician, compared to other physician specialties, was associated with earlier inpatient hospitalization (HR 4.45, 95 % CI 1.43-13.87). There was a significant interaction between sex and First Nations status in both models. Females with First Nations status re-visited the ED sooner (HR 3.19; 95 % CI 1.41-7.22) and were hospitalized sooner (HR 4.18; 95 % CI 1.24-14.06).

Conclusions: This study identifies predictors of time to care for adolescents with psychotic symptoms that are worthy of additional investigation. To ensure the pathway to care for these adolescents reduces the duration of untreated problems, health care aspects that require urgent investigation include the type assessments and clinical decisions made during post-ED physician visits.

Keywords: Adolescent; Emergency department; Pathways to care; Primary care; Psychosis.

References

    1. Kelleher I, Connor D, Clarke M, Devlin N, Harley M, Cannon M. Prevalence of psychotic symptoms in childhood and adolescence: a systematic review and meta-analysis of population-based studies. Psychol Med. 2012;42:1857–63. doi: 10.1017/S0033291711002960.
    1. McGrath JJ, Saha S, Al-Hamzawi AO, Alonso J, Andrade L, Borges G, et al. Age of onset and lifetime projected risk of psychotic experiences: cross-national data from the World Mental Health Survey. Schizophr Bull. 2016;42(4):933–41. doi: 10.1093/schbul/sbw011.
    1. McGorry PD, Killackey EJ. Early intervention in psychosis: a new evidence based paradigm. Epidemiol Psychiatr Soc. 2002;11:237–47. doi: 10.1017/S1121189X00005807.
    1. Perkins D, Hongbin GU, Boteva K, Lieberman J. Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia: a critical review and meta-analysis. Am J Psychiatry. 2005;162:1785–804. doi: 10.1176/appi.ajp.162.10.1785.
    1. Anderson K, Fuhrer R, Malla A. The pathways to mental health care of first-episode psychosis patients: a systematic review. Psychol Med. 2010;40:1585–97. doi: 10.1017/S0033291710000371.
    1. Singh S, Grange T. Measuring pathways to care in first-episode psychosis: a systematic review. Schizophr Res. 2006;81:75–82. doi: 10.1016/j.schres.2005.09.018.
    1. Addington J, van Mastrigt S, Hutchinson J, Addington D. Pathways to care: help seeking behaviour in first episode psychosis. Acta Psychiatr Scand. 2002;106(5):358–64. doi: 10.1034/j.1600-0447.2002.02004.x.
    1. Cheung D, Roper L, Purdon SE. Pathways to (specialized) care: patient costs and contacts en route to a first-episode psychosis clinic. Early Interv Psychiatry. 2014;8(4):375–81. doi: 10.1111/eip.12093.
    1. O’Callaghan E, Turner N, Renwick L, Jackson D, Sutton M, Foley S, et al. First episode psychosis and the trail to secondary care: help-seeking and health-system delays. Soc Psychiatry Psychiatr Epidemiol. 2010;45(3):381–91. doi: 10.1007/s00127-009-0081-x.
    1. Platz C, Umbricht D, Cattapan-Ludewig K, Dvorsky D, Arbach D, Brenner H, et al. Help-seeking pathways in early psychosis. Soc Psychiatry Psychiatr Epidemiol. 2006;41(12):967–74. doi: 10.1007/s00127-006-0117-4.
    1. Sheridan DC, Spiro DM, Fu R, Johnson KP, Sheridan JS, Oue AA, et al. Mental health utilization in a pediatric emergency department. Pediatr Emerg Care. 2015;31(8):555–9. doi: 10.1097/PEC.0000000000000343.
    1. Newton AS, Ali S, Johnson DW, Haines C, Rosychuk RJ, Keaschuk RA, et al. A 4-year review of pediatric mental health emergencies in Alberta. CJEM. 2009;11(5):447–54. doi: 10.1017/S1481803500011647.
    1. Cappelli M, Glennie JE, Cloutier P, Kennedy A, Vloet M, Newton A, et al. Physician management of pediatric mental health patients in the emergency department: assessment, charting, and disposition. Pediatr Emerg Care. 2012;28(9):835–41. doi: 10.1097/PEC.0b013e31826764fd.
    1. Pittsenbarger ZE, Mannix R. Trends in pediatric visits to the emergency department for psychiatric illnesses. Acad Emerg Med. 2014;21(1):25–30. doi: 10.1111/acem.12282.
    1. Pira S, Durr G, Pawliuk N, Joober R, Malla A. Mode of entry to an early intervention service for psychotic disorders: determinants and impact on outcome. Psychiatr Serv. 2013;64(11):1166–9. doi: 10.1176/appi.ps.201200474.
