Social psychiatry and psychiatric epidemiology
-
Soc Psychiatry Psychiatr Epidemiol · Dec 2003
Comparative StudyPathways to care and psychological problems of general practice patients in a "gate keeper" and an "open access" health care system: a comparison of Germany and the Netherlands.
The comparison of different health care systems is one way to give empirical evidence to health care reform and policy. The differences between health care systems in which general practitioners serve as gate keepers in comparison to systems in which patients are free to contact every physician and specialist they like are a question of high interest. ⋯ Family physicians in a gate keeper system reduce the number of contacts to other physicians and the intensity of treatment, while at the same time the rate of hospital admissions is increased.
-
Soc Psychiatry Psychiatr Epidemiol · Oct 2003
Randomized Controlled Trial Clinical TrialDay hospital vs. home treatment--a comparison of illness severity and costs.
Acute home treatment services, providing short-term intensive input as an alternative to in-patient admission, have been recommended by the Department of Health as part of a spectrum of care. The lack of research evidence for such services is in contrast to acute day hospital care which has been better researched, but not widely adopted. This paper compares the patients treated in a randomised controlled trial (RCT) of day hospital vs. in-patient care with patients treated several years later in the home treatment service which developed from the original acute day hospital. ⋯ Extending the remit of an acute day hospital to provide 24-h care and a choice of treatment location is associated with an increase in the severity of illness treated. The impact on costs is unclear and the total cost of the new service may not be significantly less than in-patient care. The results need to be interpreted with caution because of differences in recruitment methods.
-
Soc Psychiatry Psychiatr Epidemiol · Jun 2003
Excess mortality among long-stay psychiatric patients in Northern Finland.
According to several studies, mortality in psychiatric patients is higher than in the general population, but cause-specific mortality analyses in long-stay psychiatric patients have not been studied very much. Individual follow-ups have been called for in order to identify possible treatment deficiencies and to make recommendations for clinical practices. In this study, mortality of long-stay psychiatric patients has been monitored for the years 1992-2000 and contrasted with that prevalent in the general population. ⋯ Long-stay psychiatric patients were found to die from the same natural causes as the rest of the general population. However, the mortality risk of the long-stay psychiatric patients compared with that of the general population was notably higher, despite ongoing improvements in medical care and facilities. Inadequately organised somatic care and the prevailing culture of "non-somatic" treatment in psychiatry were suggested to, at least in part, explain this phenomenon. Attention ought to increasingly focus on somatic examinations and various health educational programmes specially designed for psychiatric patients and involving matters like healthy diet, smoking cessation and physical exercise. These practices should be a regular part of any patient's treatment programme. Also, the need to recognise factors associated with a patient's psychiatric disorder that could limit that patient's ability to communicate somatic symptoms and/or even lead to a refusal by that patient to have somatic diseases treated was seen as essential for providers of psychiatric services.
-
Soc Psychiatry Psychiatr Epidemiol · Mar 2003
Comparative StudyPredictors of life satisfaction in retired physicians and spouses.
With the current demographic changes, adjustment to retirement has become a major concern for physicians. Yet information on adjustment to retirement gathered from retired physicians is sparse. Information on physician spouses following retirement is currently not available. Therefore, we conducted a survey of a multi-disciplinary group of retired physicians and their spouses on adjustment to retirement. ⋯ Physicians and their spouses reported high levels of life satisfaction. The factors predicting life satisfaction and change in life satisfaction following retirement differed for physicians and spouses. For physicians, life satisfaction and change in life satisfaction were affected by time since retirement.
-
Soc Psychiatry Psychiatr Epidemiol · Nov 2002
How the inner world is reflected in relation to perceived ward atmosphere among patients with psychosis.
This study focused on how cognitive ability, personality traits, self-rated psychiatric symptoms, and social functioning were related to the way in which patients with psychosis perceived supportive aspects of the ward atmosphere. ⋯ The results from this study indicate that individual factors such as self-control, paranoid symptoms and social competence may be important for how the ward atmosphere is perceived. This is important knowledge when monitoring the ward atmosphere to better fit a unit's target group.