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Carbonell-Aranda V, Herrera-Imbroda J, Moreno-Küstner B, Guzmán-Parra J. Gender differences and risk of readmission in hospitalizations with a diagnosis of psychotic spectrum disorders. Arch Womens Ment Health 2024; 27:731-735. [PMID: 38363368 DOI: 10.1007/s00737-024-01442-4] [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: 11/05/2023] [Accepted: 02/05/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Gender differences in psychosis are a topic that has been studied considering different aspects. Although some available evidence would point to a possible better prognosis in women, this claim is far from conclusively established. METHODS We propose an analysis of gender differences in the risk of readmission to an acute hospitalization unit, an indicator related to prognosis. RESULTS AND CONCLUSIONS We found that although the risk of readmission at 1 year is lower in women, this seems to be explained by other confounding factors.
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Affiliation(s)
- Vera Carbonell-Aranda
- Unidad de Gestión Clínica de Salud Mental, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), 29010, Malaga, Spain
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Facultad de Psicología, Universidad de Málaga, Andalucía Tech, Campus de Teatinos S/N, 29071, Malaga, Spain
| | - Jesús Herrera-Imbroda
- Unidad de Gestión Clínica de Salud Mental, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), 29010, Malaga, Spain.
- Departamento Farmacología y Pediatría, Facultad de Medicina, Universidad de Málaga, Andalucía Tech, Campus de Teatinos S/N, 29071, Malaga, Spain.
- Grupo de Neuropsicofarmacología, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), 29010, Malaga, Spain.
| | - Berta Moreno-Küstner
- Unidad de Gestión Clínica de Salud Mental, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), 29010, Malaga, Spain
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Facultad de Psicología, Universidad de Málaga, Andalucía Tech, Campus de Teatinos S/N, 29071, Malaga, Spain
| | - José Guzmán-Parra
- Unidad de Gestión Clínica de Salud Mental, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), 29010, Malaga, Spain
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Kane JM, Eshet R, Harary E, Tohami O, Elgart A, Knebel H, Sharon N, Suett M, Franzenburg KR, Davis GL, Correll CU. A Long-Term Safety and Tolerability Study of TV-46000 for Subcutaneous Use in Patients with Schizophrenia: A Phase 3, Randomized, Double-Blinded Clinical Trial. CNS Drugs 2024; 38:625-636. [PMID: 38954317 PMCID: PMC11258069 DOI: 10.1007/s40263-024-01102-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND TV-46000 is a long-acting subcutaneous antipsychotic (LASCA) formulation of risperidone that is approved by the United States Food and Drug Administration for the treatment of schizophrenia in adults. In the phase 3, randomized, double-blind RIsperidone Subcutaneous Extended-release (RISE) study, TV-46000 once monthly (q1m) and once every 2 months (q2m) significantly prolonged time to impending relapse compared with placebo [5.0-fold (q1m) and 2.7-fold (q2m)]. This phase 3, randomized, double-blind Safety in Humans of TV-46000 subcutaneous INjection Evaluation (SHINE) study was designed to evaluate the long-term safety, tolerability, and exposure of TV-46000 in schizophrenia. METHODS Patients who completed RISE without relapse (rollover) or who were newly recruited (de novo) were eligible for the SHINE study. Patients were initially stabilized on oral risperidone for 12 weeks (completed in RISE for rollover, or in SHINE for de novo). Patients in the de novo cohort and patients who received placebo in RISE were randomized 1:1 in SHINE to receive TV-46000 q1m or q2m for up to 56 weeks. Primary endpoint for SHINE was frequency of reported adverse events (AEs); event rates [ER; events per 100 patient-years (PYs)] were calculated for each AE by patients upon general questioning. RESULTS Overall, 336 patients were randomized in SHINE [TV-46000 q1m, n = 174; TV-46000 q2m, n = 162; of these, de novo, n = 109 and rollover, n = 227 (n = 172 patients were treated and n = 55 received placebo)]. A total of 334 patients were evaluated for safety [q1m, n = 172 (PY = 97.8); q2m, n = 162 (PY = 104.5)]. Proportions of patients (ER) with ≥ 1 AE and ≥ 1 treatment-related AE were 37% (180.0) and 21% (84.9) for TV-46000 q1m and 46% (157.9) and 20% (70.8) for TV-46000 q2m, respectively. Frequent treatment-related AEs [≥ 3% of patients in either group; proportion of patients (ER)] were injection site pain [q1m, 5% (24.5); q2m, 4% (22.0)] and injection site nodule [q1m, 2% (9.2); q2m, 6% (12.4)]. The proportions of patients with serious AEs was 5% for TV-46000 q1m and 7% for TV-46000 q2m; serious AEs reported for ≥ 2 patients overall were worsening schizophrenia [q1m, n = 1 (< 1%; ER, 1.02); q2m, n = 2 (1%; ER, 1.91)] and hyperglycemia [q1m, n = 1 (< 1%; ER, 1.02); q2m, n = 1 (< 1%; ER, 0.96)]. Of three reported deaths, none were related to treatment. Overall, eight patients discontinued treatment because of AEs. Similar or somewhat lower rates of AEs were reported for patients who rolled over from TV-46000 treatment compared with those who had no prior TV-46000 treatment (de novo and placebo rollover). Most AEs related to injection site reactions were mild; no patient had a severe reaction. CONCLUSION Results from this long-term safety study add to the favorable safety profiles of TV-46000 q1m and q2m, consistent with other formulations of risperidone and previous studies with TV-46000. REGISTRATION ClinicalTrials.gov, NCT03893825; 27 March 2019.
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Affiliation(s)
- John M Kane
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, 75-59 263rd St, Glen Oaks, NY, 11004, USA
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Feinstein Institutes for Medical Research, Institute of Behavioral Science, Manhasset, NY, USA
| | - Roy Eshet
- Innovative Medicines, Global Clinical Development, Teva Pharmaceutical Industries Ltd., Netanya, Israel
| | - Eran Harary
- Innovative Medicines, Global Clinical Development, Teva Pharmaceutical Industries Ltd., Netanya, Israel
| | - Orna Tohami
- Innovative Medicines, Global Clinical Development, Teva Pharmaceutical Industries Ltd., Netanya, Israel
| | - Anna Elgart
- Innovative Medicines, Global Clinical Development, Teva Pharmaceutical Industries Ltd., Netanya, Israel
| | - Helena Knebel
- Global Patient Safety and Pharmacovigilance, Teva Pharmaceutical Industries Ltd. , Netanya, Israel
| | - Nir Sharon
- Innovative Medicines, Global Clinical Development, Teva Pharmaceutical Industries Ltd., Netanya, Israel
| | - Mark Suett
- Global Medical Affairs, Teva UK Limited, Harlow, UK
| | - Kelli R Franzenburg
- Global Medical Affairs, Teva Branded Pharmaceutical Products R&D, Inc., West Chester, PA, USA
| | - Glen L Davis
- Global Clinical Operations, Teva Branded Pharmaceutical Products R&D, Inc., West Chester, PA, USA
| | - Christoph U Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, 75-59 263rd St, Glen Oaks, NY, 11004, USA.
