1/28/2010

Psychology in the Emergency Room: psychotherapy reduces return visits

The "medical cost offset effect" is well known and has long been documented.  In brief:  when emotionally distressed medical patients receive therapy,  they tend to reduce their utilization of all forms of medical care,  and it saves money.

A recent demonstration of this cost saving strategy is of particular interest because it focused on patients who were admitted to the emergency room.  Published in the Canadian Journal of Emergency Medicine,  the study was titled:  "Intensive short-term dynamic psychotherapy to reduce rates of emergency department return visits for patients with medically unexplained symptoms: preliminary evidence from a pre-post intervention study."

More typically,  studies of this type focus on patients seen in the offices of general practice physicians,  even though many have tracked subsequent hospital visits as an outcome measure.

In this case,  patients who arrived at the emergency room with "medically unexplained symptoms" were referred to a therapist,  and on average they were seen for about four sessions.  One of the study's authors noted that among patients arriving at the emergency room with chest pains,  there are no physical findings in three out of four cases.

The patients who were referred to therapy were matched with patients who had similar rates of emergency room utilization or who had presented with similar complaints.  The implication is that this group (those who come in with chest pains that tests could not explain) tend to seek medical care quite regularly.  In the hospital where the study was conducted,  the identified patient group was averaging 4.6 emergency visits per year!

What was the outcome?  The result was an almost 70% reduction in return visits to the hospital.  According to the lead author:  "For every 100 people seen by the staff psychologist, there will be 300 fewer emergency visits a year, which adds up to a huge savings and reduction in unnecessary tests."

These results are not at all surprising.  If you are distressed,  depressed,  experiencing anxiety and having a panic attack,  you are likely to have shortness of breath and to experience chest pain and perhaps light-headedness.   Of course you are going to call or go to the emergency room.

If you resolve the feelings and understand the emotions that lead to panic and anxiety,  or if you relieve the stress that might be causing distress,  the chances are that you are not going to panic and end up needing emergency medical care.

That is one of the reasons we know that therapy works.  It saves money. 



Copyright Paul G. Mattiuzzi, Ph.D.