1
|
Lindkvist RM, Steen Carlsson K, Daukantaitė D, Flyckt L, Westling S. Brief admission by self-referral as an add-on to usual care for individuals with self-harm at risk of suicide: cost-effectiveness and 4-year health-economic consequences after a Swedish randomized controlled trial. Nord J Psychiatry 2024; 78:497-506. [PMID: 38875018 DOI: 10.1080/08039488.2024.2366854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 04/06/2024] [Accepted: 06/05/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Brief Admission by self-referral (BA) is a crisis-management intervention standardized for individuals with self-harm at risk of suicide. We analyzed its health-economic consequences. MATERIALS AND METHODS BA plus treatment as usual (TAU) was compared with TAU alone in a 12-month randomized controlled trial with 117 participants regarding costs for hospital admissions, coercive measures, emergency care and health outcomes (quality-adjusted life years; QALYs). Participants were followed from 12 months before baseline to up to five years after. RESULTS Over one year BA was associated with a mean annual cost reduction of 4800 or incremental cost of 4600 euros, depending on bed occupancy assumption. Cost-savings were greatest for individuals with >180 admission days in the year before baseline. In terms of health outcomes BA was associated with a QALY gain of 0.078. Uncertainty analyses indicated a significant QALY gain and ambiguity in costs, resulting in BA either dominating TAU or costing 59 000 euros per gained QALY. CONCLUSION BA is likely to produce QALY gains for individuals living with self-harm and suicidality. Cost-effectiveness depends on targeting high-need individuals and comparable bed utilization between BA and other psychiatric admissions. Future research should elaborate the explanatory factors for individual variations in the usage and benefit of BA.
Collapse
Affiliation(s)
- Rose-Marie Lindkvist
- Department of Clinical Sciences Malmö, Psychiatry, Faculty of Medicine, Lund University, Lund, Sweden
| | - Katarina Steen Carlsson
- Department of Clinical Sciences, Malmö, Health Economics, Lund University, Malmö, Lund, Sweden
| | | | - Lena Flyckt
- Centre for Psychiatric Research, Dept. of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden
| | - Sofie Westling
- Department of Clinical Sciences Malmö, Psychiatry, Faculty of Medicine, Lund University, Lund, Sweden, Office for Psychiatry and Habilitation, Psychiatric Clinic Lund, Malmö, Sweden
| |
Collapse
|
2
|
Eckerström J, Rosendahl I, Lindkvist RM, Amin R, Carlborg A, Flyckt L, Jayaram-Lindström N. Effects of Patient-Initiated Brief Admissions on Psychiatric Care Consumption in Borderline Personality Disorder: ARegister-Based Study. Int J Ment Health Nurs 2024. [PMID: 38855833 DOI: 10.1111/inm.13371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 05/08/2024] [Accepted: 05/19/2024] [Indexed: 06/11/2024]
Abstract
Previous studies have reported that patients with borderline personality disorder (BPD) often have negative experiences in psychiatric inpatient care. To address this issue, a novel intervention known as patient-initiated brief admission (PIBA) has been developed. PIBA offers a constructive approach to crisis management in situations of heightened anxiety, as well as during instances of self-harm and suicidal ideation. The intervention allows patients to directly contact the psychiatric ward to initiate a brief admission lasting 1-3 days. This easily accessible care option during a crisis has the potential to prevent harm to the patient and reduce the need for prolonged hospital stays. The aim of the present study is to investigate the effects of PIBA on psychiatric care consumption among patients diagnosed with BPD. This retrospective register-based study includes data from both inpatient and outpatient care registries for patients diagnosed with BPD. Data were extracted from the National Board of Health and Welfare in Sweden. The study period encompasses 2013-2020, with the PIBA intervention occurring between 2016 and 2019. The sample included 107 patients in the PIBA group and 5659 matched controls. Data were analysed using a difference-in-differences (DiD) approach through ordinary least squares (OLS) regression and ordinal logistic regression. Throughout the 3-year follow-up, both groups exhibited a reduction in the number of days