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
- Feinstein Institutes for Medical Research, Institute of Behavioral Science, Manhasset, NY, USA.
- Department of Child and Adolescent Psychiatry, Charité - Universitätsmedizin Berlin, Berlin, Germany.
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Engels A, Konnopka C, Henken E, Härter M, König HH. A flexible approach to measure care coordination based on patient-sharing networks. BMC Med Res Methodol 2024; 24:1. [PMID: 38172777 PMCID: PMC10762822 DOI: 10.1186/s12874-023-02106-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/16/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Effective care coordination may increase clinical efficiency, but its measurement remains difficult. The established metric "care density" (CD) measures care coordination based on patient-sharing among physicians, but it may be too rigid to generalize across disorders and countries. Therefore, we propose an extension called fragmented care density (FCD), which allows varying weights for connections between different types of providers. We compare both metrics in their ability to predict hospitalizations due to schizophrenia. METHODS We conducted a longitudinal cohort study based on German claims data from 2014 through 2017 to predict quarterly hospital admissions. 21,016 patients with schizophrenia from the federal state Baden-Württemberg were included. CD and FCD were calculated based on patient-sharing networks. The weights of FCD were optimized to predict hospital admissions during the first year of a 24-month follow-up. Subsequently, we employed likelihood ratio tests to assess whether adding either CD or FCD improved a baseline model with control variables for the second follow-up year. RESULTS The inclusion of FCD significantly improved the baseline model, Χ2(1) = 53.30, p < 0.001. We found that patients with lower percentiles in FCD had an up to 21% lower hospitalization risk than those with median or higher values, whereas CD did not affect the risk. CONCLUSIONS FCD is an adaptive metric that can weight provider relationships based on their relevance for predicting any outcome. We used it to better understand which medical specialties need to be involved to reduce hospitalization risk for patients with schizophrenia. As FCD can be modified for different health conditions and systems, it is broadly applicable and might help to identify barriers and promoting factors for effective collaboration.
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Affiliation(s)
- Alexander Engels
- Department of Health Economics and Health Services Research, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Claudia Konnopka
- Department of Health Economics and Health Services Research, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Espen Henken
- Department of Health Economics and Health Services Research, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Mao W, Shalaby R, Owusu E, Elgendy H, Shalaby N, Agyapong B, Nichols A, Eboreime E, Nkire N, Agyapong VIO. Status after Hospital Discharge: An Observational Study of the Progression of Patients' Mental Health Symptoms Six Weeks after Hospital Discharge. J Clin Med 2023; 12:7559. [PMID: 38137628 PMCID: PMC10744019 DOI: 10.3390/jcm12247559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/03/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
(1) Background: Transitioning from mental health inpatient care to community care is often a vulnerable time in the treatment process where additional risks and anxiety may arise. We collected data for this study as part of a pragmatic cluster-randomized, longitudinal approach in Alberta. As the first phase of the ongoing innovative supportive program, this paper assessed the progression of mental health symptoms in patients six weeks after hospital discharge. Factors that may contribute to the presence or absence of anxiety and depression symptoms, as well as well-being, following return to the community were investigated. This provides evidence and baseline data for future phases of the project. (2) Methods: An observational study design was adopted for this study. Data on a variety of sociodemographic and clinical factors were collected at discharge and six weeks after via REDCap. Anxiety, depression, and well-being symptoms were assessed using the Generalized Anxiety Disorder (GAD-7) questionnaire, the Patient Health Questionnaire-9 (PHQ-9), and the World Health Organization-Five Well-Being Index (WHO-5), respectively. Descriptive, chi-square, independent t-tests, and multivariate regression analyses were conducted. (3) Result: The survey was completed by 88 out of 306 participants (28.8% response rate). The chi-square/Fisher exact test and independent t-test revealed no significant change in the mental health conditions from baseline to six weeks after discharge. It was found that the only significant factor predicting symptoms six weeks after discharge from inpatient treatment was the baseline symptoms in all three logistic regression models. It was four times more likely for those who experienced anxiety and depression at baseline to experience anxiety and depression symptoms six weeks after discharge (OR = 4.27; 95% CI: 1.38-13.20) (OR = 4.04; 95% CI: 1.25-13.05). Those with poor baseline well-being were almost 12 times more likely to experience poor well-being six weeks after discharge (OR = 11.75; 95% CI: 3.21-42.99). (4) Conclusions: Study results found no significant change in mental health conditions in the short term following hospital discharge. It is essential that researchers and policymakers collaborate in order to implement effective interventions to support and maintain the mental health conditions of patients following discharge.
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Affiliation(s)
- Wanying Mao
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada (N.N.)
| | - Reham Shalaby
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada (N.N.)
| | - Ernest Owusu
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada (N.N.)
| | - Hossam Elgendy
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada (N.N.)
| | - Nermin Shalaby
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada (N.N.)
| | - Belinda Agyapong
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada (N.N.)
| | - Angel Nichols
- Queen Elizabeth II Hospital, Alberta Health Services, Grande Prairie, AB T5J 3E4, Canada
| | - Ejemai Eboreime
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, 5909 Veterans Memorial Lane, 8th Floor, Abbie J. Lane Memorial Building, QEII Health Sciences Centre, Halifax, NS B3H 2E2, Canada;
| | - Nnamdi Nkire
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada (N.N.)
| | - Vincent I. O. Agyapong
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada (N.N.)
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, 5909 Veterans Memorial Lane, 8th Floor, Abbie J. Lane Memorial Building, QEII Health Sciences Centre, Halifax, NS B3H 2E2, Canada;
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Barliana MI, Ramdini DA, Afifah NN, Alfian SD, Sumiwi SA. Investigating the Effect of Adherence to Antipsychotic Therapy on the Length of Stay and Number of Hospitalizations in Patients with Schizophrenia - A Descriptive Analysis. Patient Prefer Adherence 2023; 17:2737-2747. [PMID: 37936717 PMCID: PMC10625877 DOI: 10.2147/ppa.s430083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/20/2023] [Indexed: 11/09/2023] Open
Abstract
Background Optimizing long-term outcomes in schizophrenia treatment requires effective pharmacological interventions. Medication adherence is known to influence clinical outcomes, yet there is a scarcity of studies examining its correlation with factors like Length of Stay (LOS) and re-hospitalization frequency. These outcomes are crucial indicators of how medication adherence affects overall patient well-being. Purpose This study aims to describe the effect of medication adherence on the length of stay (LOS) and number of hospitalizations in patients with schizophrenia. Patients and Methods A total of 157 subjects from the West Java Psychiatric Hospital were included in this cross-sectional retrospective study. Data, including demographics, comorbidities, duration of illness, antipsychotic adherence, LOS, and the number of hospitalizations, were collected from the patients' medical records. All the data were analyzed using the Chi-Square (χ²) test with a significance level set at p < 0.05. Results Our findings showed that 88% of all schizophrenia inpatients were in the nonadherence group. The highest (40.7%) LOS (>30 days) was found in the non-adherence group with discontinued therapy/stopped therapy group, while the highest percentage of patients with less than five hospitalizations was identified in the obedient and regular therapy group (94.4%). In the statistical results, we observed a significant association between therapy adherence (p = 0.043) and therapy regimen (p = 0.014) with gender. Additionally, the distinction between male and female schizophrenia patients demonstrated statistical significance (p = 0.000). Conclusion In this study, therapy adherence and therapy regimen were found to have a significant association with gender, as well as differences between the number of male and female schizophrenia patients that were statistically significant. While other variables may exhibit clinical associations, their statistical significance has not been fully depicted. The results of this study could be preliminary study for subsequent observational studies.
