Who Benefits from Acute Psychiatric Home Treatment? A Systematic Review.

Home treatment (HT) treats patients in an acute crisis through an interdisciplinary team with daily appointments for a short treatment period. The effectiveness of HT has already been confirmed. However, only few studies addressed specific patient characteristics associated outcome of treatment. This study aimed to identify patient characteristics associated with successful outcomes of HT. A systematic literature search was conducted according to the PRISMA guidelines. A total of 13 studies were included in the systematic review. Being employed, having a regular income, having an anxiety disorder and family involvement were associated with a successful treatment outcome in HT. High symptom severity and former hospital admissions were associated with unsuccessful treatment outcome in HT in the selected studies. HT seems to be especially beneficial for patients with paid employment or regular income, patients with anxiety disorders, and patients with familial or other social support

Study protocol of an observational study in acute psychiatric home treatment: How does home treatment work? Identification of common factors and predictors of treatment success

Background: Systematic reviews indicated that home treatment is an effective and cost-saving alternative to conventional acute psychiatric treatment options. Treatment success has often been defined as a reduction of hospital admissions. In the current study, symptoms and well-being are assessed regularly during treatment as an indicator for treatment success. Patients' characteristics such as diagnosis, age, substance use, and motivation for treatment were discussed as predictors for treatment success. A second focal point of the study lies in the examination of the therapeutic relationship in terms of the outcome, which has not yet been systematically investigated in home treatment. Methods: This is an observational study with a prospective naturalistic design. Measurements are carried out at baseline, during and at the end of treatment as well as at the 3‑month follow-up. Patients' characteristics as potential predictors for treatment success will be assessed at baseline. In addition, the perceived relationship between the patients and the team will be measured daily and weekly throughout the treatment. Treatment success is by the changes in symptoms and general well-being assessed weekly. We aim to include 82 participants assigned to home treatment. Variance analyses with repeated measurements will be conducted to evaluate treatment success. Conclusion: By examining potential patient- and relationship-related predictors of treatment success, insights into relevant determining variables of treatment success in this setting are expected. The results might help to better identify who benefits the most from home treatment

Significance of chronic opioid medication for dental treatment: A brief overview of the special features of dental treatment for patients with chronic opioid use

Die Zahl von Patientinnen und Patienten unter chronischer Opioid-Therapie hat in der Schweiz über die letzten Jahre permanent zugenommen. Ungeduld, Angst und Unterversorgung spielen bei der Betreuung eines Teils dieser Klientel eine wesentliche Rolle. Empfehlenswert ist die aktive Kontaktaufnahme mit den somatischen und psychiatrischen Mitbehandelnden der Patienten und Patientinnen, um eine bessere Koordination, z. B. durch aktive Begleitung durch eine Bezugs-person, zu erreichen. Wenig bekannt ist, dass eine chronische Opioid-Einnahme die An- schlagszeit von Lokalanästhetika verlängert und deren Wirkdauer auf die Hälfte verkürzt. Die Kenntnis und Beachtung der veränderten Kinetik der Lokalanästhesie führt zu erhöhter Zufrie- denheit bei den Betroffenen wie auch bei den Behandelnden. Die Wirksamkeit von Nicht- Opioid-Analgetika ist nicht beeinträchtigt.The number of patients undergoing chronic opioid therapy has steadily increased in Switzerland in recent years. Impatience, anxiety and inadequate care play a significant role in the care of some of these clients. It is advisable to actively liaise with the patient's somatic and psychiatric co-treaters in order to achieve better coordination, e.g. through active support from a caregiver. It is little known that chronic opioid use prolongs the onset time of local anaesthetics and reduces their duration of action by half. Knowledge of and attention to the altered kinetics of local anaesthesia leads to increased satisfaction among patients and practitioners alike. The efficacy of non-opioid analgesics is not impaired

Mental health service areas in Switzerland

Objectives: Small area analysis is a health services research technique that facilitates geographical comparison of services supply and utilization rates between health service areas (HSAs). HSAs are functionally relevant regions around medical facilities within which most residents undergo treatment. We aimed to identify HSAs for psychiatric outpatient care (HSA-PSY) in Switzerland. Methods: We used HSAr, a new and automated methodological approach, and comprehensive psychiatric service use data from insurances to identify HSA-PSY based on travel patterns between patients' residences and service sites. Resulting HSA-PSY were compared geographically, demographically and regarding the use of inpatient and outpatient psychiatric services. Results: We identified 68 HSA-PSY, which were reviewed and validated by local mental health services experts. The population-based rate of inpatient and outpatient service utilization varied considerably between HSA-PSY. Utilization of inpatient and outpatient services tended to be positively associated across HSA-PSY. Conclusions: Wide variation of service use between HSA-PSY can hardly be fully explained by underlying differences in the prevalence or incidence of disorders. Whether other factors such as the amount of services supply did add to the high variation should be addressed in further studies, for which our functional mapping on a small-scale regional level provides a good analytical framework