of utilisation of psychiatric inpatient care services. The DiD analysis indicated an additional decrease of 1.5 days at the 6-month mark for the PIBA group (β = -1.436, SE = 1.531), expanding to 3 days fewer at the 12-month follow-up (β = -3.590, SE = 3.546), although not statistically significant. For outpatient care, the PIBA group displayed an increase in the number of visits, averaging to half a visit more every 6 months (β = 0.503, SE = 0.263) compared with the controls. Statistically significant differences were observed for two out of six measurements at the 12-month (β = 0.960, SE = 0.456) and 18-month follow-up period (β = 0.436, SE = 0.219). The PIBA group had a statistically significant lower odds of experiencing extended lengths of inpatient care days after the index date than the controls (OR 0.56, 95% CI: 0.44-0.72). In conclusion, PIBA was associated with a significant reduction in the length of individual hospital stays, but not in the overall number of inpatient care days. PIBA may be linked to a shift from longer inpatient care utilisation to outpatient care utilisation. These findings suggest that PIBA may reduce the risk of prolonged hospitalisations for patients who have access to the intervention. Future research should explore the impact of PIBA on healthcare costs and cost-effectiveness, both in relation to health care for the individual and cost-effectiveness in relation to recovery and health.
Collapse
Affiliation(s)
- Joachim Eckerström
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm, Sweden
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Ingvar Rosendahl
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm, Sweden
| | - Rose-Marie Lindkvist
- Department of Clinical Sciences Malmö, Psychiatry, Lund University, Lund, Sweden
| | - Ridwanul Amin
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Division of Infectious Diseases, Department of Medicine, Karolinska, Stockholm, Sweden
| | - Andreas Carlborg
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm, Sweden
| | - Lena Flyckt
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm, Sweden
| | - Nitya Jayaram-Lindström
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm, Sweden
| |
Collapse
|
3
|
Skjødt MK, Nicolaes J, Smith CD, Libanati C, Cooper C, Olsen KR, Abrahamsen B. Healthcare costs associated with opportunistically identifiable vertebral fractures. Bone 2023; 175:116831. [PMID: 37354964 DOI: 10.1016/j.bone.2023.116831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 06/13/2023] [Accepted: 06/17/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE Vertebral fractures (VFs) are often available on radiological imaging undertaken during daily clinical work, yet the healthcare cost burden of these opportunistically identifiable fractures has not previously been reported. In this study, we examine the direct healthcare costs of subjects with vertebral fractures available for identification on routine CT scans. METHODS Thoracolumbar vertebral fractures were identified from 2000 routine CT scans. Subjects with VF on the scan were matched 1:2 against subjects with no VF on the scan, and similarly in a 1:3-ratio against a general population cohort. We excluded those subjects who received treatment with osteoporosis medication(s) in the year prior to baseline. Direct healthcare costs, identified from the national Danish registers, were accrued over up to 6 years of follow-up, and reported per day at risk and per year. RESULTS In subjects undergoing a CT scan, costs were initially high, yet declined over time. Comparing subjects with prevalent vertebral fracture (n = 321) against those subjects with no vertebral fracture (n = 606), mean total healthcare costs per day at risk was numerically higher in the first three years after baseline, while healthcare costs per year were similar between the cohorts. No differences reached statistical significance. When compared to the general population cohort, costs were significantly higher in the vertebral fracture cohort. CONCLUSION Subjects with vertebral fractures available for identification on routine CT scans incur substantially higher healthcare costs than matched subjects representing the general population, and numerically, albeit non-significantly, higher healthcare costs per day at risk in the short term, as compared to subjects with no visible VF on the CT scan.