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Affiliation(s)
- Melisa Intan Barliana
- Department of Biological Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
- Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Dwi Aulia Ramdini
- Department of Pharmacy, Faculty of Medicine, Universitas Lampung, Bandar Lampung, Indonesia
| | - Nadiya Nurul Afifah
- Department of Biological Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Sofa Dewi Alfian
- Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Jatinangor, Indonesia
- Department of Pharmacology and Clinical Pharmacy Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Sri Adi Sumiwi
- Department of Pharmacology and Clinical Pharmacy Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
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Ma HJ, Zheng YC, Shao Y, Xie B. Status and clinical influencing factors of involuntary admission in chinese patients with schizophrenia. BMC Psychiatry 2022; 22:818. [PMID: 36544107 PMCID: PMC9769007 DOI: 10.1186/s12888-022-04480-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Though controversial for its various disadvantages, involuntary admission (IA) is necessary in providing mental health care for patients suffering from schizophrenia in China. This article examines the IA rate in a representative sample, and under which circumstances are these patients more likely to be admitted involuntarily. METHODS Adult patients consecutively admitted to two typical hospitals in Shanghai between 2013 and 2014 with a diagnosis of ICD-10 schizophrenia were included. 2167 patients were included in this study. Sociodemographic and clinical data, as well as personal information of psychiatrists who made risk assessment, were collected. The whole sample was divided into voluntary and involuntary admission groups. Group comparisons were performed with SPSS 17.0, using one-way ANOVA, Wilcoxon rank sum test, Chi-squares and Logistic regression. RESULTS Among 2167 inpatients, the majority (2003, 92.4%) were involuntarily admitted. Clinical features, including age of patients (p < 0.001, OR = 1.037), lacking of insight (p < 0.001, OR = 3.691), were statistically significant for IA. Psychiatrist's age (p < 0.001, OR = 1.042) was independently associated with IA. However, risk behaviors had dramatically affected patients' admission status, of which the strongest predictor of IA was noncompliance with treatment (p < 0.001, OR = 3.597). The areas under the curve of the ROC and accuracy for the regression model were 0.815 and 0.927, respectively. CONCLUSION IA patients account for a major proportion of all those hospitalized with schizophrenia in China. Insights and risk behaviors contributed the most reasons for admission status of patients. This research shed light on necessity of further qualitative studies learning detailed evaluation processes of IA and high-quality interventional studies aiming to limit the performance of IA among patients with schizophrenia.
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Affiliation(s)
- Hua-Jian Ma
- grid.16821.3c0000 0004 0368 8293Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 200030 Shanghai, P. R. China
| | - Yu-Chen Zheng
- grid.16821.3c0000 0004 0368 8293Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 200030 Shanghai, P. R. China
| | - Yang Shao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 200030, Shanghai, P. R. China.
| | - Bin Xie
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 200030, Shanghai, P. R. China.
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Owusu E, Oluwasina F, Nkire N, Lawal MA, Agyapong VIO. Readmission of Patients to Acute Psychiatric Hospitals: Influential Factors and Interventions to Reduce Psychiatric Readmission Rates. Healthcare (Basel) 2022; 10:healthcare10091808. [PMID: 36141418 PMCID: PMC9498532 DOI: 10.3390/healthcare10091808] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/24/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Appropriate and adequate treatment of psychiatric conditions in the community or at first presentation to the hospital may prevent rehospitalization. Information about hospital readmission factors may help to reduce readmission rates. This scoping review sought to examine the readmission of patients to acute psychiatric hospitals to determine predictors and interventions to reduce psychiatric readmission rates. Method: A scoping review was conducted in eleven bibliographic databases to identify the relevant peer-reviewed studies. Two reviewers independently assessed full-text articles, and a screening process was undertaken to identify studies for inclusion in the review. PRISMA checklist was adopted, and with the Covidence software, 75 articles were eligible for review. Data extraction was conducted, collated, summarized, and findings reported. Result: 75 articles were analyzed. The review shows that learning disabilities, developmental delays, alcohol, drug, and substance abuse, were crucial factors that increased the risk of readmission. Greater access to mental health services in residential treatment and improved crisis intervention in congregate care settings were indicated as factors that reduce the risk of readmission. Conclusion: High rates of readmission may adversely impact healthcare spending. This study suggests a need for focused health policies to address readmission factors and improve community-based care.
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Affiliation(s)
- Ernest Owusu
- Department of Psychiatry, University of Alberta, Edmonton, AB T6W 3W8, Canada
- Correspondence: ; Tel.: +1-780-710-2393
| | - Folajinmi Oluwasina
- Department of Psychiatry, University of Alberta, Edmonton, AB T6W 3W8, Canada
| | - Nnamdi Nkire
- Department of Psychiatry, University of Alberta, Edmonton, AB T6W 3W8, Canada
| | - Mobolaji A. Lawal
- Department of Psychiatry, University of Alberta, Edmonton, AB T6W 3W8, Canada
| | - Vincent I. O. Agyapong
- Department of Psychiatry, University of Alberta, Edmonton, AB T6W 3W8, Canada
- Department of Psychiatry, Dalhousie University, Halifax, NS B3H 4R2, Canada
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Portela R, Wainberg ML, Castel S, de Oliveira HN, Ruas CM. Risk factors associated with readmissions of patients with severe mental disorders under treatment with antipsychotics. BMC Psychiatry 2022; 22:189. [PMID: 35300649 PMCID: PMC8931964 DOI: 10.1186/s12888-022-03794-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to assess the risk of readmission in patients with severe mental disorders, compare it between patients using different types of antipsychotics and determine risk factors for psychiatric readmission. METHODS Medical records of a non-concurrent cohort of 625 patients with severe mental disorders (such as psychoses and severe mood disorders) who were first discharged from January to December 2012 (entry into the cohort), with longitudinal follow-up until December 2017 constitute the sample. Descriptive statistical analysis of characteristics of study sample was performed. The risk factors for readmission were assessed using Cox regression. RESULTS Males represented 51.5% of the cohort, and 75.6% of the patients had no partner. Most patients (89.9%) lived with relatives, and 64.7% did not complete elementary school. Only 17.1% used more than one antipsychotic, 34.2% did not adhere to the treatment, and 13.9% discontinued the medication due to unavailability in public pharmacies. There was a need to change the antipsychotic due to the lack of therapeutic response (11.2% of the patients) and adverse reactions to the antipsychotic (5.3% of the patients). Cox regression showed that the risk of readmission was increased by 25.0% (RR, 1.25; 95% CI, 1.03-1.52) when used typical antipsychotics, compared to those who used atypical ones, and by 92.0% (RR, 1.92; 95% CI, 1.63-2.27) when patients did not adhere to maintenance treatment compared to those who adhered. CONCLUSIONS Use of atypical antipsychotics and adherence to treatment were associated with a lower risk of psychiatric readmissions.
