Inpatient

In addition, if possible, die nurse obtains a history of any past drug or alcohol abuse. Individuals with a history of previous abuse are more likely to abuse odier drug s, such as the antianxiety drug s. Some patients, such as diose with mild anxiety or depression, do not necessarily require inpatient care. These patients are usually seen at periodic intervals in die primary health care provider s office or in a psychiatric outpatient setting. The preadministration assessments of the outpatient are the same as diose for the hospitalized patient. 

Physical assessments include obtaining blood pressure measurements on both arms with the patient in a sitting position, pulse, respiratory rate, and weight. The hospitalized patient may ultimately be discharged from the psychiatric setting. Some patients, such as those with mild schizophrenia, do not require inpatient care. The nurse usually sees these patients at periodic intervals in the psychiatric outpatient setting. 

The patient s response to drug therapy on an inpatient basis requires around-the-clock assessments because frequent dosage adjustments may be necessary during therapy. 

Sevoflurane (Ultane) is an inhalational analgesic. It is used for induction and maintenance of general anesthesia in adult and pediatric patients for inpatient and outpatient surgical procedures. 

The LMWHs are contraindicated in patients witii a hypersensitivity to the drug, heparin, or pork products and inpatients with active bleeding or thrombocytopenia... 

Serious adverse reaction means an adverse reaction, which resuits in death, is iife-threatening, requires inpatient hospitaiisation, or proiongation of existing hospitaiisation, resuits in persistent or significant disabiiity or incapacity, or is a congenitai anomaiy/birth defect. 

Increasingly, detoxification is being done on an ambulatory basis, which is much less costly than inpatient detoxification (Hayashida et al. 1989). Inpatient detoxification is indicated for patients with serious medical or surgical illness and for those with a past history of adverse withdrawal reactions or with current evidence of more serious withdrawal reactions (e.g., dehrium tremens) (Feldman et al. 1975). 

Kahel DI, Petty F A double blind smdy of fluoxetine in severe alcohol dependence adjunctive therapy during and after inpatient treatment. Alcohol Clin Exp Res 20 780-784, 1996... 

Malcolm R, Anton RF, Randall CL, et al A placebo-controlled trial of Buspirone in anxious inpatient alcoholics. Alcohol Clin Exp Res 16 1007—1013, 1992... 

Patients requiring detoxification from high or supratherapeutic dosages of benzodiazepines constitute a smaller number of patients, but they are at greater risk for life-threatening discontinuation symptoms, such as seizures, delirium, and psychoses. There has been more experience with inpatient detoxification in this group, but outpatient detoxification is possible if conducted slowly (5% reduction in dose per week), with frequent contact, and in the context of a therapeutic alliance with the patient. Often, such an alliance proves unworkable because the patient s impoverished control results in supplementation from outside sources or early exhaustion of prescribed supplies meant to be tapered. In these cases, as in the cases of patients with a history of seizures, delirium, or psychoses during previous detoxification attempts, inpatient detoxification is indicated. 

Williams H, Oyefeso A, Ghodse AH Benzodiazepine misuse and dependence among opiate addicts in treatment. It J Psychol Med 13 62-64, 1996 Wiseman SM, Spencer-Peet J Prescribing for alcoholics a survey of drugs taken prior to admission to an alcoholism unit. Practitioner 229 88—89, 1985 Wolf B, Grohmann R, Biber D, et al Benzodiazepine abuse and dependence in psychiatric inpatients. Pharmacopsychiatry 22 54—60, 1989 Wood MR, Kim JJ, Han W, et al Benzodiazepines as potent and selective bradykinin B1 antagonists. J Med Chem 46 1803—1806, 2003 Zawertailo LA, Busto UE, Kaplan HL, et al Comparative abuse liability and pharmacological effects of meprobamate, triazolam, and butabarbital. J Clin Psycho-pharmacol 23 269-280, 2003... 

Hurt RD, Offord KP, Croghan IT, et al Mortality following inpatient addictions treatment role of tobacco use in a community-based cohort. JAMA 275 1097—1103, 1996... 

Hellinger (1988,1991,1992) developed a model that estimated the provider costs of AIDS using incidence-based measures derived from US data. His findings for inpatients were similar to those by Scitovsky and Rice (1987). He added the costs of outpatient antiretroviral medications and estimated an increase of provider costs from US 5.8 billion in 1991 to US 10.4 billion in 1994 and to US 15.2 billion in 1995. 

The introduction of protease inhibitor-based regimens seemed to be responsible for a change within the structure of provider costs. There is some evidence that the share of drugs increased, whereas the importance of hospitalization declined. For instance, Hellinger (1993) estimated that drug costs to account for about 10% of the total provider costs, whereas the inpatient hospitals costs were responsible for some... 

To compare the epidemiological, clinical, and economic impacts of the HIV epidemic in Italy prior to and after the introduction of HAART, Tramarin et al. (2004) conducted a prospective and observational study with a multi-center design. They used data collected on an AIDS cohort from 1994 and updated data from a comparable cohort in 1998. Mortality and medical costs of 251 patients were measured in 1994 and in 1998, respectively. A considerable difference was observed in mortality (33.9% in 1994 vs. 3.9% in 1998). The cost per patient per year was US 15,515 in 1994 and US 10,312 in 1998. Based on the comparison of the two cohorts between both years, the authors concluded that after the introduction of HAART, hospital-based provision shifted from an inpatient-based to an outpatient-based service, with major focus on pharmaceutical care. 

