In-patient costs of agitation and containment in a mental health catchment area

BMC Psychiatry

Research Article

Luis Salvador-Carulla¹  Ignacio Aznar-Lou²  Maria Rubio-Valera³  Antoni Serrano-Blanco⁴  José Miguel Ortiz⁵  Luisa Baladón Higuera⁶  Karina Gibert⁷  Lisette Kaskens⁸  Alfredo Gracia Canales⁸ 

[1]Centre for Mental Health Research, Research School of Population Health, ANU College of Medicine, Biology & Environment, The Australian National University, Canberra, Australia

[2]Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain

[3]Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain

[4]Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain

[5]Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain

[6]Facultat de Farmàcia, Universitat de Barcelona, Barcelona, Spain

[7]Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain

[8]Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, Spain

[9]Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain

[10]Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, Spain

[11]Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, Spain

[12]Red de Investigación en Actividades Preventivas y Promoción de la Salud (RedIAPP), Barcelona, Spain

[13]Statistics and Operations Research Department, Knowledge Engineering and Machine Learning group, Universitat Politècnica de Catalunya-Barcelona Tech, Barcelona, Spain

[14]Área científica, Ferrer, Barcelona, Spain

关键词: Agitation;    Seclusion;    Restraint;    Containment;    In-patient;    Costs;    Mental health;    Health economics;    Violence;    Aggression;   

DOI  :  10.1186/s12888-017-1373-4

 received in 2016-12-20, accepted in 2017-05-26,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundThere 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.MethodsA 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.ResultsDuring 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.ConclusionsAgitation 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.

【 授权许可】

CC BY   
© The Author(s). 2017