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Affiliation(s)
- Ronaldo Portela
- Faculty of Pharmacy, Social Pharmacy Department, UFMG, PPGMAF, Presidente Antônio Carlos, Av., 6627 - Pampulha CEP: 31270-901, Belo Horizonte MG, Brasil.
| | - Milton Leonard Wainberg
- grid.413734.60000 0000 8499 1112Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, USA
| | - Saulo Castel
- grid.17063.330000 0001 2157 2938Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Helian Nunes de Oliveira
- grid.8430.f0000 0001 2181 4888UFMG, Social and Preventive Medicine Department of Medical School, Belo Horizonte, Brazil
| | - Cristina Mariano Ruas
- grid.8430.f0000 0001 2181 4888Faculty of Pharmacy, Social Pharmacy Department, UFMG, PPGMAF, Presidente Antônio Carlos, Av., 6627 - Pampulha CEP: 31270-901, Belo Horizonte MG, Brasil
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Warner AR, Lavagnino L, Glazier S, Hamilton JE, Lane SD. Inpatient Early Intervention for Serious Mental Illnesses Is Associated With Fewer Rehospitalizations Compared With Treatment as Usual in a High-volume Public Psychiatric Hospital Setting. J Psychiatr Pract 2022; 28:24-35. [PMID: 34989342 DOI: 10.1097/pra.0000000000000596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE High-acuity publicly funded inpatient psychiatric settings usually feature short lengths of stay and high readmission rates. This study examined the influence of an early intervention program for serious mental illnesses (SMI) on readmissions at 6 and 12 months postdischarge at a high-volume, urban public inpatient psychiatric hospital. METHODS The Early Onset Treatment Program (EOTP) is a cost-free, 90-day inpatient multidisciplinary service intervention program for uninsured patients who are within 5 years of SMI onset, funded as a pilot program by the Texas state legislature. Rehospitalization rates at 6 and 12 months were extracted from electronic medical records for EOTP participants (n=165) and comparison patients matched on demographics and diagnosis (n=155). The comparison group received treatment as usual at the same psychiatric hospital. Group re-admission rates were compared using logistic and Poisson regression analyses. RESULTS Group membership was a significant predictor of rehospitalization (P<0.0001) at both 6 and 12 months. Expressed as 1/odds ratio (OR), the EOTP group was less likely to readmit once and more than once at 6 months postdischarge (1/OR=3.82 and 4.74, respectively) compared with the non-EOTP group. The EOTP group was also less likely to readmit once and more than once at 12 months postdischarge (1/OR=2.96 and 3.51, respectively). CONCLUSIONS The results suggest that participation in the EOTP service in this high-acuity setting was significantly related to reduced likelihood of rehospitalization at 6 and 12 months. Several variables may account for this observation, including length of stay, longer medication adherence, environmental stability, and more individualized and extensive psychotherapy treatment.
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Affiliation(s)
- Alia R Warner
- WARNER, LAVAGNINO, GLAZIER, HAMILTON, LANE: Louis A. Faillace, MD, Department of Psychiatry & Behavioral Sciences, UTHealth McGovern Medical School, UTHealth Harris County Psychiatric Center, University of Texas Health Science Center at Houston, Houston, TX
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Warner AR, Glazier S, Lavagnino L, Ruiz A, Hernandez S, Lane SD. Inpatient early intervention for serious mental illnesses and post-discharge criminal involvement in a high-volume psychiatric hospital setting. J Psychiatr Res 2021; 143:285-291. [PMID: 34530339 DOI: 10.1016/j.jpsychires.2021.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/28/2021] [Accepted: 09/01/2021] [Indexed: 12/01/2022]
Abstract
Individuals with serious mental illness (SMI) are at increased risk for arrest and incarceration relative to the same-community population without SMI. Publicly-funded inpatient psychiatric hospitals usually feature short lengths of stay and limited opportunities for extended services that might impact criminal justice involvement after discharge. This study examined the influence of an early intervention program for SMI at a high-volume public psychiatric hospital on involvement in the criminal justice system post-discharge. The Early Onset Treatment Program (EOTP) is an extended service intervention program for uninsured patients who are within 5 years of SMI onset. Criminal justice records (number of arrests with conviction, days of incarceration) were obtained for EOTP participants (n = 164) and comparison patients (n = 164) matched on demographics, diagnosis, and discharge date via propensity score matching. Data were zero-inflated and analyzed using hurdle models, controlling for prior arrests. The EOTP group was less likely to be convicted of at least one crime post-discharge (0 arrests vs. > 0, p < .001), and spent fewer days incarcerated (if incarcerated ≥1 day, p < .03). Participation in the EOTP service was linked to reduced likelihood of post-discharge arrest and days incarcerated. Several alternative variables may contribute to this preliminary observation, including length of stay, medication adherence, longer environmental stability, and individual patient characteristics.
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Affiliation(s)
- Alia R Warner
- Louis A. Faillace, MD, Department of Psychiatry & Behavioral Sciences, UTHealth McGovern Medical School UTHealth Harris County Psychiatric Center, University of Texas Health Science Center at Houston, Houston, 77054, TX, USA
| | - Stephen Glazier
- Louis A. Faillace, MD, Department of Psychiatry & Behavioral Sciences, UTHealth McGovern Medical School UTHealth Harris County Psychiatric Center, University of Texas Health Science Center at Houston, Houston, 77054, TX, USA
| | - Luca Lavagnino
- Louis A. Faillace, MD, Department of Psychiatry & Behavioral Sciences, UTHealth McGovern Medical School UTHealth Harris County Psychiatric Center, University of Texas Health Science Center at Houston, Houston, 77054, TX, USA
| | - Ana Ruiz
- Louis A. Faillace, MD, Department of Psychiatry & Behavioral Sciences, UTHealth McGovern Medical School UTHealth Harris County Psychiatric Center, University of Texas Health Science Center at Houston, Houston, 77054, TX, USA
| | - Sarah Hernandez
- Louis A. Faillace, MD, Department of Psychiatry & Behavioral Sciences, UTHealth McGovern Medical School UTHealth Harris County Psychiatric Center, University of Texas Health Science Center at Houston, Houston, 77054, TX, USA
| | - Scott D Lane
- Louis A. Faillace, MD, Department of Psychiatry & Behavioral Sciences, UTHealth McGovern Medical School UTHealth Harris County Psychiatric Center, University of Texas Health Science Center at Houston, Houston, 77054, TX, USA.