Flori and le Vaillant (2004) studied the temporal relationship between the uptake of the more aggressive antiretroviral therapy and the use and cost of hospital treatment for HIV-infected patients in France from 1995 to 2000 from a hospital perspective. The authors found that during this period the proportion of patients on ARV treatment increased from 69.5% to 97%, with a large rise in the use of polytherapy. This increase was most notable for patients with CD4 cell counts above 500. ART expenditures per patient increased between the study years by 220%, reaching US 1,886 in 2000. Unlike that, inpatient hospitalization fell by 60% and average length of stay declined. Thus hospital costs (excluding ART) decreased to US 2,137 in 2000. 

Yazdanpanah et al. (2002) calculated the resource use and cost for different stages of HIV infection in France based on a clinical database of HIV-infected patients between 1994 and 1998. The total costs attributable to bed-day and day-care inpatient care included the mean cost of each inpatient day times the length of stay, as well as total number of laboratory tests, dosage and quantity of medications, and total number of procedures. The total cost attributable to outpatient care included the mean physician and nurse fees per visit, as well as total number of laboratory tests and total number of procedures. In the absence of an AIDS-deflning event, the average total cost of care ranged from US 797 per person-month in the highest CD4 stratum to US 1,261 per person-month in the lowest CD4 stratum. 

Caekelbergh et al. calculated the direct costs of HIV/AIDS in Belgium from the health care pay perspective. On the basis of 150 patients, they determined the costs of antiretrovirals, outpatient and inpatient resource use for the year 2005. They realize that the costs strongly depend on the CD4- - T-cell count, that is, the annual costs per patient are on average about US 2,900 for a patient with a CD4+ T-cell count >500, US 3,200 (CD4 351-500), US 8,650 (CD4 210-350), US 16,600 (CD4 101-200), US 31,300 (CD4 51-100), and US 49,400 (CD4 0-50), respectively. Consequently, the early detection of an HIV-infection as well as proper management that prohibits disease transition is of high cost-importance. 

Finally, Kimura (2002) estimated the socio-economic impact of HIV/AIDS in Japan and estimated the inpatient and outpatient costs of beating HIV-infected adults. He calculated costs of US 17,858 to US 21,431 p.a. for outpatients, whereas 83% were due to antiretrovirals. The cost estimates for inpatients with Aids varies strongly. Inpatients with a CD4+ count from 200-499 had costs of US 37,007 p.a., inpatients with a CD4- - count between 50 and 199 had costs of US 76,197 p.a., and inpatients with a CD4+ count of less then 50 had average cost of US 170,155 p.a. 

Based on two clinics specialized in AIDS treatment, Papaevangelou et al. (1995) calculated lifetime costs per patient in Greece at US 24,160, consisting of drug costs (US 9,022), costs for outpatient care (US 963), and inpatient care (US 14,175). 

Compared with the standard health economic methodology applied in COI studies for other diseases (e.g. Keith and Shackleton 2006 Welte et al. 2000 Leidl et al. 1999 Henke et al. 1997 Xie et al. 1996), the quality of health economic analysis of HIV/AIDS is not always satisfactory as far as costs are concerned (Levy et al. 2006). Sometimes it is not clear whether researchers included both inpatient and outpatient medications in their analyses. Equally important, many of the early studies used costs and charges interchangeably data using charges may not accurately reflect true costs. Drummond and Davis (1988) also argued that there have been incorrect estimates of the survival times and costs in aU these early studies, since there were no explicit adjustments made for disease severity. 

Berthelsen CL. Evaluation of coding data quality of the HCUP National Inpatient Sample. Top Health Inf Manage 2000 21 10-23. 

Economic studies should consider the costs of all the resources and services used in the process of care. In addition, the outcomes that are a consequence of the health or social care interventions evaluated need to be included. For dementia, these include the costs of hospital inpatient and out-patient care, primary and community-based health-care services, social welfare services, and care provided by voluntary agencies or by femily and friends. Ideally, a broad perspective reflecting the costs and outcomes to society should be adopted. As a minimum, the perspective of the analysis should include the costs and outcomes to key health and social care providers or funders and to patients and their families. 

Chouinard G, Jones B, Remington G, et al (1993). A Canadian multicentre placebo controlled study of fixed doses of risperidone and haloperidol in the treatment of chronic schizophrenic inpatients./Clin Psychopharmacol25—40. 

Fleishman JA, Hellinger FH (2003) Recent trends in HIV-related inpatient admissions 1996-2000 a 7-state study. J Acquir Immune Defic Syndr 34(1) 102-110 Freeman R, Roberts MS et al (1990) Autonomic function and human immunodeficiency virus infection. Neurology 40(4) 575-580... 

Reed SD, Cramer SC, Blough DK, Meyer K, Jarvik JG. Treatment with tissue plasminogen activator and inpatient mortality rates for patients with ischemic stroke treated in community hospitals. Stroke. 2001 32 1832-1840. 

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