[Heavy users of inpatient services: a comparison of diagnostic subgroups]

[Aftercare of Psychiatric and Psychosomatic Inpatients with ICD-10 Disorders F3 and F4 (PfAD Study)]

OBJECTIVE

We investigated treatment pathways after discharge from in-patient treatment and their predictors.

METHODS

Within a prospective naturalistic study, 320 adult inpatients treated in four settings were examined at admission, discharge, and two follow-up time points. In addition to sociodemographic and clinical data, standardized instruments have been employed to collect data on pathways within the mental care system a half year before and one year after index treatment, respectively. Descriptive analyses and logistic regression models were applied.

RESULTS

Inpatient admissions in the first half of the follow-up year were common in psychiatric inpatients as planned aftercare. The majority of participants received outpatient aftercare. Main predictors of both inpatient readmission and outpatient psychotherapy after discharge were the setting of the index-treatment (psychiatry versus psychosomatics) as well as previous and planned forms of care.

CONCLUSION

Though according to plan, the pathways of aftercare in psychiatry and psychosomatics are predominantly disconnected and show little overlap.

["But you know Mr. M., you won't get hospitalised" : A qualitative study on service users' experience of seeking psychiatric inpatient admission]

In a qualitative study using thematic analysis of focus group interviews with service users their perspectives and experiences concerning the process of seeking admission to psychiatric inpatient care in Austria were explored. The aim of the study was to better understand service users' motivation, decisions and actions in the process of seeking psychiatric hospitalisation. Results show that admission to psychiatric inpatient care was often sought directly without a referral from an outpatient service. An important motivation was the lack of availability of alternatives to inpatient care in situations of a severe acute crisis. In this situation service users often found themselves in a conflict between positive expectations related to symptom improvement and a protective environment, and memories of previous negative experiences, such as stigma and coercion. Coercion and involuntary admission were recurring topics in the narratives of the focus group participants, not only of those who had actually experienced such situations. Seeking hospitalisation was considered as enormously burdening, which was intensified in many cases by the experience of refusal of hospitalisation by the staff. Overall, service users stressed that they found themselves at the lower end of the decision hierarchy, with relatives, doctors, ambulance services and police having more impact on the decision about a psychiatric hospitalisation. Suggestions for improving psychiatric care derived from the analysis include a better coordination between inpatient and outpatient care and the creation of alternative services which are located between the acute inpatient services and the selective ambulatory services in the outpatient sector.

[Relevance of type of diagnosis and occupational status for the results of psychiatric rehabilitation]

OBJECTIVE

The specific effectiveness of psychiatric rehabilitation has been confirmed in numerous studies. Of particular interest is to what extend different results can be observed regarding the occupational status and type of mental illness of patients. Unemployment at the start of treatment is generally deemed to be a disadvantage for treatment outcome. Weaker treatment effects have also been reported for some types of mental illnesses, such as pain- und somatoform disorders.

METHODS

Results from the evaluation of a sample of 2260 patients form the psychiatric rehabilitation clinic Gars am Kamp were analyzed, with regard to the occupational status and type of mental illness of patients. Changes in general symptom severity, quality of life and functioning were assessed.

RESULTS

Regarding the occupational status, overall unemployed patients suffered from higher degrees of global symptom severity and the lower levels of global quality of life compared to employed and retired patients. However, improvements in the course of rehabilitative treatment could be observed regardless of the occupational status of patients. Regarding the type of mental illness, overall patients with burnout (Z73.0) reported the lowest levels of global symptom severity and highest degree of global quality of life. In comparison patients with somatoform disorders (F45) showed the lowest degree of global quality of life. However, positive treatment effects regarding general symptom severity and health related quality of life could be observed regardless of the type of mental illness (diagnosis) of patients. In respect to the improvement of global functioning small differences in absolute treatment effects were detected depending on the type of diagnosis of patients. However, relative treatment effects in respect to global functioning were comparable for all types of diagnosis.

CONCLUSIONS

Improvements in the course of rehabilitative treatment regarding general symptom severity, quality of life and global functioning can be obtained independent of occupational status and type of mental illness of patients.

[Psychiatry and psychiatric patients : A study of the adherence after psychiatric inpatient treatment at the department of psychiatry and psychotherapy at the Clinicum Klagenfurt am Wörthersee.]

BACKGROUND

Based on the data of an analysis of costs of psychopharmacological treatment by the Austrian Rechnungshof in 2011, which also revealed remarkable differences between Salzburg and Carinthia (federal states of Austria), a panel of experts discussed the potential causes. A consequence was the following prospective study, which took place at the department of psychiatry and psychotherapy in Klagenfurt/Carinthia.

METHODS

The aim in this mirror design study was to analize the data of psychopharmacologic treatment, epidemiological data of the treated patients (N = 230) and utilization of healthcare ressources such as contacts to psychiatrists or practicioners after discharge.

RESULTS

We could show a high adherence concerning the redeem of the prescriptions, a low proportion of generics, and a very low rate of contacts to psychiatrists contrasting contacts to practitioners.

CONCLUSIONS

Beneath that in the sense of descriptive epidemiology the data help to characterize adherence behavior after discharge and details of in- and outdoor treatment.

[Comorbid somatic illnesses in psychiatric inpatients - an analysis of administrative data]

PURPOSE

This study intended to analyze the prevalence of physical diagnoses at psychiatric inpatient hospital wards.

METHODS

For this purpose we used partially aggregated administrative data from routine diagnostic documentation of Austrian hospitals. All psychiatric and physical main and secondary diagnoses according to ICD-10 of all psychiatric inpatient units in Austria of the years 2007 were used.

RESULTS

Of 79,027 psychiatric hospital admissions 75,224 received a psychiatric and 3803 a somatic main diagnosis at discharge. Diseases of the vascular system (20 %) were the most frequent somatic diagnoses, followed by endocrine and metabolic diseases (16.4 %) and neurological diseases (14.4 %). Among patients suffering from schizophrenia, the most frequent physical diagnoses were endocrine and metabolic diseases. Among those with affective disorders, vascular diseases as well as endocrine and metabolic diseases were found most often.

CONCLUSIONS

Physical diagnoses are very common among psychiatric inpatients. Mass screening and specialized prevention programs should be evaluated regarding their effectiveness for this population.