Fairchild Roseanne, Ferng-Kuo Shiaw-Fen, Rahmouni Hicham, Hardesty Daniel
Department of Research, Richard Lugar Center for Rural Health, Union Hospital, Terre Haute, Indiana, USA.
Department of Applied Health Sciences, Indiana State University, Terre Haute, Indiana, USA.
Telemed Rep. 2020 Nov 18;1(1):22-35. doi: 10.1089/tmr.2020.0005. eCollection 2020.
Rates for all-cause U.S. emergency department (ED) visits to rural critical access hospitals (CAHs) have increased by 50% since 2005. During the same time period, total number of U.S. hospital admissions for a mental health (MH) crisis has increased by 12.2%, with rural counties demonstrating the largest suicide rate increases overall. Increasing number of rural patients are reporting need for MH care in the region's four rural EDs. Characteristics of ED telemental health services were evaluated, including MH diagnostic category, voluntary vs. involuntary commitment (IC), forensic vs. nonforensic presentation, ED throughput, disposition, and payor reimbursement. Observational 2.5-year program evaluation of telemental health care delivery for children ( = 114) and adults ( = 417) who were evaluated by a rural ED physician and received an MH diagnosis. Participants ( = 531) were treated by a licensed psychiatrist through telemental care delivery from September 2017 to April 2020. Noncommitted ED MH patients (86%; = 455) were distributed across three major diagnostic groups: (1) depression, anxiety, or other mental illness (35%); (2) substance abuse (33%); or (3) suicide risk (32%), with 47% admitted inpatients (IPs), 47% referred outpatient (OPs), and 6% admitted to CAH. Fourteen percent ( = 76/531) of ED MH patients were subsequently IC, with 67% of those assessed as needing IP care. Forty-nine percent ( = 37) of IC patients presented in police custody. Most common diagnosis for IC patients was suicidal ideation/attempt (χ [2, = 452] = 12.884, = 0.002). Admitted patients experienced significantly longer length of stay than those with OP referral ( = 0.001). Mean total payor reimbursements for ED MH care were significantly lower than actual ED costs ( < 0.001). Innovative approaches to telemental care for IC and non-IC patients need to be piloted and comparatively evaluated in rural CAHs. As the gateway to critically needed MH care, rural CAHs and public services pivotal to care access (e.g., law enforcement) need additional resources and support.
自2005年以来，美国农村急救医院（CAH）因各种原因前往急诊科（ED）就诊的人数增加了50%。在同一时期，美国因心理健康（MH）危机而住院的总人数增加了12.2%，农村县的自杀率总体上升幅度最大。越来越多的农村患者表示，该地区的四家农村急诊科需要提供心理健康护理。对急诊科远程心理健康服务的特点进行了评估，包括心理健康诊断类别、自愿与非自愿住院（IC）、法医与非法医就诊情况、急诊科周转情况、处置方式以及付款人报销情况。对接受农村急诊科医生评估并被诊断为患有心理健康问题的儿童（n = 114）和成人（n = 417）的远程心理健康护理进行了为期2.5年的观察性项目评估。参与者（n = 531）在2017年9月至2020年4月期间由一名持牌精神科医生通过远程护理进行治疗。非住院的急诊科心理健康患者（86%；n = 455）分布在三个主要诊断组中：（1）抑郁症、焦虑症或其他精神疾病（35%）；（2）药物滥用（33%）；或（3）自杀风险（32%），47%为住院患者（IP），47%被转诊至门诊（OP），6%被收治到急救医院。14%（n = 76/531）的急诊科心理健康患者随后被非自愿住院，其中67%被评估为需要住院护理。49%（n = 37）的非自愿住院患者是在警方拘留期间就诊的。非自愿住院患者最常见的诊断是自杀意念/企图（χ[2, n = 452] = 12.884，P = 0.002）。住院患者的住院时间明显长于转诊至门诊的患者（P = 0.001）。急诊科心理健康护理的平均付款人报销总额明显低于实际急诊科成本（P < 0.001）。需要在农村急救医院试点并比较评估针对非自愿住院和非非自愿住院患者的创新远程护理方法。作为急需的心理健康护理的入口，农村急救医院和对护理获取至关重要的公共服务（如执法部门）需要额外的资源和支持。
