1. Intoxicated persons showing challenging behavior demand complexity interventions: a pilot study at the interface of the ER and the complexity intervention unit
- Author
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Rutger Jan van der Gaag, Jeroen A. van Waarde, Wiepke Cahn, Maarten A. van Schijndel, Freek ten Doesschate, Stefan M. H. Verheesen, and Adult Psychiatry
- Subjects
Biopsychosocial model ,medicine.medical_specialty ,Psychological intervention ,Pilot Projects ,03 medical and health sciences ,0302 clinical medicine ,Acute care ,medicine ,Humans ,Pharmacology (medical) ,Social determinants of health ,Psychiatry ,Referral and Consultation ,Biological Psychiatry ,Integrated healthcare ,Original Paper ,business.industry ,030208 emergency & critical care medicine ,Emergency room ,General Medicine ,medicine.disease ,Triage ,Intoxicated persons ,030227 psychiatry ,Integrated care ,Hospitalization ,Substance abuse ,Psychiatry and Mental health ,Challenging behavior ,Psychiatric disturbances ,Emergency Service, Hospital ,business ,Alcoholic Intoxication ,Hospital Units - Abstract
Intoxicated persons showing challenging behavior (IPCBs) under influence of alcohol and/or drugs frequently have trouble finding appropriate acute care. Often IPCBs are stigmatized being unwilling or unable to accept help. Separated physical and mental healthcare systems hamper integrated acute care for IPCBs. This pilot aimed to substantiate the physical, psychiatric, and social health needs of IPCBs visiting the emergency room (ER) during a 3-month period. All ER visits were screened. After triage by the ER physician, indicated IPCBs were additionally assessed by the consultation–liaison–psychiatry physician. If needed, IPCBs were admitted to a complexity intervention unit for further examinations to provide integrated treatments and appropriate follow-up care. The INTERMED and Health of the Nation Outcome Scale (HoNOS) questionnaires were used to substantiate the complexity and needs. Field-relevant stakeholders were interviewed about this approach for acute integrated care. Alongside substance abuse, almost half of identified IPCBs suffered from comorbid psychiatric disturbances and one third showed substantial physical conditions requiring immediate medical intervention. Almost all IPCBs (96%) accepted the acute medical care voluntarily. IPCBs showed high mean initial scores of INTERMED (27.8 ± 10.0) and HoNOS (20.8 ± 6.9). At discharge from the complexity intervention unit, the mean HoNOS score decreased significantly (13.4 ± 8.6; P
- Published
- 2021