2 research outputs found
Care of Psychiatric Patients: The Challenge to Emergency Physicians
Psychiatric patients frequently present to the emergency
department (ED) for care when they are in crisis. Recent
studies demonstrate about 10% of all ED patients present with
psychiatric illness.1 However, this is not an adequate estimate
of the number of patients because many of these patients do
not have a psychiatric diagnosis. Two recent studies have
demonstrated that 45% of adults and 40% of pediatric patients
who present to the ED with non-psychiatric complaints have
undiagnosed mental illness.2-3 These studies did not determine
whether these psychiatric illnesses affected the patients’
presentation. The purpose of this article is to discuss disparity
and challenges in caring for these patients
Coordinated Health Care Interventions for Childhood Asthma Gaps in Outcomes (CHICAGO) plan
Background: Evidence-based strategies to improve outcomes in minority children with uncontrolled asthma discharged from the emergency department (ED) are needed. Objectives: This multicenter pragmatic clinical trial was designed to compare an ED-only intervention (decision support tool), an ED-only intervention and home visits by community health workers for 6 months (ED-plus-home), and enhanced usual care (UC). Methods: Children aged 5 to 11 years with uncontrolled asthma were enrolled. The change over 6 months in the Patient-Reported Outcomes Measurement Information System Asthma Impact Scale score in children and Satisfaction with Participation in Social Roles score in caregivers were the primary outcomes. The secondary outcomes included guideline-recommended ED discharge care and self-management. Results: Recruitment was significantly lower than expected (373 vs 640 expected). Of the 373 children (64% Black and 31% Latino children), only 63% completed the 6-month follow-up visit. In multivariable analyses that accounted for missing data, the adjusted odds ratios and 98% CIs for differences in Asthma Impact Scores or caregivers’ Satisfaction with Participation in Social Roles scores were not significant. However, guideline-recommended ED discharge care was significantly improved in the intervention groups versus in the UC group, and self-management behaviors were significantly improved in the ED-plus-home group versus in the ED-only and UC groups. Conclusions: The ED-based interventions did not significantly improve the primary clinical outcomes, although the study was likely underpowered. Although guideline-recommended ED discharge care and self-management did improve, their effect on clinical outcomes needs further study