In-patient costs of agitation and containment in a mental health catchment area.
Por:
Serrano-Blanco A, Rubio-Valera M, Aznar I, Baladon L, Gibert K, Gracia Canales A, Kaskens L, Ortiz JM and Salvador-Carulla L
Publicada:
6 jun 2017
Ahead of Print:
6 jun 2017
Categoría:
Psychiatry and mental health
Resumen:
BACKGROUND: There is a scarce number of studies on the cost of agitation and containment interventions and their results are still inconclusive. We aimed to calculate the economic consequences of agitation events in an in-patient psychiatric facility providing care for an urban catchment area. METHODS: A mixed approach combining secondary analysis of clinical databases, surveys and expert knowledge was used to model the 2013 direct costs of agitation and containment events for adult inpatients with mental disorders in an area of 640,572 adult inhabitants in South Barcelona (Spain). To calculate costs, a seven-step methodology with novel definition of agitation was used along with a staff survey, a database of containment events, and data on aggressive incidents. A micro-costing analysis of specific containment interventions was used to estimate both prevalence and direct costs from the healthcare provider perspective, by means of a mixed approach with a probabilistic model evaluated on real data. Due to the complex interaction of the multivariate covariances, a sensitivity analysis was conducted to have empirical bounds of variability. RESULTS: During 2013, 918 patients were admitted to the Acute Inpatient Unit. Of these, 52.8% were men, with a mean age of 44.6 years (SD = 15.5), 74.4% were compulsory admissions, 40.1% were diagnosed with schizophrenia or non-affective psychosis, with a mean length of stay of 24.6 days (SD = 16.9). The annual estimate of total agitation events was 508. The cost of containment interventions ranges from 282€ at the lowest level of agitation to 822€ when verbal containment plus seclusion and restraint have to be used. The annual total cost of agitation was 280,535€, representing 6.87% of the total costs of acute hospitalisation in the local area. CONCLUSIONS: Agitation events are frequent and costly. Strategies to reduce their number and severity should be implemented to reduce costs to the Health System and alleviate patient suffering.
Filiaciones:
Serrano-Blanco A:
Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
Rubio-Valera M:
Facultat de Farmàcia, Universitat de Barcelona, Barcelona, Spain
Aznar I:
Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
Baladon L:
Red de Investigación en Actividades Preventivas y Promoción de la Salud (RedIAPP), Barcelona, Spain
Gibert K:
Statistics and Operations Research Department, Knowledge Engineering and Machine Learning group, Universitat Politècnica de Catalunya-Barcelona Tech, Barcelona, Spain
Gracia Canales A:
Área científica, Ferrer, Barcelona, Spain
Kaskens L:
Área científica, Ferrer, Barcelona, Spain
Ortiz JM:
Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, Spain
Salvador-Carulla L:
Centre for Mental Health Research, Research School of Population Health, ANU College of Medicine, Biology & Environment, The Australian National University, Canberra, Australia
Open Access
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