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11
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Smith TE, Haselden M, Corbeil T, Wall MM, Tang F, Essock SM, Frimpong E, Goldman ML, Mascayano F, Radigan M, Schneider M, Wang R, Dixon LB, Olfson M. Factors Associated With Discharge Planning Practices for Patients Receiving Inpatient Psychiatric Care. Psychiatr Serv 2021; 72:498-506. [PMID: 33657838 PMCID: PMC8102313 DOI: 10.1176/appi.ps.202000021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study examined associations of patient, hospital, and service system factors with provision of discharge planning to individuals treated in hospital psychiatric units. METHODS This retrospective cohort analysis used 2012-2013 New York State Medicaid claims data of 18,185 patients ages <65 years who were treated in hospital psychiatric units and discharged to the community. The claims data were linked to data from managed behavioral health care organizations indicating whether inpatient staff scheduled a follow-up outpatient appointment with a mental health provider. Additional data regarding hospital and service system characteristics were obtained from the American Hospital Association Annual Survey, the Area Health Resource File, and other state administrative databases. Rates and adjusted odds ratios were assessed for the likelihood of inpatient staff scheduling a follow-up appointment. RESULTS Inpatient staff scheduled outpatient appointments for 79.8% of discharges. The adjusted odds of not having an outpatient appointment scheduled as part of the patient's discharge plan were significantly associated with several factors, including being homeless on admission, having a diagnosis of a co-occurring substance use disorder, having high levels of medical comorbid conditions, and not being engaged in psychiatric outpatient services in the month prior to admission. CONCLUSIONS Patient characteristics were more strongly associated with failure to receive discharge planning than were hospital and service system characteristics.
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Affiliation(s)
- Thomas E Smith
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Morgan Haselden
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Tom Corbeil
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Melanie M Wall
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Fei Tang
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Susan M Essock
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Eric Frimpong
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Matthew L Goldman
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Franco Mascayano
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Marleen Radigan
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Matthew Schneider
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Rui Wang
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Lisa B Dixon
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Mark Olfson
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
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12
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Park S, Park S, Lee YJ, Park CS, Jung YC, Kim S. Nurse Staffing and Health Outcomes of Psychiatric Inpatients: A Secondary Analysis of National Health Insurance Claims Data. J Korean Acad Nurs 2021; 50:333-348. [PMID: 32632069 DOI: 10.4040/jkan.19203] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 01/29/2023]
Abstract
PURPOSE The present study investigated the association between nurse staffing and health outcomes among psychiatric inpatients in Korea by assessing National Health Insurance claims data. METHODS The dataset included 70,136 patients aged 19 years who were inpatients in psychiatric wards for at least two days in 2016 and treated for mental and behavioral disorders due to use of alcohol; schizophrenia, schizotypal and delusional disorders; and mood disorders across 453 hospitals. Nurse staffing levels were measured in three ways: registered nurse-to-inpatient ratio, registered nurse-to-adjusted inpatient ratio, and nursing staff-to-adjusted inpatient ratio. Patient outcomes included length of stay, readmission within 30 days, psychiatric emergency treatment, use of injected psycholeptics for chemical restraint, and hypnotics use. Relationships between nurse staffing levels and patient outcomes were analyzed considering both patient and system characteristics using multilevel modeling. RESULTS Multilevel analyses revealed that more inpatients per registered nurse, adjusted inpatients per registered nurse, and adjusted inpatients per nursing staff were associated with longer lengths of stay as well as a higher risk of readmission. More adjusted inpatients per registered nurse and adjusted inpatients per nursing staff were also associated with increased hypnotics use but a lower risk of psychiatric emergency treatment. Nurse staffing levels were not significantly associated with the use of injected psycholeptics for chemical restraint. CONCLUSION Lower nurse staffing levels are associated with negative health outcomes of psychiatric inpatients. Policies for improving nurse staffing toward an optimal level should be enacted to facilitate better outcomes for psychiatric inpatients in Korea.
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Affiliation(s)
- Suin Park
- College of Nursing, Kosin University, Busan, Korea
| | - Sohee Park
- Department of Biostatistics, Graduate School of Public Health, Yonsei University, Seoul, Korea
| | - Young Joo Lee
- College of Nursing, Daegu Catholic University, Daegu, Korea.,Research Institute of Nursing Science, Daegu Catholic University, Daegu, Korea
| | - Choon Seon Park
- Department of Quality Assessment Administration, Health Insurance Review and Assessment Service, Wonju, Korea
| | - Young Chul Jung
- Department of Psychiatry, College of Medicine, Yonsei University, Seoul, Korea.,Institute of Behavioral Science in Medicine, College of Medicine, Yonsei University, Seoul, Korea
| | - Sunah Kim
- College of Nursing, Yonsei University, Seoul, Korea.,Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Korea.
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13
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Budnick A, Kuhnert R, Schmidt H, Wienprecht L, Kuhlmey A, Blüher S. Sekundärdatenanalyse initial vollstationär behandelter Patienten mit Schizophrenie in einem Berliner Modellprojekt (nach § 64b SGB V). DAS GESUNDHEITSWESEN 2021; 83:936-945. [DOI: 10.1055/a-1305-9991] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Zusammenfassung
Ziel der Studie Schizophrenie zählt zu den schwersten psychiatrischen Erkrankungen. Das deutsche Versorgungssystem weist jedoch für diese und andere chronisch psychisch Erkrankte mit einem intensiven Behandlungsbedarf nach wie vor Lücken auf. Der vorliegende Beitrag fokussiert die Veränderung der Versorgung von initial vollstationär behandelten Patienten mit Schizophrenie, die an den St. Hedwig Kliniken in Berlin in einem Modellprojekt nach § 64b SGB V versorgt werden, im Vergleich zu Patienten in der Regelversorgung.
Methodik Die Zielgrößen wurden mittels Routinedaten erfasst. Dabei wurden 3 Patientenkohorten analysiert. Mittels Propensity Score Matching wurde je Kohorte eine Vergleichsgruppe gebildet.
Ergebnisse Es zeigt sich, dass im Modellprojekt die Anzahl der Krankenhausaufenthalte reduziert wurde, die Gesamtverweildauer gesenkt und Gesamtkosten teilweise gesenkt wurden. Zudem verlängerte sich die Dauer bis zur nächsten Rehospitalisierung, während sich die Gesamtzahl der Kontakte zum ambulanten Sektor erhöhte.
