PubMed Health⌕ Search

Biomedical subjects

B Astrachan

Publications and source records attributed to B Astrachan.

13 recordsLinked to original sources
PubMed1995

Case management in psychiatry: an analysis of tasks.

OBJECTIVE: The authors analyze the concept of case management from the perspective of the task areas of psychiatry and demonstrate the importance of case management in the organization of psychiatric services. METHOD: The relevant literature was reviewed, and a functional analysis of current practices is provided. RESULTS: Case management is an ambiguous concept without a clear base in a professional discipline, and thus there is ongoing uncertainty about its mission, practice, and training, as well as authority and accountability issues. The activities of the case manager in both the private and the public sectors entail work in the task areas of medical care, rehabilitation, social control, growth and development, and social welfare. In all of these areas, the case manager may function in boundary management and in system enhancement and development as well as provide clinical services. CONCLUSIONS: Case management has considerable potential as a means of organizing and delivering mental health services in a cost-effective manner as long as its purpose, practice, and organizational structures are consistent. Psychiatrists should be involved in the organization of case management services.

Health Services Administration↗
PubMed1992

Reporting alcohol-impaired drivers: results from a national survey of emergency physicians.

STUDY OBJECTIVE: The purpose of this exploratory study was to learn of physicians' opinions on mandatory reporting of alcohol-impaired drivers they encounter in the course of their clinical work to the police or authorities from the Division of Motor Vehicles. DESIGN AND PARTICIPANTS: Two thousand four hundred sixty-four physicians randomly selected from the American College of Emergency Physicians were sent an anonymous, one-time only, self-administered questionnaire seeking demographic information and assessing attitudes toward mandatory reporting and alcohol treatment. MEASUREMENTS AND MAIN RESULTS: One thousand fifty-five physicians returned the survey. Seventy-eight percent of respondents agreed with mandatory reporting. More than half expressed strong agreement. Through canonical discriminant analysis we are able to identify the complex factors influencing attitude toward mandatory reporting. CONCLUSION: Although our preliminary results must be interpreted with caution, it appears that with the appropriate legal safeguards, physicians are supportive of mandatory reporting of the alcohol-impaired driver encountered in the course of clinical work.

Adult↗
PubMed1991

Single and repeated admissions to a mental health center: demographic, clinical and use of service characteristics.

Eight hundred and forty one patients with 1,135 consecutive admissions to a university-affiliated mental health center were studied to examine patterns of treatment program use. Twenty two percent of patients had repeat admissions accounting for 42% of hospital episodes. Single admission and repeater groups are compared, and differences among repeater subgroups with progressively greater numbers of admissions per patient are described. Only 10 patients with the highest number of admissions during the study period also were very high utilizers of all services (inpatient, crisis, day hospital, regional chronic state hospital). These patients' characteristics are discussed with implications for future study.

Adolescent↗
PubMed1990

Mentally ill chemical abusers discharged from VA inpatient treatment: 1976-1988.

Discharge abstracts were analyzed for all patients discharged from Department of Veterans Affairs (VA) medical centers with a primary non-substance abuse psychiatric diagnosis over a twelve year period (1976 to 1988). Patients were identified as Mentally Ill Chemical Abusers (MICAs) if they had a primary mental illness diagnosis and either a secondary substance abuse diagnosis or an admission for substance abuse treatment during the same fiscal year. The percentage of MICAs doubled, from 22.6% to 43.6%, during these twelve years. In 1988, MICAs were younger and more likely to be minorities than other VA psychiatric patients, and they spent only half as many days in the hospital per year.

Adult↗
PubMed1990

Regional variation in patterns of inpatient psychiatric care.

Regional variation in both average length of stay and number of beds per 100,000 population is described for inpatient psychiatric care in the United States during 1983. The greatest differences were between the Northeast and Mid-Atlantic regions, on the one hand, and the Pacific and Southwest regions, on the other. Medical centers of the U.S. Department of Veterans Affairs (VA), whose policies are largely centrally determined, followed the same regional trends. Regional average length of stay, particularly in public sector mental health care organizations, was higher in regions with more occupied beds per 100,000 population.

Bed Occupancy↗
PubMed1989

Initial assessment data from a 43-site program for homeless chronic mentally ill veterans.

In May 1987 the Veterans Administration established the Homeless Chronically Mentally Ill Veterans Program at 43 sites to provide outreach, health care, and residential rehabilitation services. Intake assessment data on 10,529 homeless veterans screened as potential candidates for clinical services during the program's first 11 months are presented. With a median age of 40, the homeless veterans were considerably younger than veterans in the general U.S. population. More had served in the Vietnam era than in other military eras. Almost three-fifths were white, and a third were black; more than 40 percent were receiving some form of public support. Almost half manifested one or more severe psychiatric symptoms at screening, and almost two-thirds had previously been hospitalized for either a psychiatric or a substance abuse problem.

Adult↗
PubMed1986

Diagnosis-related groups and general hospital psychiatry: the APA Study.

Psychiatric units in general hospitals are exempt from diagnosis-related groups (DRGs), a system of per case prospective payment that is used for the majority of patients covered by Medicare. The American Psychiatric Association purchased a large hospital discharge data base and studied the potential impact of DRGs on psychiatric patients and inpatient psychiatric units in general hospitals. There was substantial inaccuracy in the psychiatric DRGs' prediction of resource use, which could lead to inappropriate discharge of patients and financial risk to hospitals that treat more severe cases. The authors advocate further research because psychiatry must anticipate prospective payment in the future.

Cost-Benefit Analysis↗
PubMed1986

The income of psychiatrists: adaptation during difficult economic times.

The earnings of psychiatrists are substantially lower than the earnings of physicians in procedurally oriented and surgical specialties of medicine. The authors offer evidence, however, that when it is compared to other cognitive medical specialties, such as pediatrics and internal medicine, psychiatry is the highest paid specialty on an hourly basis. In recent years, psychiatrists' income has improved, largely because of enhanced productivity and efficiency, diversification of treatments, work in multiple settings, the expansion of group practice, and subspecialization. The authors provide an optimistic perspective on the future of psychiatry as a medical specialty.

Economics, Medical↗