The revolving door phenomenon is commonly used to describe chronically mentally ill patients utilizing inpatient services in a cyclical pattern. This phenomenon suggests that even if these individuals represent a small proportion of the general population, they represent a significant number of psychiatric inpatient hospitalizations, which are costly. Not only do the health care costs affect the patient but also the community and economy, especially those with Medicare or Medicaid. In 2006, The Agency for Healthcare Research and Quality found that 6 out of every 10 hospitalizations for a mental health condition were paid by Medicaid and Medicare (Saba, Levit, & Elixhauser, 2008). Among 15 states, mental health ranked among one of the top five …show more content…
While it has been found that patients taking medication have more admissions, there is limited research on the direct relationship between medication regimen and hospital readmissions in the psychiatric population (Webb et al., 2007). However, Langdon et al., (2001), found that out of 128 patients who were readmitted in a year, 51% had three or more re-admissions. These patients were more likely to be prescribed more medication than patients with less than three readmissions. It is difficult to determine which factor is the preceding in these instances. It is also important to note that complexity of medication regimen is a risk factor for medication …show more content…
Although, there are numerous barriers to medication adherence, including: forgetfulness (organic/nonorganic), intentional (felt better/felt worse), lack of information, attitudes/beliefs towards medication taking, complex regimens, etc (Breen & Thornhill, 1998; Razali & Yahya, 1995). There are also many risks involved with being non-adherent which include: increase risk of relapse, hospitalizations, poor long-term course of illness, and higher yearly medical costs (Gilmer et al., 2004; Omranifard, Yazdani, Yaghoubi, Namdari, 2008). It is estimated that the United States spends $2 billion a year on readmission inpatient hospitalizations for patients diagnosed with schizophrenia alone (Weiden & Olfsen, 1995). Hence, it isn’t surprising that individuals diagnosed with schizophrenia have non adherence rates ranging from 40 to 50% (Bulloch & Patten, 2010) and can run as high as 70 to 80% (Breen & Thornhill, 1998). Other mental health illnesses, such as depression, have shown to have non-adherence rates up to 60% (Lin et al., 1995). Since individuals with schizophrenia are notorious for being noncompliance, majority of research is dedicated to this
State and federal regulations, national accreditation standards, and clinical practice standards are created, and updated regularly. In addition, to these regulations, OIG publishes a compliance work plan annually that focuses on protecting the integrity of the program, and prevention of fraud and abuse. The Office of the Inspector General examines quality‐of‐care issues in nursing facilities, organizations, community‐based settings and occurrences in which the programs may have been billed for medically unnecessary services. The Office of the Inspector General’s work plan for the fiscal year 2011 highlights five areas of investigation for acute care hospitals. Reliability of hospital-reported quality measure data, hospital readmissions, hospital admissions with conditions
Belluck’s New York Times article describes a study that ordered mentally ill patients to receive treatment instead of being hospitalized. The study found that the patients were less likely to be placed in psychiatric hospitals or arrested, and outpatient treatment and medication refills increased. This also proved economical, because the mental health system and Medicaid costs were reduced by at least fifty percent. This program doesn’t only apply to the patient to accept treatment, it also requires the mental health system to provide it, making the program more effective
-Lieberman JA, Stroup TS, McEvoy JP, Swartz MS, Rosenheck RA, Perkins DO, Keefe RS, Davis SM, Davis CE, Lebowitz BD, Severe J, Hsiao JK. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med. 2005. Web.
My clinical rotation for NURN 236 is unique in that all patients I care for at Union Memorial Hospital in Baltimore, Maryland have a diagnosis of heart failure (HF). HF occurs when the heart is unable to pump adequate blood supply, resulting in insufficient oxygen and nutrients to the tissues of the body (Smeltzer, Bare, Hinkle, and Cheever, 2012). Approximately 670,000 Americans are diagnosed with HF each year and is the most common hospital discharge diagnosis among the elderly (Simpson, 2014). Moreover, according to the Centers for Medicare and Medicaid Services (CMS), HF is the leading cause of 30-day hospital readmission followed by acute myocardial infarction (AMI) and pneumonia (medicare.gov|Hospital Compare, 2013). This information along with my weekly HF patient cohort prompted my curiosity regarding impacts of HF readmissions, factors of HF readmission, and to compare suggested evidence based practice with policies utilized at Union Memorial for reducing the 30-day readmission rate for HF.
Mental healthcare has a long and murky past in the United States. In the early 1900s, patients could live in institutions for many years. The treatments and conditions were, at times, inhumane. Legislation in the 1980s and 1990s created programs to protect this vulnerable population from abuse and discrimination. In the last 20 years, mental health advocacy groups and legislators have made gains in bringing attention to the disparity between physical and mental health programs. However, diagnosis and treatment of mental illnesses continues to be less than optimal. Mental health disparities continue to exist in all areas of the world.
Until the middle of the last century, public mental health in the United States had been the responsibility, for the most part, of individual states, who chose to deal with their most profoundly mentally-ill by housing them safely and with almost total asylum in large state mental hospitals. Free of the stresses we all face in our lives, the mentally-ill faced much better prospects for peaceful lives and even recovery than they would in their conditions in ordinary society. In the hospitals, doctors were always accessible for help, patients were assured food and care, and they could be monitored to insure they never became a danger to themselves or others. Our nation’s state hospital system was a stable, efficient way to help improve the lives of our mentally disabled.