Schlussfolgerung Die angestrebte Verlagerung der Versorgung in den ambulanten Bereich wurde für Patienten mit Schizophrenie in diesem Modellprojekt erreicht.
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Affiliation(s)
- Andrea Budnick
- Institut für Medizinische Soziologie und Rehabilitationswissenschaft,Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Ronny Kuhnert
- Institut für Medizinische Soziologie und Rehabilitationswissenschaft,Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Helen Schmidt
- Institut für Medizinische Soziologie und Rehabilitationswissenschaft,Charité Universitätsmedizin Berlin, Berlin, Deutschland
- Translational Neuromodeling Unit, Institut für Biomedizinische Technik, Universität und ETH Zürich, Zürich, Schweiz
| | - Lars Wienprecht
- Stationäre Versorgung / Rehabilitation / Regress, BARMER, Berlin, Deutschland
| | - Adelheid Kuhlmey
- Institut für Medizinische Soziologie und Rehabilitationswissenschaft,Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Stefan Blüher
- Institut für Medizinische Soziologie und Rehabilitationswissenschaft,Charité Universitätsmedizin Berlin, Berlin, Deutschland
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14
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Berardelli I, Rogante E, Sarubbi S, Erbuto D, Lester D, Pompili M. The Importance of Suicide Risk Formulation in Schizophrenia. Front Psychiatry 2021; 12:779684. [PMID: 34975579 PMCID: PMC8716825 DOI: 10.3389/fpsyt.2021.779684] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 11/02/2021] [Indexed: 12/31/2022] Open
Abstract
Suicide is a cause of early mortality in nearly 5% of patients with schizophrenia, and 25-50% of patients with schizophrenia attempt suicide in their lifetime. Evidence points to numerous individual, clinical, social, and psychological risk factors for suicide in patients with schizophrenia. Although recognizing suicidal risk factors in schizophrenia is extremely important in suicidal risk assessment, we have recently witnessed a change in suicide risk management that shifts the focus from suicide risk assessment to suicide risk formulation. Suicide risk formulation is dependent on the data gathered in the suicide risk assessment and assigns a level of suicide risk that is indispensable for the choice of treatment and the management of patients with a high suicidal risk. In this article, we extend the suicide risk formulation model to patients with schizophrenia. Suicide risk formulation results from four different areas that help clinicians collect as much information as possible for the management of suicidal risk. The four distinct judgments comprise risk status (the risk relating to the specific group to which the patient belongs), risk state (the risk for the person compared with his baseline or another reference point in the course of his life), available resources (on whom the person can count during a crisis) and foreseeable events (which can exacerbate the crisis). In schizophrenia, the suicide risk formulation model allows the clinician to evaluate in depth the clinical context of the patient, the patient's own history and patient-specific opportunities for better choosing and applying suicide prevention strategies.
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Affiliation(s)
- Isabella Berardelli
- Department of Neurosciences, Mental Health, and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Centre, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Elena Rogante
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Salvatore Sarubbi
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Denise Erbuto
- Department of Neurosciences, Mental Health, and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Centre, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - David Lester
- Psychology Program, Stockton University, Galloway, NJ, United States
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health, and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Centre, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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Abdullah-Koolmees H, Nawzad S, Egberts TCG, Vuyk J, Gardarsdottir H, Heerdink ER. The effect of non-adherence to antipsychotic treatment on rehospitalization in patients with psychotic disorders. Ther Adv Psychopharmacol 2021; 11:20451253211027449. [PMID: 34262690 PMCID: PMC8246479 DOI: 10.1177/20451253211027449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/05/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND AIMS Many patients with psychotic disorders are non-adherent to antipsychotic (AP) medication(s), potentially contributing to rehospitalization. It is unknown whether non-adherence in different phases of AP use is associated with rehospitalization. The aim of this study was to assess the association between non-adherence to APs and rehospitalization in patients with psychotic disorders. Non-adherence was assessed specifically for the initiation, continued drug use and early discontinuation of AP use. METHODS A retrospective follow-up study was performed. Adult patients were included at discharge if they suffered from schizophrenia, psychotic, or bipolar I disorder; had been hospitalized in a psychiatric hospital for ⩾7 days; and were treated with oral APs. Patients discharged between January 2006 and December 2009 from Altrecht Mental Health Care were included. Non-adherence was studied in the three phases of medication use: initiation, continued drug use (implementation) and (early) discontinuation after discharge until the end of follow up or until patients were rehospitalized. Cox regression analysis was used to assess the strength of the association between non-adherence for the different phases of AP use and rehospitalization during follow up and expressed as relative risk (RR) with 95% confidence intervals (CI). RESULTS A total of 417 patients were included. Patients who did not initiate their APs compared with those who did in the first month (RR = 1.62, 95% CI: 1.19-2.19) and between the first and third month after discharge (RR = 1.70, 95% CI: 1.04-2.79) had the highest risk for rehospitalization during follow up. Overall, patients who did not initiate their AP medication within the first year after discharge had a RR of 2.70 (95% CI: 1.97-3.68) for rehospitalization during follow up compared with those that initiated their AP. CONCLUSION Not initiating APs right after discharge was associated with an increased risk of rehospitalization. Interventions should aim to promote the initiation of APs soon after discharge to minimize the risk of rehospitalization.
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Affiliation(s)
- H Abdullah-Koolmees
- Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Postbus 85500, Utrecht 3508 GA, The Netherlands
| | - S Nawzad
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - T C G Egberts
- Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - J Vuyk
- Division of Willem Arntsz, Altrecht Institute for Mental Health Care, Utrecht, The Netherlands
| | - H Gardarsdottir
- Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - E R Heerdink
- Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
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Strålin P, Skott M, Cullberg J. Early predictors for late hospitalizations up to 14 years after first episode psychosis. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1371-1380. [PMID: 33263822 PMCID: PMC8316245 DOI: 10.1007/s00127-020-01991-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 11/10/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE New hospitalizations after first episode psychosis (FEP) may be viewed as an indicator of instability in a psychotic disorder. In the current study we wanted to analyse long term risk for psychosis hospitalizations after FEP. We also wanted to analyse predictors for late hospitalizations, with focus on early antipsychotic medication. METHODS First episode psychosis cases were recruited to the Swedish Parachute project in 1996-1997. The program offered highly available and continuous psychosocial support and a cautious use of antipsychotic medication for 5 years from inclusion. Longitudinal data from population registers on psychiatric hospitalizations up to 14 years after inclusion were analysed. One hundred and sixty-one cases were included of the original 175 in the project. Associations with possible early predictive factors from the original project data were analysed with COX regression. RESULTS A majority of the cases (67%) had hospitalizations in the first year after inclusion in the study. The cohort then diverged into a group (46%) with new hospitalizations for psychosis after the first year, most of them multiple times, and another group (54%) without new hospitalizations for psychosis, many without any late antipsychotic medication. Forty-two percentage of the cases had antipsychotic medication by month 12, and it was significantly associated with later psychosis hospitalizations (HR = 2.5, p value < 0.001). CONCLUSIONS The study demonstrates that a large part of FEP cases have a good outcome as measured by absence of new hospitalizations for psychosis, and that many cases may terminate antipsychotic medication within a year of FEP onset without later relapses needing hospitalizations.