Collapse
Affiliation(s)
- Michael Kriegbaum Skjødt
- Department of Medicine, Holbæk Hospital, Smedelundsgade 60, DK-4300 Holbæk, Denmark; OPEN - Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, J. B. Winsløws Vej 9A, 3rd floor, DK-5000 Odense C, Denmark.
| | - Joeri Nicolaes
- UCB Pharma, Allée de la Recherche 60, 1070 Brussels, Belgium; Medical Image Computing, ESAT-PSI, Department of Electrical Engineering, KU Leuven, Kasteelpark Arenberg 10, Box 2441, 3001 Leuven, Belgium
| | - Christopher Dyer Smith
- OPEN - Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, J. B. Winsløws Vej 9A, 3rd floor, DK-5000 Odense C, Denmark
| | - Cesar Libanati
- UCB Pharma, Allée de la Recherche 60, 1070 Brussels, Belgium
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Center, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK; NDORMS, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Windmill Road, Headington, Oxford OX3 7HE, UK
| | - Kim Rose Olsen
- DaCHE, Institute of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9, 1st floor, DK-5000 Odense C, Denmark
| | - Bo Abrahamsen
- Department of Medicine, Holbæk Hospital, Smedelundsgade 60, DK-4300 Holbæk, Denmark; OPEN - Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, J. B. Winsløws Vej 9A, 3rd floor, DK-5000 Odense C, Denmark; NDORMS, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Windmill Road, Headington, Oxford OX3 7HE, UK
| |
Collapse
|
4
|
Smitmanis Lyle M, Allenius E, Salomonsson S, Björkdahl A, Strand M, Flyckt L, Hellner C, Lundgren T, Jayaram-Lindström N, Rozental A. What are the effects of implementing patient-controlled admissions in inpatient care? A study protocol of a large-scale implementation and naturalistic evaluation for adult and adolescent patients with severe psychiatric conditions throughout Region Stockholm. BMJ Open 2022; 12:e065770. [PMID: 35973700 PMCID: PMC9386218 DOI: 10.1136/bmjopen-2022-065770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Patient-controlled admissions (PCAs) represent a change in psychiatric inpatient care where patients are allowed to decide for themselves when hospitalisation might be required. Prior research has demonstrated that PCA increase the number of admissions, but decrease days in inpatient care, while both the admissions to and days in involuntary care decrease. However, investigations have been restricted to specific patient groups and have not examined other possible benefits, such as effects on symptoms, quality of life and autonomy. METHODS AND ANALYSIS This study explores the implementation process and effects of PCA in Region Stockholm, who is currently introducing PCA for all patients with severe psychiatric conditions and extensive healthcare utilisation. In total, the study comprises approximately 45 inpatient wards, including child and adolescent psychiatry. In a naturalistic evaluation, patients assigned PCA will be followed up to 36 months, both with regard to hospitalisation rates and self-reported outcomes. In addition, qualitative studies will explore the experiences of patients, caregivers of adolescents and healthcare providers. ETHICS AND DISSEMINATION Approval has been granted by the Swedish Ethical Review Authority (Dnr: 2020-06498). The findings from this study will be disseminated via publications in international peer-reviewed journals, at scientific conferences, as part of two doctoral theses, and through the Swedish Partnership for Mental Health. TRIAL REGISTRATION NUMBER NCT04862897.
