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Iglesias, Katia

Nom
Iglesias, Katia
Affiliation principale
Fonction
Ancien.ne collaborateur.trice
Identifiants
https://libra.unine.ch/handle/123456789/856
_
0000-0003-1308-1631

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  • Publication
    Accès libre
    Screening of mental health and substance users in frequent users of a general Swiss emergency department
    (2015)
    Vu, Francis
    ;
    Daeppen, Jean-Bernard
    ;
    Hugli, Olivier
    ;
    Iglesias, Katia 
    ;
    Stucki, Stephanie
    ;
    Paroz, Sophie
    ;
    Canepa Allen, Marina
    ;
    Bodenmann, Patrick
    Background
    The objectives of this study were to determine the proportions of psychiatric and substance use disorders suffered by emergency departments’ (EDs’) frequent users compared to the mainstream ED population, to evaluate how effectively these disorders were diagnosed in both groups of patients by ED physicians, and to determine if these disorders were predictive of a frequent use of ED services.
    Methods This study is a cross-sectional study with concurrent and retrospective data collection. Between November 2009 and June 2010, patients’ mental health and substance use disorders were identified prospectively in face-to-face research interviews using a screening questionnaire (i.e. researcher screening). These data were compared to the data obtained from a retrospective medical chart review performed in August 2011, searching for mental health and substance use disorders diagnosed by ED physicians and recorded in the patients’ ED medical files (i.e. ED physician diagnosis). The sample consisted of 399 eligible adult patients (≥18 years old) admitted to the urban, general ED of a University Hospital. Among them, 389 patients completed the researcher screening. Two hundred and twenty frequent users defined by >4 ED visits in the previous twelve months were included and compared to 169 patients with ≤4 ED visits in the same period (control group).
    Results Researcher screening showed that ED frequent users were more likely than members of the control group to have an anxiety, depressive disorder, post-traumatic stress disorder (PTSD), or suffer from alcohol, illicit drug abuse/addiction. Reviewing the ED physician diagnosis, we found that the proportions of mental health and substance use disorders diagnosed by ED physicians were low both among ED frequent users and in the control group. Using multiple logistic regression analyses to predict frequent ED use, we found that ED patients who screened positive for psychiatric disorders only and those who screened positive for both psychiatric and substance use disorders were more likely to be ED frequent users compared to ED patients with no disorder.
    Conclusions This study found high proportions of screened mental health and/or substance use disorders in ED frequent users, but it showed low rates of detection of such disorders in day-to-day ED activities which can be a cause for concern. Active screening for these disorders in this population, followed by an intervention and/or a referral for treatment by a case-management team may constitute a relevant intervention for integration into a general ED setting.
  • Publication
    Accès libre
    Case management for frequent users of the emergency department: study protocol of a randomised controlled trial
    (2014)
    Bodenmann, Patrick
    ;
    Velonaki, Venetia-Sofia
    ;
    Ruggeri, Ornella
    ;
    Hugli, Olivier
    ;
    Burnand, Bernard
    ;
    Wasserfallen, Jean-Blaise
    ;
    Moschetti, Karine
    ;
    Iglesias, Katia 
    ;
    Baggio, Stéphanie
    ;
    Daeppen, Jean-Bernard
    Background We devised a randomised controlled trial to evaluate the effectiveness and efficiency of an intervention based on case management care for frequent emergency department users. The aim of the intervention is to reduce such patients’ emergency department use, to improve their quality of life, and to reduce costs consequent on frequent use. The intervention consists of a combination of comprehensive case management care and standard emergency care. It uses a clinical case management model that is patient-identified, patient-directed, and developed to provide high intensity services. It provides a continuum of hospital- and community-based patient services, which include clinical assessment, outreach referral, and coordination and communication with other service providers.
    Methods/Design We aim to recruit, during the first year of the study, 250 patients who visit the emergency department of the University Hospital of Lausanne, Switzerland. Eligible patients will have visited the emergency department 5 or more times during the previous 12 months. Randomisation of the participants to the intervention or control groups will be computer generated and concealed. The statistician and each patient will be blinded to the patient’s allocation. Participants in the intervention group (N = 125), additionally to standard emergency care, will receive case management from a team, 1 (ambulatory care) to 3 (hospitalization) times during their stay and after 1, 3, and 5 months, at their residence, in the hospital or in the ambulatory care setting. In between the consultations provided, the patients will have the opportunity to contact, at any moment, the case management team. Participants in the control group (N = 125) will receive standard emergency care only. Data will be collected at baseline and 2, 5.5, 9, and 12 months later, including: number of emergency department visits, quality of life (EuroQOL and WHOQOL), health services use, and relevant costs. Data on feelings of discrimination and patient’s satisfaction will also be collected at the baseline and 12 months later.
    Discussion Our study will help to clarify knowledge gaps regarding the positive outcomes (emergency department visits, quality of life, efficiency, and cost-utility) of an intervention based on case management care.