Post on 16-Dec-2015
An Emergency Department and Centre for Emotions and Health Collaboration
Contact: Allan Abbass 902473-2514, allan.abbass@dal.ca
www.istdp.ca
EmotionDysregulation
Physical SymptomsPhysical IllnessesLow self careSelf InjuryRelationshipsLow ComplianceComplaints
Hospital DaysEmergency useMedical VisitsTests + ProceduresExcess MedicationsPoor OutcomesDisabilityMorbidityMortality
Irritable BowelDyspepsiaAbdominal pain
FibromyalgiaFatigue
DepressionAnxietyPanic
HypertensionChest pain
ConversionPseudoneurologicalPhenomena
ChemicalSensitivity
HeadacheConfusion
Bladder dysfunctionPelvic Pain
Great Overlap Between Common Problems
PsoriasisDermatitis
Irritable BowelDyspepsiaAbdominal pain
FibromyalgiaFatigue
DepressionAnxietyPanic
HypertensionChest pain
ConversionPseudoneurologicalPhenomena
ChemicalSensitivity
HeadacheConfusion
Bladder dysfunctionPelvic Pain
Great Overlap Between Common Problems
PsoriasisDermatitis
EmotionDysregulation
SpecialtySpecialty % with 1 or more % with 1 or more unexplained unexplained symptomssymptoms
GynecologyGynecology 6666
NeurologyNeurology 6262
GastroenterologyGastroenterology 5858
Chest ClinicChest Clinic 5151
RheumatologyRheumatology 4545
TotalTotal 5252
Emergency use: ~15-20,000 visits/yr Hospital Days: ~13,000 days per yearMedical Visits: 25-50% of all new consultsExcess Tests + Procedures: ?Excess Medications: ~$150,000/yr in Hospital Suboptimal Outcomes: ? CostExcess Side effects: ? Cost: many admissionsDisability: ~$6,000,000/ year in Capital HealthMortality: a measurable excess in reviews
Info from Emergency Database, Decision Support, Occupational Health and Pharmacy
Unexplained Chest Pain, Headache, Panic, Abdominal Pain account for
16% of all CDHA ED Visits each year
75% of all Chest Pain complaints come out with no diagnosis: 9000
visits
88% of all Abdominal Pain complaints come out with no
diagnosis: 7000 visits
Wait Times
A method based on videotaped research to diagnose and address problems handling emotions
Effective with broad range of physical and psychological problems
Actively researched and taught in our Centre More information
http://www.istdp.ca/whatis.htm
Voluntary Muscle Tension Fibromyalgia, chest pain, abdominal pain, hyperventilation, panic attacks
Involuntary Muscle Tension Hypertension, IBS, Dyspepsia, Urinary symptoms, pelvic pain, migraine
Physical Problems treatable with ISTDP
Cognitive-perceptual Disruption dizziness, fainting, weakness, memory problems, accidents, injury, psychotic features
Motor Conversion Falling, loss of speech, spasm, weakness
21 published outcome studies Effective with multiple medical conditions and
physical symptom syndromes Marked drop in Dr and Hospital costs Majority stop psychiatric medications Around 85% of treated patients return to work
from disabilities (several studies) Single session brings 25% symptom reduction
on average Saves approximately 10 times what it costs
each year through service use and disability reduction.
How Effective is ISTDP
0
1
2
3
4
5
6
7
1 Year Pre 1 year Post
Emer
genc
y V
isits
/yr
ISTDP
Control
p<.01
p<.001
p=0.2
ISTDP reduced Repeat Emergency Visits for Medically Unexplained Symptoms Abbass, Campbell et al, Can J Emerg Med, 2009, 2010a, 2010b
Control
ISTDP
Innovation Grant to staff ED with Diagnostic Clinicians
Established long term relationship between CEH and ED
Provided videotape based education sessions to the emergency staff
Developed an information pamphlet for patients. Introduced rapid access referrals to the service
where emergency patients were seen in less than 2 weeks when possible.
Showed videotape of the emergency-referred cases we had seen.
Provided literature to emergency physician and other staff.
Provided a month of on-site consultation and liaison with emergency physicians.
3.8 sessions average Significant Improvement on symptom measure
(BSI) High Patient Satisfaction ratings (~8/10) Marked increase in referral rates by more
Emergency Doctors Major reduction in repeat Emergency Use (65-
70% reduction) “Net Cost saving” of 500 per patient Funding received for 1.2 FTE Psychologists to
staff the ED Named Canadian Leading Practice by
Accreditation Canada 2010 Nova Scotia expected to roll this program out to
other emergency departments
Simply understanding that emotional factors were responsible for symptoms was enough to reduce symptoms and ED use. Only 2 returned to ED, after assessment and during course of clinic.
Almost all patients were suitable referrals for service. Only 2 or 3 did not fit the service.
More complex patients needed coordinated Tx
While all had multiple issues, at the core of the problem was some form of attachment trauma in early life.
Nearly all were moderate resistant, highly resistant or fragile
The service is widely acceptable and well used
Patients benefit with reduced ED visits Service use reduction can help to reduce
wait times This service matches meeting the patient
at point of entry, and Exemplifies patient-centred care at Capital
Health
Canadian Journal of Emergency Medicine 2009 article: http://www.istdp.ca/docs/CJEM_2009.pdf
Journal of Academy of Medical Psychology articles on Cost Effectiveness and Implementation
http://www.istdp.ca/docs/Cost%20Saving%20ED%20Treatment.pdfhttp://www.istdp.ca/docs/Implementing%20ISTDP%20in%20the%20ED.pdf