    1. Anderson KK, Fuhrer R, Schmitz N, Malla AK. Determinants of negative pathways to care and their impact on service disengagement in first-episode psychosis. Soc Psychiatry Psychiatr Epidemiol. 2013;48(1):125–36. doi: 10.1007/s00127-012-0571-0.
    1. Newton AS, Ali S, Johnson DW, Haines C, Rosychuk RJ, Keaschuk RA, et al. Who comes back? Characteristics and predictors of return to emergency department services for pediatric mental health care. Acad Emerg Med. 2010;17(2):177–86. doi: 10.1111/j.1553-2712.2009.00633.x.
    1. Anderson KK, Fuhrer R, Wynant W, Abrahamowicz M, Buckeridge D, Malla A. Patterns of health services use prior to a first diagnosis of psychosis: the importance of primary care. Soc Psychiatry Psychiatr Epidemiol. 2013;48(9):1389–98. doi: 10.1007/s00127-013-0665-3.
    1. Newton AS, Rosychuk RJ, Niu X, Radomski AD, McGrath PJ. Emergency department use and postvisit care for anxiety and stress disorders among children: a population-based cohort study in Alberta, Canada. Pediatr Emerg Care. 2016;32:658-63.
    1. Newton AS, Rosychuk RJ, Dong K, Curran J, Slomp M, McGrath PJ. Emergency health care use and follow-up among sociodemographic groups of children who visit emergency departments for mental health crises. CMAJ. 2012;184(12):E665–74. doi: 10.1503/cmaj.111697.
    1. Alberta Health and Wellness. Ambulatory Care in Alberta using Ambulatory Care Classification System Data. Edmonton: Government of Alberta; 2004.
    1. Canadian Institute for Health Information. National Ambulatory Care Reporting System (NACRS) Metadata. 2015. . Accessed 3 Aug 2016.
    1. Canadian Institute for Health Information. Data Quality Documentation, National Ambulatory Care Reporting System – Multi-Year Information. 2015. . Accessed 3 Aug 2016.
    1. World Health Organization. International Statistical Classification of Diseases and Related Health Problems. 2010. . Accessed 6 May 2011.
    1. Gravel J, Manzano S, Arsenault M. Validity of the Canadian Paediatric Triage and Acuity Scale in a tertiary care hospital. CJEM. 2009;11(1):23–8. doi: 10.1017/S1481803500010885.
    1. Warren DW, Jarvis A, LeBlanc L, Gravel J. CTAS National Working Group. Revisions to the Canadian Triage and Acuity Scale Paediatric Guidelines (PaedCTAS) CJEM. 2008;10(3):224–32. doi: 10.1017/S1481803500010149.
    1. Canadian Institute for Health Information. Discharge Abstract Database (DAD) Metadata. . Accessed 23 Aug 2016.
    1. Perkins DO, Gu H, Boteva K, Lieberman JA. Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia: a critical review and meta-analysis. Am J Psychiatry. 2005;162(10):1785–804. doi: 10.1176/appi.ajp.162.10.1785.
    1. Monteiro VB, dos Santos JQ, Martin D. Patients’ relatives delayed help seeking after a first psychotic episode. Rev Bras Psiquiatr. 2006;28(2):104–10.
    1. Morgan C, Abdul-Al R, Lappin JM, Jones P, Fearon P, Leese M, Croudace T, Morgan K, Dazzan P, Craig T, Leff J, Murray R, AESOP Study Group. Clinical and social determinants of duration of untreated psychosis in the AESOP first-episode psychosis study. Br J Psychiatry. 2006;189:446-52.
    1. Simon AE, Lester H, Tait L, Stip E, Roy P, Conrad G, Hunt J, Epstein I, Larsen TK, Amminger P, Holub D, Wenigová B, Turner M, Berger GE, O’Donnell C, Umbricht D. The International Study on General Practitioners and Early Psychosis (IGPS). Schizophr Res. 2009;108(1-3):182-90.
    1. Malla AK, Norman RMG, Voruganti LP Improving outcomes in schizophrenia: the case for early intervention. CMAJ. 1999;160:843-6.
    1. Gfellner BM, Hundleby JD. Patterns of drug use among Native and white adolescents: 1990-1993. Can J Public Health. 1995;86(2):95-7.
    1. Alaghehbandan R, Sikdar KC, MacDonald D, Collins KD, Rossignol AM. Unintentional injuries among children and adolescents in Aboriginal and non-Aboriginal communities, newfoundland and labrador, Canada. Int J Circumpolar Health. 2010;69(1).
    1. Lincoln C, Harrigan S, McGorry PD. Understanding the topography of the early psychosis pathways. An opportunity to reduce delays in treatment. Br J Psychiatry. 1998;172:21-25.

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner