The Relation between Psychiatric Diagnoses and Constipation in Hospitalized Patients: A Cross-Sectional Study.

Objective. Constipation is a prevalent problem in patients with psychiatric disorders; it reduces quality of life and may lead to severe complications. The prevalence distribution of constipation across all psychiatric diagnoses in patients with severe mental illness (SMI) has hardly been studied. The aim of this study is to estimate the association between psychiatric disorders and constipation in SMI inpatients. Methods. The strength of the association between constipation (based on use of laxatives) and DSM-IV psychiatric diagnosis was studied in a cross-sectional study with "adjustment disorders" as the reference group. The association was analyzed using logistic regression. Results. Of the 4728 patients, 20.3% had constipation. In the stratum of patients older than 60 years, all psychiatric categories except for substance related disorders were significantly associated with a higher prevalence of constipation (odds ratios ranging from 3.38 to 6.52), whereas no significant associations were found in the stratum of patients between 18 and 60 years (odds ratios ranging from 1.00 to 2.03). Conclusion. In the elderly, all measured psychiatric diagnoses are strongly associated with an increased prevalence of constipation. Physicians should be extra alert for constipation in SMI patients, independent of specific psychiatric diagnoses.

Routine outcome monitoring and process quality in mental health care: a descriptive study in daily practice.

RATIONALE, AIMS AND OBJECTIVES: Routine outcome monitoring (ROM) is used to improve quality of health care by improving the process of care. ROM was introduced nationwide in mental health care in the Netherlands with the primary goal of enhancing the quality of treatment. This study aims to establish the impact of ROM on the process quality of treatment in the daily practice of secondary mental health care in the Netherlands. METHODS: Two cohorts from the same treatment programme were identified, before and after implementation of ROM. Data on patient characteristics, presence of baseline ROM measurement and indicators of the quality of the treatment process were retrieved from the electronic health care information system. Patient data were collected until 6 months after enrolment in the treatment programme. The magnitude of the effect of ROM on the quality of the treatment process was established. RESULTS: The pre-ROM cohort comprised 271 patients and 231 patients constituted the post-ROM cohort. In the ROM cohort, both indicators for process quality 'presence of treatment plan' and 'presence of cancellations' were significantly higher; the odd ratios were 3,37 [confidence interval (CI) 2.32-4.89] and 1,63 (CI 1.14-2.33), respectively. CONCLUSIONS: Indicators on process quality are important for understanding and establishing the impact of ROM in daily practice of secondary mental health care. Implementing ROM moderately increased the presence of a treatment plan. While this suggests improved treatment agreement, it did not result in better compliance of patients with individual treatment activities, as presence of cancellations was significantly higher after introduction of ROM.

Accident proneness, does it exist? A review and meta-analysis.

Accident related health problems have been suggested to cluster within persons. This phenomenon became known as accident proneness and has been a subject of many discussions. This study provides an overview of accident proneness. Therefore, 79 articles with empirical data on accident rates were identified from databases Embase, Medline, and Psychinfo. First, definitions of accidents varied highly, but most studies focused on accidents resulting in injuries requiring medical attention. Second, operationalisations of accident proneness varied highly. Studies categorised individuals into groups with ascending accident rates or made non-accident, accident, and repetitive accident groups. Third, studies examined accidents in specific contexts (traffic, work, and sports) or populations (children, students, and patients). Therefore, we concluded that no overall prevalence rate of accident proneness could be given due to the large variety in operationalisations. However, a meta-analysis of the distribution of accidents in the general population showed that the observed number of individuals with repeated accidents was higher than the number expected by chance. In conclusion, accident proneness exists, but its study is severely hampered by the variation in operationalisations of the concept. In an effort to reach professional consensus on the concept, we end this paper with recommendations for further research.

The identification of trends in the utilisation of mental health services by elderly: a Dutch case register study.

OBJECTIVE: In view of the rapid ageing of the population any changes in the use of mental health services by the elderly became increasingly important for policy development. This study aimed at the supply of information about trends in the numbers of elderly clients, the services they used and the volume and pattern of service utilisation. METHODS: Details of elderly users and their use of community- and hospital-based services between 1990 and 1999 were retrieved from the Groningen case register. Developments in population size and age distribution in the register area were taken into account, as were the unit costs of mental health services. RESULTS: Large age specific changes were found that caused only the expenditures on the oldest elderly to increase due to a shift from outpatient clinics to prolonged psychogeriatric day treatment and inpatient care. Comparatively young elderly used fewer inpatient services and more community care. The number of new elderly clients declined progressively. In some age groups treated prevalence also decreased, but to a lesser extent, because of a prolonged use of mental health services. CONCLUSIONS: Study results seemed well in accordance with mental health policy as to deinstitutionalization and active ageing. Research on the effect of mental health care on life expectancy and the time lag between the intake of mental health providers and treated prevalence was proposed in order to improve the prediction of future service use by elderly.