by You Tube | Oct 4, 2019 | Anxiety, Asthma, Brain and Behavior, Depression, Emergency Room, Environment, Health-related, LifeHelper, Memory and Perception, Mental Health and Wellness, Parenting, Professional, Psychology, Psychology and Therapy News, Research, Students
A new study finds that children with asthma have a higher likelihood of also suffering from anxiety and depression. Moreover, when all three conditions are present, patients are almost twice as likely as those with asthma alone to seek care in the Emergency Room.
ER visits are frequently avoidable and sometimes unnecessary, say researchers at UCSF Benioff Children’s Hospitals, who led the study. ER visits, together with the hospital stays that may follow, account for 61.7% of all asthma-related expenditures for U.S. children, according to the National Medical Expenditure Survey.
UCSF researchers followed more than 65,000 children and youth with asthma, ages 6 to 21. They found that 7.7% of participants with both depression and anxiety had a rate of 28 ER visits per 100 child years. This is almost twice the rate — 16 ER visits per 100 child years — of those without depression and anxiety.
For asthma patients who just had depression, the rate was lower, with 22 visits per 100 child years, and for those asthma patients who just had anxiety, the rate was 19 visits per 100 child years.
“Asthma self-management is complex, requiring recognition of symptoms, adherence to medication and avoidance of triggers,” said first author Naomi Bardach, MD, MAS.
“The symptoms of anxiety and depression can make it more challenging to follow treatment, leading to more ER visits,” she said. “There also may be a greater tendency to use the ER for supportive services, even in the absence of a serious asthma attack.”
The authors noted that anxiety and depression are more common in children with asthma. In their study, 11.2% had anxiety and 5.8% had depression, versus 7.1% and 3.2%, respectively, for children ages 3 to 17, according to data from the Centers for Disease Control and Prevention.
To qualify for the study, the 65,342 participants needed to have had asthma-related doctor visits or hospitalizations, or prior use of preventive medications with an asthma-related doctor visit. They were identified with anxiety and depression if they had at least one inpatient, outpatient or ER visit for either condition.
“The study highlights a population of children and youth who may benefit from more intensive care coordination,” said Bardach.
“This may mean more careful counseling to improve medication compliance and symptom recognition. It may also mean improved mental health care for children in whom untreated depression or anxiety may hinder asthma self-management.”
In some children with asthma, depression and anxiety, it can be difficult to tease out which symptom is attributed to which condition, said senior author Michael Cabana, MD, MPH, formerly of UCSF and currently with Children’s Hospital at Montefiore.
“Children with these conditions may seek care not only for asthma attacks, but for symptoms like shortness of breath, rapid heartbeat and chest pain, of which the causes may be ambiguous.”
The research results confirm studies in adults with asthma who also had depression and anxiety. This group of patients was also found to have a higher likelihood of visits to the ER, urgent care clinics and unscheduled visits with their providers, compared to adults with asthma alone.
Source: UCSF
by You Tube | Aug 9, 2019 | ADHD, Advocacy and Policy, Assessment and Diagnosis, Bipolar, Children and Teens, Emergency, Emergency Room, General, Hospital, kids, Mental Health and Wellness, psychiatric hold, Psychiatry, Psychology, Psychology and Therapy News, Psychosis, Research, Schizophrenia, Teens
Children without health insurance who present to the emergency department (ED) for mental health issues are more likely to be transferred to another hospital compared to kids with private insurance, according to a new study by researchers at the University of California (UC) Davis Children’s Hospital and the UC Davis Department of Psychiatry.
Previous research has shown a significant increase in the number of children and teens presenting to the ED for mental health issues. Between 2012 and 2016, hospital EDs saw a 55 percent jump in kids with mental health problems, according to findings presented at a meeting of the American Academy of Pediatrics in 2018. The increase is highest among minorities.
Transferring a child from one hospital to another creates additional burdens for the patient, family and health care system as a whole. It can add to overcrowding in busy emergency departments, higher costs of care and higher out-of-pocket costs for the family.
For the study, the researchers analyzed a national sample of 9,081 acute mental health events among children in EDs. They looked at the patient’s insurance coverage and a hospital’s decision to admit or transfer patients with a mental health disorder.
“We found that children without insurance are 3.3 times more likely to be transferred than those with private insurance,” said Jamie Kissee Mouzoon, research manager for the Pediatric Telemedicine Program at UC Davis Children’s Hospital and first author on the study.
“The rate was even higher for patients presenting with bipolar disorder, attention-deficit and conduct disorders and schizophrenia.”
The findings, published in the journal Pediatric Emergency Care, reveal gaps in providing equitable and quality care to pediatric patients with mental health emergencies based on their insurance coverage.
According to James Marcin, senior author on the study, there are regulations in place to prevent EDs from making treatment decisions based on the patients’ insurance. Transferring a patient for any other reason than clinical necessity should be avoided.
“Unfortunately, the financial incentives are sometimes hard to ignore and can be even unconscious,” said Marcin, who also is director for the UC Davis Center for Health and Technology and leads the telemedicine program at UC Davis Health.
“What we have found in this study is consistent with other research that demonstrates that patients without health insurance are more likely to get transferred from clinic to clinic or hospital to hospital.”
Marcin is currently looking into how telemedicine — video visits delivered to the children who seek care in remote EDs — might be a solution to the tendency to transfer the patient to another hospital.
Source: University of California – Davis Health
