The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #65698

Cynthia L. Arfken, PhD, Lori Lackman Zeman, PhD, Lindsay Yeager, Aja Temple, and Serena Roth. Department of Psychiatry and Behavioral Neurosciences, Wayne State University, 2761 E. Jefferson, Detroit, MI 48207, (313) 993-3490, carfken@med.wayne.edu

Emergency psychiatric services provide crisis care and screen for inpatient psychiatric admissions. Over-reliance on their services can be costly to the system, burdensome to staff, and detrimental to patients. Our previous work identified risk factors for high utilization in an urban setting. One factor, seeking care because needed medications, suggested focused medication reviews might reduce high utilization. The use of focused reviews (costing less than 10% of usual admission) might also absorb budgetary declines. They would, however, require additional communication with outpatient clinics providing primary psychiatric care. To evaluate the impact of focused reviews, we surveyed staff at the emergency psychiatric service and at outpatient clinics. We also surveyed 80 patients receiving focused reviews and examined their healthcare utilization patterns. Patients reported high level of satisfaction. Those patients expressing dissatisfaction wanted more time in the service but not more time with the physician. The staff at the emergency psychiatric service reported moderate satisfaction along with improvements in workload and patient care. In contrast, the staffs at the outpatient clinics were mostly unaware of the availability of focused reviews. Among those aware, lower satisfaction, increased workload and no change in patient care were reported. Emergency psychiatric service utilization for the 80 patients increased after the medication review, but there was no increase in hospitalization. The results reflect patients' preference and the need to examine the fiscal impact to the larger system. Change affecting multiple institutions may face lingering obstacles and resentment.

Learning Objectives:

• At the conclusion of the session, the participant in this session will be able to: list possible challenges of serving an urban population, evaluate the merits of focused reviews for mental health budgets

Keywords: Emergency Department/Room, Urban Health Care

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.