Providing Continuity of Care for Mental Illness Patients Beyond Hospital Discharge

Last Updated on Friday, 14 October 2011 04:21 Written by Natural Health Team Friday, 14 October 2011 04:21

Health Information about Providing Continuity of Care for Mental Illness Patients Beyond Hospital Discharge

A strong family and caregiver support system is important to the continued treatment of after they leave the hospital. In fact, it is critical in assisting with medication adherence to ensure consumers appear for their appointments with service providers, particularly during transition between inpatient and outpatient settings. However, when discussing family support systems, some physicians contest that less than half of consumers have an “adequate” social support system to meet their daily needs.

Because a strong family support system cannot be “manufactured” or bought through funding, it is important to focus on other controllable issues that can create a positive impact on the continuity of care for mental illness patients. A recent mental health study identified three factors that positively influence the efficiency of the transition process between inpatient facility discharge and intake with a community-based program.

These include:

Of course, in addition to having a strong family and care support, there are other issues involved. Public policy and government funding are two particularly impactful issues. From a mental healthcare systems perspective, matters involving policy and financing issues impacting continuity of care can be conceptualized along two broad approaches:

This approach is conceptually similar to what is referred to as Primary Care Case Management in some disease management or chronic care programs.

Under the first approach, consultation and care coordination would be a defined benefit with its own billing codes and defined coverage limits, eligible providers, allowed situations, and limitations and exclusions. For example, situations where this might be applicable include: hospital discharge planning and short-term transition support; developmental transitions (e.g. child to adult); coordination between primary care and mental health providers; consultation with primary care; consultation with other professionals to implement treatment plans (e.g. schools, residential programs); clinical coordination among multi-disciplinary teams, especially home-based services.

Under the second approach, coordination of care is built into “” or episodes of care. This concept is seen in current disease management models and chronic care models and can include: assertive community treatment, multi-systemic therapy, and Dialectical Behavioral Therapy (DBT). Hospital payment methods assume linkage with step-down, aftercare, and outpatient services, similar conceptually to Medicare Part A that covers hospital stays and 100 days of nursing home or home health rehabilitation as follow-up, when necessary.

Levels of communication between various clinicians and other staff in inpatient and outpatient settings can vary greatly, impacting continuity of therapy. Typically, there is very little communication between psychiatrists in inpatient and outpatient facilities and this applies as well to nursing staff in these two settings. The most frequent communications occur between inpatient discharge planners and outpatient intake coordinators. Three specific models of interaction between inpatient and outpatient facilities have been identified:

In this model, the outpatient setting is highly dependent on the inpatient setting and/or the consumer for receiving documents.

With this model, the sharing of resources provides a continuum of care for consumers, so there is never really a “gap” between discharge and intake.

For this model, a member of the outpatient treatment team actively participates in the discharge process, which leads to the timely receipt of appropriate/relevant documents, as well as increased consumer participation.

Despite the link between positive consumer outcomes and continuity of therapy, it remains unclear, in many cases, how referrals are made throughout the system of care; how hospital and program admission criteria are developed and applied; how consumers are discharged from hospital settings and into the community; and who is responsible for their care. Data regarding who is going to hospital emergency departments for acute psychiatric care and why they are in that setting rather than in community mental health program are scarce, as are data about individuals who could be moved out of hospital emergency rooms if consumers were provided with better transition services or if appropriate acute psychiatric care were available in other settings. The same observation can be made regarding those individuals who could be moved out of state psychiatric hospitals if appropriate services such as care management, medication management, housing, and employment supports were available in the community. Obtaining these observations and data of this kind is a big and important step in ensuring a continuity of care for all patients.

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Laparoscopic Ectopic Pregnancy Evacuation Treatment solved only in Aastha Health Care Hospital

Last Updated on Tuesday, 13 September 2011 07:28 Written by Natural Health Team Tuesday, 13 September 2011 07:28

Health Information about Laparoscopic Ectopic Pregnancy Evacuation Treatment solved only in Aastha Health Care Hospital

Once the egg gets fertilized, it travels down the fallopian tube to uterus. But when the tubes are damaged or blocked and fail to propel the egg toward the womb, the egg may become implanted in the tube and continue to develop there. Because almost all Ectopic pregnancies occur in one of the fallopian tubes, they are often called “tubal” pregnancies. Much less often, an egg implants in an ovary, in the cervix, directly in the abdomen, or even in a c-section scar. In rare cases, a woman has a normal pregnancy in her uterus and an Ectopic pregnancy at the same time. This is called a heterotopic pregnancy and it’s more likely to happen if one has had fertility treatments, such as in-vitro fertilization.