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Affiliation(s)
- Pontus Strålin
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Maria Skott
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
| | - Johan Cullberg
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
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17
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Can Empathy Improve Therapeutic Adherence in Schizophrenia? J Clin Psychopharmacol 2020; 40:89-90. [PMID: 31804453 DOI: 10.1097/jcp.0000000000001161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Medication Use and Health Care Utilization After a Cost-sharing Increase in Schizophrenia: A Nationwide Analysis. Med Care 2020; 58:763-769. [PMID: 32732784 PMCID: PMC7497420 DOI: 10.1097/mlr.0000000000001369] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Increases in prescription drug cost-sharing may decrease adherence to treatment among persons with schizophrenia and lead to discontinuation of use and an increased risk of hospitalization. OBJECTIVE The objective of this study was to investigate the impact of new deductible and increased drug copayments implemented on antipsychotic and other drug purchases and on rates of hospitalizations and primary care contacts among persons with schizophrenia in Finland. RESEARCH DESIGN Interrupted time series analysis. SUBJECTS All persons with schizophrenia in Finland who were alive at the beginning of 2015 (N=41,017). MEASURES We measured the rates of antipsychotic, other psychotropic and cardiometabolic drug purchasers, hospitalizations, and primary care contacts during 2015 and 2016 with data collected from several nationwide health care registers. RESULTS During 2016, the proportion of antipsychotic purchasers decreased by -0.26 percentage points per month [95% confidence interval (CI): -0.47 to -0.05] compared with 2015. The trend of other psychotropic purchasers decreased to -0.13 percentage points per month in 2016 (95% CI: -0.22 to -0.04) compared with 2015 and cardiometabolic drug purchases to -0.17 percentage points per month (95% CI: -0.29 to -0.05) compared with 2015. The decreasing trend of psychiatric hospitalizations in 2015 halted in 2016. There were no other significant differences in health care utilization. CONCLUSIONS In our nationwide time-series analysis, we observed decreases in the slopes of antipsychotic and other drug purchases of persons with schizophrenia after prescription drug cost-sharing increase implementation on January 1, 2016. Policymakers need to be aware of the unintended consequences of increasing cost-sharing among people with severe mental disorders.
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Psychometric evaluation of the illness perception questionnaire for schizophrenia in a Chinese population. Asian J Psychiatr 2020; 50:101972. [PMID: 32109801 DOI: 10.1016/j.ajp.2020.101972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 01/17/2020] [Accepted: 02/09/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Illness perceptions have been associated with patients' reactions to health threats and further health outcomes. The Illness Perception Questionnaire for Schizophrenia (IPQS)1 has been applied in different contexts. However, the validity and reliability of IPQS remain unknown in mainland China. AIMS AND OBJECTIVES To test the psychometric properties of the Chinese version of IPQS in mainland China. DESIGN A cross-sectional survey. METHODS A total of 200 community-dwelling patients with schizophrenia were surveyed in Beijing, China. The validity and reliability of the instrument were tested. As well as demographic data, the IPQS and the Knowledge About Schizophrenia Test (KAST)2 were also administered. RESULTS Factor analysis was utilised to refine the factor structure of the IPQS. The difference between IPQS and KAST denoted the discriminant validity. The subscale scores among patients of different illness duration, educational attainment, and medication adherence in the past two years were significantly different (P<0.05), indicating the known-group validity of the IPQS. Except for 'personal control' and 'burdensome effect', other subscales were internally consistent. Most of the subscales proved stable over a four-week period. CONCLUSION The Chinese version of IPQS can be used, with some refinements, to assess illness perceptions about schizophrenia for patients in future studies. This will provide empirical evidence for its generalizability and clinical utility and provide deeper insight into Chinese patients' illness perceptions about schizophrenia.
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Shimada T, Ohori M, Inagaki Y, Shimooka Y, Ishihara I, Sugimura N, Tanaka S, Kobayashi M. Effect of adding individualized occupational therapy to standard care on rehospitalization of patients with schizophrenia: A 2-year prospective cohort study. Psychiatry Clin Neurosci 2019; 73:476-485. [PMID: 31077519 DOI: 10.1111/pcn.12858] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 04/25/2019] [Accepted: 04/30/2019] [Indexed: 12/11/2022]
Abstract
AIM We examined the effect of individualized occupational therapy (IOT) compared to the usual group occupational therapy (GOT) on the rehospitalization of patients with schizophrenia. METHODS A prospective cohort study included patients with schizophrenia who were discharged within 1 year from a psychiatric hospital. Time to rehospitalization by treatment group (GOT + IOT or GOT-alone) was evaluated with Kaplan-Meier survival analysis. The impact of demographics and clinical factors associated with rehospitalization was investigated using Cox proportional hazards models. RESULTS Of the 111 patients who met the criteria, 54 were in the GOT + IOT group and 57 in the GOT-alone group. Over the 2 years from discharge, the overall rehospitalization rate was 51.376% (56 patients); the GOT + IOT group demonstrated a significantly lower rehospitalization rate with 16 patients rehospitalized compared to 40 patients from the GOT-alone group. Time to rehospitalization was significantly longer for the GOT + IOT group compared to those in the GOT-alone group (P < 0.001). The multivariate Cox proportional hazards models showed that type of occupational therapy (hazard ratio [HR] = 0.543), medication adherence (HR = 0.343), access to resident support persons (HR = 0.450), and executive function at discharge (HR = 0.740) were all significantly associated with rehospitalization. CONCLUSION Our results provide support for the prolonging effects of IOT in relation to rehospitalization and the reduction of rehospitalization risk compared to patients with schizophrenia who receive GOT alone, in addition to supporting good cognition at discharge and favorable medication adherence.
