7 research outputs found
The role of local inpatient psychiatric units and general practitioner on continuity of care in Northern Norway: A case-register study
Objectives: The general practitioners' (GP) role in the care of mental health patients has received increased attention. The literature underlines the need for integration of primary and specialist services, but cross-boundary continuity for patients with severe conditions may be particularly poor. The aim of this study was to analyze the collaboration between primary care and different models of specialized psychiatric services for patients with severe conditions.
Methods: We compared a local and a centralized model of mental health care. Service utilization over a 5-year period was studied.
Results: Findings suggest that a local institution-based model of services positively affects the use of both GP and specialist outpatient care, with most inpatients utilizing both GP and specialist outpatient consultations. In the centralized model, a substantial proportion of inpatients only used GP outpatient care. Furthermore, inpatients that used both GP and specialist outpatient services received more of both services compared to those who did not enter specialist outpatient care at all.
Conclusion: Local inpatient units may positively affect continuity of care and collaboration between general practitioners and specialist psychiatric services compared to more traditional hospital units, probably because better functional integration of services, better facilitation of clinical alliances/relationships, or a more network-oriented treatment philosophy.publishedVersio
Psychiatric readmission rates in a multi-level mental health care system â a descriptive population cohort study
Background Readmission rates are frequently used as a quality indicator for health care, yet their validity for evaluating quality is unclear. Published research on variables affecting readmission to psychiatric hospitals have been inconsistent. The Norwegian specialist mental health care system is characterized by a multi-level structure; hospitals providing specialized -largely unplanned care and district psychiatric centers (DPCs) providing generalized -more often planned care. In certain service systems, readmission may be an integral part of individual patientsâ treatment plan. The aim of the present study was to describe and examine the task division in a multi-level health care system. This we did through describing differences in patient population (age, sex, diagnosis, substance abuse comorbidity and length of stay) and admissions types (unplanned vs. planned) treated at different levels (hospital, DPC or both), and by examining whether readmission risk differ according to type and place of treatment of index-admission and travel-time to nearest hospital and DPC. Methods In this population-based cohort study using administrative data we included all individuals aged 18 and older who were discharged from psychiatric inpatient care with an ICD-10 diagnosis F2-F6 (âfunctional mental disordersâ) in 2012. Selecting each individualâs first discharge during 2012 as index gave N =â16,185 for analyses following exclusions. Analysis of readmission risk were done using Kaplan-Maier failure curves. Results Overall, 15.1 and 47.7% of patients were readmitted within 30 and 365âdays, respectively. Unplanned admission patients were more likely to be readmitted within 30âdays than planned patients. Those transferred between hospital and DPC during index admission were more likely to be readmitted within 365âdays, and to experience planned readmission. Patients with short travel time were more likely to have unplanned readmission, while patients with long travel time were more likely to have planned readmission. Conclusions DPCs and hospitals fill different purposes in the Norwegian health care system, which is reflected in different patient populations. Differences in short term readmission rates between hospitals and DPCs disappeared when type of admission (unplanned/planned) was considered. The results stress the importance of addressing differences in organisation and task distribution when comparing readmission rates between mental health systems. Keywords: Readmission, Psychiatry, Multi-level mental health care system, Survival analysispublishedVersio
Changes in patterns of coercion during a nine-year period in a Norwegian psychiatric service area
Objective:
There is debate regarding the use of coercion in the psychiatric services and how to minimize its use. We examine changes in the use of coercion in one Norwegian psychiatric service area during a nine-year period.
Methods:
All patients receiving psychiatric services during the periods 2003â2006 and 2008â2012 in the study area were identified, subsequently also only those who had been involuntarily admitted or subjected to involuntary outpatient treatment. Yearwise rates of patients admitted to coercion and coercive treatment-episodes throughout the study period were calculated.
Results:
The overall number and the rate of coerced patients decreased to the total patient population. Most of the reduction were initially of the observational period. However, the number of coercive episodes per coerced patient increased. The pattern of outpatient versus inpatient modes of coercion both reflected this main trend.
Conclusion:
The use of coercion seem to be reduced overall, although the increase in treatment-episodes per patient may indicate a complex pattern in use and registration of coercion. The results may be related to legislative changes, restructuring of psychiatric services, or/and modified attitudes of health-personnel to coercion following a range of efforts to reduce it.publishedVersio
Local psychiatric beds appear to decrease the use of involuntary admission: A case-register study
Background: Studies on the effect of organizational factors on the involuntary admission of psychiatric patients have
been few and yielded inconclusive results. The objective was to examine the importance of type of service-system,
level of care, length of inpatient stay, gender, age, and diagnosis on rates of involuntary admission, by comparing one
deinstitutionalized and one locally institutionalized service-system, in a naturalistic experiment.
Methods: 5538 admissions to two specialist psychiatric service-areas in North Norway were studied, covering a
four-year period (2003-2006). The importance of various predictors on involuntary admission were analyzed in a
logistic regression model.
Results: Involuntary admission to the services was associated with the diagnosis of psychosis, male sex, being
referred to inpatient treatment, as well as type of service-system. Patients from the deinstitutionalized system were
more likely to be involuntarily admitted.
