TY - JOUR
T1 - In-patient costs of agitation and containment in a mental health catchment area
AU - Serrano-Blanco, Antoni
AU - Rubio-Valera, Maria
AU - Aznar-Lou, Ignacio
AU - Baladón Higuera, Luisa
AU - Gibert, Karina
AU - Gracia Canales, Alfredo
AU - Kaskens, Lisette
AU - Ortiz, José Miguel
AU - Salvador-Carulla, Luis
N1 - Funding Information:
The research was conducted with the support of an unrestricted grant from Ferrer. The funding was used for the design and development of the study, statistical analyses and dissemination of results. The funder had no influence on the decisions concerning the study design, data collection and/or analysis.
Publisher Copyright:
© 2017 The Author(s).
PY - 2017/6/6
Y1 - 2017/6/6
N2 - Background: There is a scarce number of studies on the cost of agitation and containment interventions and their results are still inconclusive. We aimed to calculate the economic consequences of agitation events in an in-patient psychiatric facility providing care for an urban catchment area. Methods: A mixed approach combining secondary analysis of clinical databases, surveys and expert knowledge was used to model the 2013 direct costs of agitation and containment events for adult inpatients with mental disorders in an area of 640,572 adult inhabitants in South Barcelona (Spain). To calculate costs, a seven-step methodology with novel definition of agitation was used along with a staff survey, a database of containment events, and data on aggressive incidents. A micro-costing analysis of specific containment interventions was used to estimate both prevalence and direct costs from the healthcare provider perspective, by means of a mixed approach with a probabilistic model evaluated on real data. Due to the complex interaction of the multivariate covariances, a sensitivity analysis was conducted to have empirical bounds of variability. Results: During 2013, 918 patients were admitted to the Acute Inpatient Unit. Of these, 52.8% were men, with a mean age of 44.6 years (SD = 15.5), 74.4% were compulsory admissions, 40.1% were diagnosed with schizophrenia or non-affective psychosis, with a mean length of stay of 24.6 days (SD = 16.9). The annual estimate of total agitation events was 508. The cost of containment interventions ranges from 282€ at the lowest level of agitation to 822€ when verbal containment plus seclusion and restraint have to be used. The annual total cost of agitation was 280,535€, representing 6.87% of the total costs of acute hospitalisation in the local area. Conclusions: Agitation events are frequent and costly. Strategies to reduce their number and severity should be implemented to reduce costs to the Health System and alleviate patient suffering.
AB - Background: There is a scarce number of studies on the cost of agitation and containment interventions and their results are still inconclusive. We aimed to calculate the economic consequences of agitation events in an in-patient psychiatric facility providing care for an urban catchment area. Methods: A mixed approach combining secondary analysis of clinical databases, surveys and expert knowledge was used to model the 2013 direct costs of agitation and containment events for adult inpatients with mental disorders in an area of 640,572 adult inhabitants in South Barcelona (Spain). To calculate costs, a seven-step methodology with novel definition of agitation was used along with a staff survey, a database of containment events, and data on aggressive incidents. A micro-costing analysis of specific containment interventions was used to estimate both prevalence and direct costs from the healthcare provider perspective, by means of a mixed approach with a probabilistic model evaluated on real data. Due to the complex interaction of the multivariate covariances, a sensitivity analysis was conducted to have empirical bounds of variability. Results: During 2013, 918 patients were admitted to the Acute Inpatient Unit. Of these, 52.8% were men, with a mean age of 44.6 years (SD = 15.5), 74.4% were compulsory admissions, 40.1% were diagnosed with schizophrenia or non-affective psychosis, with a mean length of stay of 24.6 days (SD = 16.9). The annual estimate of total agitation events was 508. The cost of containment interventions ranges from 282€ at the lowest level of agitation to 822€ when verbal containment plus seclusion and restraint have to be used. The annual total cost of agitation was 280,535€, representing 6.87% of the total costs of acute hospitalisation in the local area. Conclusions: Agitation events are frequent and costly. Strategies to reduce their number and severity should be implemented to reduce costs to the Health System and alleviate patient suffering.
KW - Aggression
KW - Agitation
KW - Containment
KW - Costs
KW - Health economics
KW - In-patient
KW - Mental health
KW - Restraint
KW - Seclusion
KW - Violence
UR - http://www.scopus.com/inward/record.url?scp=85020287077&partnerID=8YFLogxK
U2 - 10.1186/s12888-017-1373-4
DO - 10.1186/s12888-017-1373-4
M3 - Article
C2 - 28583103
AN - SCOPUS:85020287077
SN - 1471-244X
VL - 17
SP - 1
EP - 11
JO - BMC Psychiatry
JF - BMC Psychiatry
IS - 1
M1 - 212
ER -