Collapse
Affiliation(s)
- Maria Smitmanis Lyle
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm County Council, Stockholm Health Care Services, Stockholm, Sweden
| | - Emelie Allenius
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm County Council, Stockholm Health Care Services, Stockholm, Sweden
| | - Sigrid Salomonsson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm County Council, Stockholm Health Care Services, Stockholm, Sweden
| | - Anna Björkdahl
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm County Council, Stockholm Health Care Services, Stockholm, Sweden
| | - Mattias Strand
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm County Council, Stockholm Health Care Services, Stockholm, Sweden
| | - Lena Flyckt
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm County Council, Stockholm Health Care Services, Stockholm, Sweden
| | - Clara Hellner
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm County Council, Stockholm Health Care Services, Stockholm, Sweden
| | - Tobias Lundgren
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm County Council, Stockholm Health Care Services, Stockholm, Sweden
| | - Nitya Jayaram-Lindström
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm County Council, Stockholm Health Care Services, Stockholm, Sweden
| | - Alexander Rozental
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm County Council, Stockholm Health Care Services, Stockholm, Sweden
- Department of Psychology, Uppsala University, Uppsala, Sweden
| |
Collapse
|
5
|
Lindkvist RM, Westling S, Eberhard S, Johansson BA, Rask O, Landgren K. 'A Safe Place Where I Am Welcome to Unwind When I Choose to'-Experiences of Brief Admission by Self-Referral for Adolescents Who Self-Harm at Risk for Suicide: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:300. [PMID: 35010557 PMCID: PMC8751031 DOI: 10.3390/ijerph19010300] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 06/14/2023]
Abstract
Evidence is lacking on how to manage imminent suicidality in adolescents with self-harm. Brief Admission by Self-referral (BA) is a crisis-management intervention, developed for adults with self-harm at risk for suicide. Structured, individualized and based on responsible autonomy, BA aims to provide a respite while minimizing negative effects of hospitalization. This qualitative interview study illuminates adolescents' experiences of BA, adapted for this target group. Nineteen adolescents aged 14 to 19 years, described BA as helpful for timely rest and recovery to save themselves from impulses to self-harm. The individual contract, which is a prerequisite for access to BA, was perceived to give access to professional support in a safe environment, also among adolescents not using their contract. Being trusted with responsibility to self-admit was also hard work with struggles of self-doubt. Challenges included experiencing distrust from staff and fear of not being able to abstain from self-harm, which BA is conditioned upon. However, this condition was also perceived to induce self-motivation and growth. BA appeared well-adapted to the target group, fulfilling needs of predictability, autonomy, and opportunity for recovery to prevent self-harm. Suggestions for improvement included continually informing staff about important features of BA. To further evaluate benefits and challenges of BA, future research may evaluate clinical and health-economic outcomes and perspectives from parents and caregivers.
Collapse
Affiliation(s)
- Rose-Marie Lindkvist
- Department of Clinical Sciences Lund, Psychiatry, Lund University, 22100 Lund, Sweden; (S.W.); (S.E.); (B.A.J.); (O.R.)
| | - Sofie Westling
- Department of Clinical Sciences Lund, Psychiatry, Lund University, 22100 Lund, Sweden; (S.W.); (S.E.); (B.A.J.); (O.R.)
- Office of Psychiatry and Habilitation, Psychiatric Clinic Lund, Region Skåne, 22185 Lund, Sweden
- Office for Psychiatry and Habilitation, Psychiatry Research Skåne, Region Skåne, 22185 Lund, Sweden;
| | - Sophia Eberhard
- Department of Clinical Sciences Lund, Psychiatry, Lund University, 22100 Lund, Sweden; (S.W.); (S.E.); (B.A.J.); (O.R.)
- Psychiatry, Habilitation and Aid, Child and Adolescent Psychiatry, Regional Inpatient Care, Emergency Unit, Region Skåne, 20502 Malmö, Sweden
| | - Björn Axel Johansson
- Department of Clinical Sciences Lund, Psychiatry, Lund University, 22100 Lund, Sweden; (S.W.); (S.E.); (B.A.J.); (O.R.)
- Psychiatry, Habilitation and Aid, Child and Adolescent Psychiatry, Regional Inpatient Care, Emergency Unit, Region Skåne, 20502 Malmö, Sweden
| | - Olof Rask
- Department of Clinical Sciences Lund, Psychiatry, Lund University, 22100 Lund, Sweden; (S.W.); (S.E.); (B.A.J.); (O.R.)
- Psychiatry, Habilitation and Aid, Child and Adolescent Psychiatry, Regional Inpatient Care, Emergency Unit, Region Skåne, 20502 Malmö, Sweden
| | - Kajsa Landgren
- Office for Psychiatry and Habilitation, Psychiatry Research Skåne, Region Skåne, 22185 Lund, Sweden;
- Department of Health Sciences, Lund University, 22240 Lund, Sweden
| |
Collapse
|