Faculty Bibliography

A follow-up study of a cohort of suburban alcoholics who are comprehensively served by the public mental health sector used a Cox survival time analyses to examine the relationship of patient characteristics, receipt of outpatient services and readmission to inpatient care. Patients were followed up until their first readmission to inpatient care or for 2 yr subsequent to an inpatient episode. As expected, established chronicity was associated with short 'survival' in the community, as were youth and living alone. For first admissions, the receipt of aftercare was associated with a decreased likelihood of readmission, especially in conjunction with inpatient stays of treatment that included rehabilitation services. Patients who had established a pattern of chronicity, however, appeared resistant to the effect of these services. The transition from inpatient to aftercare services was identified as a crucial point in treatment. Aftercare patients who did not receive services beyond 6 months in the community were likely to be readmitted, suggesting that this period is also an important focus for treatment planning

A study was carried out across 11 psychiatric and mental retardation, and developmental disabilities facilities to investigate the impact of a computerized drug prescription monitoring system on clinicians' prescribing behavior, knowledge of pharmacotherapy, attitudes toward computers, and the relationships between their attitudes and changes in their prescribing practices. The results document that surveillance systems can improve prescribing practices. The tangible feedback provided by the exception report, although in the form of a surveillance mechanism, also increased user acceptance to computer technology. However, the findings also suggest that user acceptance is not necessarily required to see positive effects, which in environments where clinical and fiscal accountability are paramount, may override some clinicians' concerns. Attention to human factors components may help to alleviate some negativism

A side benefit of a current systems assessment carried out prior to automation was the development of a systematic picture of the clinical care system as captured in the system flow chart. The results of this assessment provided clinical administrators with a blueprint identifying the current system's strengths and weaknesses, which could be used both to introduce improvements and to measure the effect of such changes totally apart from the initial question of automation.