There’s no way to transplant an Ectopic (literally, “out of place”) pregnancy into the uterus, so ending the pregnancy is the only option. In fact, if an Ectopic pregnancy is not recognized and treated, the embryo will grow until the fallopian tube ruptures, resulting in severe abdominal pain and bleeding. It can cause permanent damage to the tube or loss of the tube, and if it involves very heavy internal bleeding that’s not treated promptly, it can even lead to death. Fortunately, the vast majority of Ectopic pregnancies are caught in time.

Many factors are known to increase the risk of having an Ectopic pregnancy. Anything that alters the tubal function may affect further pregnancies. Fallopian tubes are not like a hollow pipe that sits there with the egg rolling down. They have little hairs on the inside (cilia) which move with a wave-like motion to encourage the egg toward the womb. If the tube becomes blocked or the cilia damaged then ectopic is more likely. Besides this, there are some risk factors, like:

* Advancing age
* Pelvic inflammatory disease – eg. previous Chlamydia or gonorrhoea. Infection causes scar tissue adhesions in the tube and may damage the cilia. PID is one of the main causes of the increase seen in Ectopic pregnancies in recent years. Risk of an Ectopic pregnancy increases about 7-fold after a woman suffers acute pelvic infection.

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* Tubal surgery – women who have had operations on their tubes are more at risk of Ectopic. This includes tubal ligation, reversal of sterilisation or tubal surgery for a previous Ectopic.
* Previous Ectopic – about 10-20% of those attempting pregnancy after one Ectopic will have another.
* DES exposure – this is a drug that was once used during pregnancy, until it was found that female babies of women who used it were at risk of developmental abnormalities of the genital system. Their tubes are more likely to be abnormal and predisposed to Ectopic pregnancy. This is a very rare problem.
* Previous termination of pregnancy – the risk of ectopic increases among those who have had two or more terminations, particularly if there was infection afterwards.
* IVF (test-tube baby) and ovulation induction – both these techniques of assisted reproduction are associated with increased chances of Ectopic pregnancy.

Ectopic pregnancy can be tricky to diagnose. If your symptoms suggest this type of pregnancy, your caregiver will do several tests to try to confirm the diagnosis :

A blood test- to check level of the pregnancy hormone human chorionic gonadotropin (hCG). If it’s high enough to suggest pregnancy, but not as high as it should be at your stage, the pregnancy may be ectopic. If you’re not in pain and there’s still some question about the diagnosis, the test may be repeated in two to three days. If your hCG level doesn’t increase as it’s supposed to, this probably indicates either an Ectopic pregnancy or a miscarriage.

A vaginal exam- If the vaginal area is very tender or your caregiver detects a mass or an enlarged fallopian tube, an Ectopic is likely the cause.

An ultrasound- If the sonographer can see an embryo in the fallopian tube, you definitely have an Ectopic pregnancy. But in most cases, the embryo will have died early in the process and be too small for the sonographer to find. Instead, she may notice that a fallopian tube is swollen, and may see blood clots as well as tissue that remain from the embryo.

If the diagnosis remains unclear, your tubes may be examined more closely by using laparoscopic surgery, a procedure that may also be used to treat an Ectopic pregnancy and remove the embryo (see below).

The earlier you end an Ectopic pregnancy, the less damage you’ll have in that tube and the greater your chances will be of carrying another baby to term. And even if you do lose one of your tubes, you can still have a normal pregnancy as long as your other tube is normal. If and when you do conceive again, call your health practitioner as soon as you suspect that you might be pregnant so that she can schedule you for an early sonogram and monitor you closely. Overall, your chances of having another Ectopic pregnancy are about 10 to 15 percent, depending on what caused the first one and what type of treatment you had. That means that your overall chances of having a normal pregnancy next time are still very high – about 85 to 90 percent.

If, on the other hand, you’re unable to conceive because of Ectopic pregnancies or damaged tubes, the good news is that you’re likely to be an excellent candidate for fertility treatments such as in vitro fertilization (IVF), in which your healthy embryos are implanted directly in your uterus.

So Laparoscopic hysterectomy has many advantages like:

* Less postoperative pain
* May shorten hospital stay
* May result in a quicker return to bowel function
* Quicker return to normal activity
* Better cosmetic results

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