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Understanding Pre-Hospital Care for Self-Harm: Views and Experiences of Yorkshire Ambulance Service Clinicians
- Daniel Romeu, Elspeth Guthrie, Suzanne Mason
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, p. S69
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Aims
Self-harm is a common presentation in emergency services, and ambulance clinicians are often the first professionals involved. The aims of this study were to explore the experiences of Yorkshire Ambulance Service (YAS) clinicians of caring for people who self-harm, and to seek their views of the care provided to this group in the pre-hospital setting.
MethodsThis preliminary cross-sectional study involved a self-completed questionnaire using an online platform (Online Surveys, www.onlinesurveys.ac.uk). The questionnaire was designed by the research team, piloted by four academic paramedics, and shared with ambulance clinicians employed by YAS via social media and email bulletins. Multiple-choice answers were analysed using descriptive statistics, and two researchers (DR, EG) independently analysed free-text responses thematically. Participants could only proceed to the questionnaire if they agreed to an online consent statement. Ethical approval was granted by the University of Leeds.
Results26 clinicians responded to the questionnaire (1.0% response rate), of whom 17 (65%) were female and 16 (62%) were paramedics. 17 (65%) indicated that they had not received specific mental health training in their roles. Only nine (35%) respondents felt comfortable caring for this group, and four (15%) thought that their training had adequately prepared them.
Respondents identified the following as facilitators to high-quality clinical care for people who have self-harmed: previous clinical experience, training in mental health and injury management, availability of mental health advice and services, good communication skills, relevant online resources, and support from senior colleagues. Barriers identified included patient factors, a lack of mental health pathways, services and support and a lack of training and education in mental health. Suggested improvements to emergency services for self-harm were alternatives to emergency departments, greater availability of mental health support, more staff, mental health training for ambulance clinicians, and guidance for the management of patients declining to attend hospital.
ConclusionRespondents generally felt unconfident and unprepared when called to assess and manage people who have harmed themselves. Improvements in mental health training for ambulance clinicians and greater availability of mental health services are needed to improve pre-hospital care for people who self-harm. Although the study was limited by a low response rate, it has begun to address the literature gap in paramedic care for self-harm. Questionnaire responses corroborate NICE recommendations that alternative services to emergency departments, where appropriate, could improve patient satisfaction and the quality of clinical care. This should be considered by commissioners and policymakers.
Cost Analysis of Methylprednisolone Treatment of Multiple Sclerosis Patients
- Lynda S. Robson, Charlene Bain, Shann Beck, Suzanne Guthrie, Peter C. Coyte, Paul O'Connor
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- Journal:
- Canadian Journal of Neurological Sciences / Volume 25 / Issue 3 / August 1998
- Published online by Cambridge University Press:
- 18 September 2015, pp. 222-229
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Background:
Intravenous methylprednisolone (IVMP) is the treatment of choice for multiple sclerosis (MS) patients undergoing acute exacerbation of disease symptoms and yet its cost has not been accurately determined. Determination of this cost in different settings is also pertinent to consideration of cost-saving alternatives to in-patient treatment.
Methods:Cost analysis from the point of view of the health care system of IVMP treatment of MS patients receiving treatment in association with a selected Toronto teaching hospital in fiscal year 1994/95 was carried out. Costs of any concurrent treatments were excluded.
Results:Total cost for 92 patients, based on a 4 dose regime, was estimated to be $78,527. The the cost per patient was $1,1181.84 for in-patients (IP), $714.64 for out-patients of the MS Clinic (OP) and $774.21 for patients whose treatment was initiated in the Clinic, but completed in the home (HC). Sensitivity analyses indicated: 1) IP treatment was in all cases more expensive than that of OP or HC; 2) the cost savings of OP vs. HC was sensitive to assumptions made regarding Clinic overhead, Clinic nursing costs and Home Care Program overhead.
Conclusion:Alternatives to in-patient care must be considered carefully. In this study, both out-patient and in-home treatment were cost-saving alternatives to in-patient treatment, but large differences in the cost of hospital out-patient vs. in-home care could not be demonstrated.
Contributors
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- By Linda S. Aglio, Cyrus Ahmadi Yazdi, Syed Irfan Qasim Ali, Caryn Barnet, Jessica Bauerle, Felicity Billings, Evan Blaney, Beverly Chang, Christopher Chen, Zinaida Chepurny, Hyung Sun Choi, Allison Clark, Lauren J. Cornella, Lisa Crossley, Michael D’Ambra, Galina Davidyuk, Whitney de Luna, Manisha S. Desai, Sukumar P. Desai, Kelly G. Elterman, Michaela K. Farber, Iuliu Fat, Jaida Fitzgerald, Devon Flaherty, John A. Fox, Gyorgy Frendl, Rejean Gareau, Joseph M. Garfield, Andrea Girnius, Laverne D. Gugino, J. Tasker Gundy, Carly C. Guthrie, Lisa M. Hammond, M. Tariq Hanifi, James Hardy, Philip M. Hartigan, Thomas Hickey, Richard Hsu, Mohab Ibrahim, David Janfaza, Yuka Kiyota, Suzanne Klainer, Benjamin Kloesel, Hanjo Ko, Bhavani Kodali, Vesela Kovacheva, J. Matthew Kynes, Robert W. Lekowski, Joyce Lo, Jeffrey Lu, Alvaro A. Macias, Zahra M. Malik, Erich N. Marks, Brendan McGinn, Jonathan R. Meserve, Annette Mizuguchi, Srdjan S. Nedeljkovic, Ju-Mei Ng, Michael Nguyen, Olutoyin Okanlawon, Jennifer Oliver, Krishna Parekh, Jessica Patterson, Christian Peccora, Pete Pelletier, Sujatha Pentakota, James H. Philip, Marc Philip T. Pimentel, Timothy D. Quinn, Elizabeth M. Rickerson, Susan L. Sager, Julia Serber, Shaheen Shaikh, Stanton Shernan, David Silver, Alissa Sodickson, Pingping Song, George P. Topulos, Agnieszka Trzcinka, Richard D. Urman, Rosemary Uzomba, Joshua Vacanti, Assia Valovska, Michael Vaninetti, Scott W. Vaughan, Kamen Vlassakov, Christopher Voscopoulos, Emily L. Wang, Laura Westfall, Zhiling Xiong, Stephanie Yacoubian, Dongdong Yao, Martin Zammert, Maksim Zayaruzny, Jose Luis Zeballos, Natthasorn Zinboonyahgoon, Jie Zhou
- Edited by Linda S. Aglio, Robert W. Lekowski, Richard D. Urman
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- Book:
- Essential Clinical Anesthesia Review
- Published online:
- 05 February 2015
- Print publication:
- 08 January 2015, pp xi-xvi
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