According to Gamble and Brennan (2000), the effectiveness of medication for schizophrenia to relieve patients from psychotic symptoms is limited. Although patients have adequate medication, some received little or no benefit from it and almost half of them still experience psychotic symptoms. They are also more likely to suffer relapse (Gamble and Brennan, 2000). Furthermore, Valmaggia, et al. (2005) found that 50% of patients who fully adhere to anti-psychotic medication regimes still have ongoing positi...
If the United States had unlimited funds, the appropriate response to such a high number of mentally ill Americans should naturally be to provide universal coverage that doesn’t discriminate between healthcare and mental healthcare. The United States doesn’t have unlimited funds to provide universal healthcare at this point, but the country does have the ability to stop coverage discrimination. A quarter of the 15.7 million Americans who received mental health care listed themselves as the main payer for the services, according to one survey that looked at those services from 2005 to 2009. 3 Separate research from the same agency found 45 percent of those not receiving mental health care listing cost as a barrier.3 President Obama and the advisors who helped construct The Affordable Care Act recognized the problem that confronts the mentally ill. Mental healthcare had to be more affordable and different measures had to be taken to help patients recover. Although The Affordable Care Act doesn’t provide mentally ill patients will universal coverage, the act has made substantial changes to the options available to them.
“Insurance companies often cover mental illness in a more limited fashion than physical illness” (Christensen). The lack of mental health care provided for the mentally ill has been a growing issue in the US during the previous years, and there has been some progress. For example, there has been the Mental Health Care and Parity Law of 2008 that was enacted so that the insurers would cover mental illness just as they would cover other illnesses. In addition, the Affordable Care Act was enacted to enforce that the insurers abide by the rules. Unfortunately, that hasn’t helped much, hence: the sneaky behavior of insurance companies. This sneaky behavior seems to be unnoticed by the government the majority of the time unless the patient or his family decides to file a lawsuit. Until then, insurance companies have been constantly bending rules and finding loopholes to not pay insurance for mental illness.
Classical antipsychotic treatments are commonly used to treat schizophrenic patients with major positive symptoms of schizophrenia, such as Thorazine, Haldol, and Stelazine (Gleitman et al., 2011). Antipsychotic treatments are usually administered with a variety of psychosocial treatments including social skills training, vocational rehabilitation, supported employment, family therapy, or individual therapy (Barlow & Durand, 2014). This is to reduce relapse and help the patient improve their skills in deficits and comply in consuming the
Those with mental illness would live in the community with an array of services and be able to be free from the constraints of confinement. In the early 1960’s the United States began an initiative to reduce and close publicly-operated mental hospitals. This became known as deinstitutionalization. The goal of deinstitutionalization was to allow people suffering from mental illness to live more independently in the community with treatments provided through community health programs. Unfortunately, the federal government did not provide sufficient ongoing funding for the programs to meet the growing demand. States reduced their budgets for mental hospitals but failed to increase funding for on-going community-based mental health programs. As a result of deinstitutionalization hundreds of thousands of mentally ill people were released into the community without the proper resources they needed for their treatment. (Harcourt,
BIBLIOGRAPHY Arasse, Daniel. Complete Guide to Mental Health. Allen Lane Press,New York, 1989. Gingerich, Susan. Coping With Schizophrenia. New Harbinger Publications, Inc. Oakland, 1994. Kass, Stephen. Schizophrenia: The Facts. Oxford University Press. New York, 1997. Muesen, Kim. “Schizophrenia”. Microsoft Encarta Encyclopedia. Microsoft Corporation, 1998. Young, Patrick. The Encyclopedia od Health, Psychological Disorders and Their Treatment. Herrington Publications. New York, 1991.
States obtain many services that fall under mental health care, and that treat the mentally ill population. These range from acute and long-term hospital treatment, to supportive housing. Other effective services utilized include crisis intervention teams, case management, Assertive Community Treatment programs, clinic services, and access to psychiatric medications (Honberg at al. 6). These services support the growing population of people living in the...
The debate over the right of clinical psychologists to prescribe psychoactive medications is certainly not new to the scene. In fact, the debate spans over the past two decades with strong arguments on each end of the spectrum. While opponents to the issue question, among many other things, the qualifications of psychologists, advocates on the issue stress the important public needs that are not currently being met in our mental healthcare system (Lavoie & Barone, 2006). Although the issue of prescription privileges for psychologist stems back many years with plenty of arguments on both sides, I believe the evidence presents a clear and evident solution on the topic. Based on research articles and journals in this field of study, I find that new standards for prescription privileges would pose a substantial benefit for mental health professionals, both psychologist and psychiatrists. Prescription privileges in today’s world would essentially broaden public access and availability to the mental health professionals who have the powers to prescribe (Lavoie & Fleet, 2002).
Hospitalizations account for more than 30% of the total annual costs for healthcare and around 20% of all hospital admissions occur within 30 days of a previous discharge. A readmission is defined as any re-entry to a hospital 30 days or less from a prior discharge. A financial impact is that US Medicare and Medicaid will either not pay or will reduce the payment made to hospitals for expenses incurred. By the end of 2015, over 2600 hospitals will incur these losses from a Medicare and Medicaid expense that exceeds $24B annually. These situations are expensive and often preventable: one-third of readmissions may be preventable, so there is room for improvement in care and reduction in cost.