Conclusions: Several factors predicted involuntary status, including male sex, the diagnosis of psychosis, and type
of service-system. The results suggests that having psychiatric beds available locally may be more favourable than a
traditional deinstitutionalized service system with local outpatient clinics and central mental hospitals, with respect
to the use of involuntary admission
How mental health service systems are organized may affect the rate of acute admissions to specialized care: Report from a natural experiment involving 5338 admissions
Objectives: Studies on the dynamics between service organization and acute admissions to psychiatric specialized care
have given ambiguous results. We studied the effect of several variables, including service organization, coercion, and
patient characteristics on the rate of acute admissions to psychiatric specialist services. In a natural experiment-like study in
Norway, we compared a âdeinstitutionalizedâ and a âlocally institutionalizedâ model of mental health services. One had only
community outpatient care and used beds at a large Central Mental Hospital; the other also had small bed-units at the local
District Psychiatric Centre.
Methods: From the case registries, we identified a total of 5338 admissions, which represented all the admissions to the
psychiatric specialist services from 2003 to 2006. The data were analyzed with chi-square tests and Z-tests. In order to
control for possible confounders and interaction effects, a multivariate analysis was also performed, with a logistic regression
model.
Results: The use of coercion emerged as the strongest predictor of acute admissions to specialist care (odds ratio = 7.377,
95% confidence interval = 4.131â13.174) followed by service organization (odds ratio = 3.247, 95% confidence interval = 2.582â
4.083). Diagnoses of patients predicted acute admissions to a lesser extent. We found that having psychiatric beds available
at small local institutions rather than beds at a Central Mental Hospital appeared to decrease the rate of acute admissions.
Conclusion: While it is likely that the seriousness of the patientsâ condition is the most important factor in doctorsâ decisions
to refer psychiatric patients acutely, other variables are likely to be important. This study suggests that the organization of
mental health services is of importance to the rate of acute admissions to specialized psychiatric care. Systems with beds at
local District Psychiatric Centers may reduce the rate of acute admissions to specialized care, compared to systems with
local community outpatient services and beds at Central Mental Hospitals
Local inpatient units may increase patients' utilization of outpatient services: A comparative cohort-study in Nordland County, Norway
Objectives: In the last few decades, there has been a restructuring of the psychiatric services
in many countries. The complexity of these systems may represent a challenge to patients that
suffer from serious psychiatric disorders. We examined whether local integration of inpatient
and outpatient services in contrast to centralized institutions strengthened continuity of care.
Methods: Two different service-systems were compared. Service-utilization over a 4-year
period for 690 inpatients was extracted from the patient registries. The results were controlled for
demographic variables, model of service-system, central inpatient admission or local inpatient
admission, diagnoses, and duration of inpatient stays.
Results: The majority of inpatients in the area with local integration of inpatient and outpatient
services used both types of care. In the area that did not have beds locally, many patients that had
been hospitalized did not receive outpatient follow-up. Predictors of inpatientsâ use of outpatient
psychiatric care were: Model of service-system (centralized vs decentralized), a diagnosis of
affective disorder, central inpatient admission only, and duration of inpatient stays.
Conclusion: Psychiatric centers with local inpatient units may positively affect continuity
of care for patients with severe psychiatric disorders, probably because of a high functional
integration of inpatient and outpatient care
Psychiatric readmission rates in a multi-level mental health care system â a descriptive population cohort study
Background Readmission rates are frequently used as a quality indicator for health care, yet their validity for evaluating quality is unclear. Published research on variables affecting readmission to psychiatric hospitals have been inconsistent. The Norwegian specialist mental health care system is characterized by a multi-level structure; hospitals providing specialized -largely unplanned care and district psychiatric centers (DPCs) providing generalized -more often planned care. In certain service systems, readmission may be an integral part of individual patientsâ treatment plan. The aim of the present study was to describe and examine the task division in a multi-level health care system. This we did through describing differences in patient population (age, sex, diagnosis, substance abuse comorbidity and length of stay) and admissions types (unplanned vs. planned) treated at different levels (hospital, DPC or both), and by examining whether readmission risk differ according to type and place of treatment of index-admission and travel-time to nearest hospital and DPC. Methods In this population-based cohort study using administrative data we included all individuals aged 18 and older who were discharged from psychiatric inpatient care with an ICD-10 diagnosis F2-F6 (âfunctional mental disordersâ) in 2012. Selecting each individualâs first discharge during 2012 as index gave N =â16,185 for analyses following exclusions. Analysis of readmission risk were done using Kaplan-Maier failure curves. Results Overall, 15.1 and 47.7% of patients were readmitted within 30 and 365âdays, respectively. Unplanned admission patients were more likely to be readmitted within 30âdays than planned patients. Those transferred between hospital and DPC during index admission were more likely to be readmitted within 365âdays, and to experience planned readmission. Patients with short travel time were more likely to have unplanned readmission, while patients with long travel time were more likely to have planned readmission. Conclusions DPCs and hospitals fill different purposes in the Norwegian health care system, which is reflected in different patient populations. Differences in short term readmission rates between hospitals and DPCs disappeared when type of admission (unplanned/planned) was considered. The results stress the importance of addressing differences in organisation and task distribution when comparing readmission rates between mental health systems. Keywords: Readmission, Psychiatry, Multi-level mental health care system, Survival analysi