Needs-oriented discharge planning and monitoring for high utilisers of psychiatric services (NODPAM): Design and methods

<p>Abstract</p> <p>Background</p> <p>Attempts to reduce high utilisation of psychiatric inpatient care by targeting the critical time of hospital discharge have been rare.</p> <p>Methods</p> <p>This paper presents design and methods of the study "Effectiveness and Cost-Effectiveness of Needs-Oriented Discharge Planning and Monitoring for High Utilisers of Psychiatric Services" (NODPAM), a multicentre RCT conducted in five psychiatric hospitals in Germany. Inclusion criteria are receipt of inpatient psychiatric care, adult age, diagnosis of schizophrenia or affective disorder, defined high utilisation of psychiatric care during two years prior to the current admission, and given informed consent. Consecutive recruitment started in April 2006. Since then, during a period of 18 months, comprehensive outcome data of 490 participants is being collected at baseline and during three follow-up measurement points.</p> <p>The manualised intervention applies principles of needs-led care and focuses on the inpatient-outpatient transition. A trained intervention worker provides two intervention sessions: (a) Discharge planning: Just before discharge with the patient and responsible clinician at the inpatient service; (b) Monitoring: Three months after discharge with the patient and outpatient clinician. A written treatment plan is signed by all participants after each session.</p> <p>Primary endpoints are whether participants in the intervention group will show fewer hospital days and readmissions to hospital. Secondary endpoints are better compliance with aftercare, better clinical outcome and quality of life, as well as cost-effectiveness and cost-utility.</p> <p>Discussion</p> <p>If a needs-oriented discharge planning and monitoring proves to be successful in this RCT, a tool will be at hand to improve patient outcome and reduce costs via harmonising fragmented mental health service provision.</p> <p>Trial Registration</p> <p>ISRCTN59603527</p

English Abstract: A new standardized short term therapy program for sleep disorders in tinnitus patients

Hintergrund: Schlafstörungen sind häufig mit Tinnitus vergesellschaftet und tragen erheblich zur subjektiven Beeinträchtigung bei. Obwohl mindestens ein Viertel aller Tinnituspatienten davon betroffen sind, gibt es keine evidenzbasierten Therapieprogramme für diese Störungskombination. Material und Methoden: In Zusammenarbeit des Schlaflabors und des Tinnituszentrums an der&nbsp; Universitätsklinik Regensburg wurde ein spezifisches interdisziplinäres Therapieprogramm unter Beteiligung der Fachrichtungen HNO, Audiologie, Psychiatrie und psychologischer Psychotherapie entwickelt. Das Kurzzeitprogramm (14 Tage) wird stationär durchgeführt und besteht im wesentlichen aus psychoedukativen und verhaltenstherapeutischen Elementen. Das Programm wurde an einer kontrollierten Fallserie mit vier Patienten geprüft. Ergebnisse: Das Programm hat sich als gut praktikabel im klinisch stationären Setting erwiesen. Drei von vier Patienten zeigten sowohl eine Verbesserung des Schlafes als auch des Tinnitus. Schlussfolgerung: Das vorgestellte interdisziplinäre gruppentherapeutische Programm scheint eine vielversprechende Methode zur Behandlung von Schlafstörungen bei Tinnituspatienten zu sein. Weitere Untersuchungen mit größeren Patientenzahlen sind erforderlich, um die Wirksamkeit dieser Maßnahme zu belegen.Sleep disorders are a frequent complaint among patients with tinnitus and can severely affect quality of life. Despite the high prevalence, there are no specific evidence-based therapy programs for this combination of disorders. In a collaborative project of the Tinnitus and Sleep Disorders Centers at the University of Regensburg involving psychiatrists, psychotherapists, audiologists and otolaryngologists, a specific short-term treatment program (14 days) has been developed, which uses mainly elements of cognitive behaviour therapy. First clinical data are promising suggesting beneficial effects both on tinnitus and on insomnia. Further controlled studies with larger sample sizes are needed for evaluating efficacy of this treatment