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Affiliation(s)
- Takeshi Shimada
- Department of Health Sciences, Graduate School of Medicine, Shinshu University, Nagano, Japan.,Medical Corporation Seitaikai Mental Support Soyokaze Hospital, Nagano, Japan
| | - Manami Ohori
- North Alps Medical Center Azumi Hospital, Nagano, Japan
| | - Yusuke Inagaki
- Nagano Prefectural Mental Wellness Center Komagane, Nagano, Japan
| | - Yuko Shimooka
- Social Medical Corporation Ritsuzankai Iida Hospital, Nagano, Japan
| | - Ikuyo Ishihara
- Medical Corporation Aiseikai Matsuoka Hospital, Nagano, Japan
| | - Naoya Sugimura
- Medical Corporation Akitsukai Nanshin Hospital, Nagano, Japan
| | - Sachie Tanaka
- Department of Health Sciences, Graduate School of Medicine, Shinshu University, Nagano, Japan
| | - Masayoshi Kobayashi
- Department of Health Sciences, Graduate School of Medicine, Shinshu University, Nagano, Japan
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22
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Strålin P, Hetta J. Medication, hospitalizations and mortality in 5 years after first-episode psychosis in a Swedish nation-wide cohort. Early Interv Psychiatry 2019; 13:902-907. [PMID: 29888512 DOI: 10.1111/eip.12697] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 03/03/2018] [Accepted: 05/16/2018] [Indexed: 12/13/2022]
Abstract
AIM To investigate medication, rehospitalizations and mortality after first-episode hospital-treated psychosis. METHODS A population-based nation-wide cohort (n = 2488) with a first hospitalization for psychosis at ages between 16 and 25 was identified. Cases were followed for up to 5 years after the first psychosis hospitalization with regard to mortality, hospitalizations and dispensations of antipsychotics and benzodiazepines. RESULTS The proportion of patients dispensing antipsychotics decreased from 80% year 1 after first discharge to 55% year 5. The proportion of patients having episodes of inpatient care also decreased year by year from 46% year 1 to 27% year 5. Of 863 cases with 5 years of observation time 41% had dispensations of antipsychotics every year; 21% had no dispensation of antipsychotics or hospitalization after the first year. The cumulative 5-year mortality was 3.9%. Cumulative suicide mortality was 2.4%. Incidence of suicide was highest in the first year. Male gender, benzodiazepines, recent hospital-discharge and self-harm were identified as risk factors for suicide. CONCLUSIONS The proportion of cases dispensing antipsychotics decreases year by year after first discharge. Mortality and rates of rehospitalization also decrease year by year from high levels the first year.
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Affiliation(s)
- Pontus Strålin
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Jerker Hetta
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
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23
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Robinson DG, Schooler NR, Rosenheck RA, Lin H, Sint KJ, Marcy P, Kane JM. Predictors of Hospitalization of Individuals With First-Episode Psychosis: Data From a 2-Year Follow-Up of the RAISE-ETP. Psychiatr Serv 2019; 70:569-577. [PMID: 31084291 PMCID: PMC6602852 DOI: 10.1176/appi.ps.201800511] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Despite treatment advances in other domains, inpatient psychiatric hospitalization rates for individuals with first-episode psychosis remain high. Even with early intervention services, a third or more of individuals are hospitalized over the first 2 years of treatment. Reducing hospitalization is desirable from the individual's perspective and for public health reasons because hospitalization costs are a major component of treatment costs. METHODS Univariate and multivariate baseline and time-varying covariate analyses were conducted to identify predictors of hospitalization in the Recovery After an Initial Schizophrenia Episode-Early Treatment Program (RAISE-ETP) study, a 2-year cluster randomized trial for participants experiencing a first episode of psychosis who were outpatients at study entry. The trial compared an early intervention treatment model (NAVIGATE) with usual community care at 34 clinics across the United States. RESULTS RAISE-ETP enrolled 404 participants of whom 382 had one or more postbaseline assessments that included hospitalization data. Thirty-four percent of NAVIGATE and 37% of usual-care participants were hospitalized during the trial. Risk analyses revealed significant predictors of hospitalization to be the number of hospitalizations before study entry; duration of untreated psychosis; and time-varying days of substance misuse, presence of positive symptoms, and beliefs about the value of medication. CONCLUSIONS These results indicate that hospital use may be decreased by reducing the duration of untreated psychosis and prior hospitalizations, minimizing residual symptoms, preventing substance misuse, and facilitating adherence to medication taking. Addressing these factors could enhance the impact of first-episode early intervention treatment models and also enhance outcomes of people with first-episode psychosis treated using other models.
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Affiliation(s)
- Delbert G Robinson
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, Feinstein Institute for Medical Research, Manhasset, New York (Robinson, Kane); Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, New York (Schooler); Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (Rosenheck); Yale School of Public Health, New Haven (Lin, Sint); Vanguard Research Group, Glen Oaks, New York (Marcy)
| | - Nina R Schooler
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, Feinstein Institute for Medical Research, Manhasset, New York (Robinson, Kane); Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, New York (Schooler); Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (Rosenheck); Yale School of Public Health, New Haven (Lin, Sint); Vanguard Research Group, Glen Oaks, New York (Marcy)
| | - Robert A Rosenheck
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, Feinstein Institute for Medical Research, Manhasset, New York (Robinson, Kane); Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, New York (Schooler); Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (Rosenheck); Yale School of Public Health, New Haven (Lin, Sint); Vanguard Research Group, Glen Oaks, New York (Marcy)
| | - Haiqun Lin
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, Feinstein Institute for Medical Research, Manhasset, New York (Robinson, Kane); Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, New York (Schooler); Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (Rosenheck); Yale School of Public Health, New Haven (Lin, Sint); Vanguard Research Group, Glen Oaks, New York (Marcy)
| | - Kyaw J Sint
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, Feinstein Institute for Medical Research, Manhasset, New York (Robinson, Kane); Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, New York (Schooler); Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (Rosenheck); Yale School of Public Health, New Haven (Lin, Sint); Vanguard Research Group, Glen Oaks, New York (Marcy)
| | - Patricia Marcy
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, Feinstein Institute for Medical Research, Manhasset, New York (Robinson, Kane); Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, New York (Schooler); Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (Rosenheck); Yale School of Public Health, New Haven (Lin, Sint); Vanguard Research Group, Glen Oaks, New York (Marcy)
| | - John M Kane
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, Feinstein Institute for Medical Research, Manhasset, New York (Robinson, Kane); Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, New York (Schooler); Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (Rosenheck); Yale School of Public Health, New Haven (Lin, Sint); Vanguard Research Group, Glen Oaks, New York (Marcy)
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Abdullah-Koolmees H, Gardarsdottir H, Minnema LA, Elmi K, Stoker LJ, Vuyk J, Goedhard LE, Egberts TCG, Heerdink ER. Predicting rehospitalization in patients treated with antipsychotics: a prospective observational study. Ther Adv Psychopharmacol 2018; 8:213-229. [PMID: 30065813 PMCID: PMC6058452 DOI: 10.1177/2045125318762373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 01/22/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Prediction of rehospitalization in patients treated with antipsychotics is important for identifying patients in need of additional support to prevent hospitalization. Our aim was to identify factors that predict rehospitalization in patients treated with antipsychotics at discharge from a psychiatric hospital. METHODS Adult patients suffering from schizophrenia, psychotic or bipolar I disorders who had been hospitalized in a psychiatric hospital for ⩾7 days and were treated with oral antipsychotics at discharge were included. The main outcome was rehospitalization within 6 months after discharge. A prediction model for rehospitalization was constructed including: patient/disease and medication characteristics, patients' beliefs about medicines, and healthcare-professional-rated assessment for all patients. The patients were stratified by diagnosis (schizophrenia and nonschizophrenia). Area under the receiver operating characteristic curve (AUCROC) was also assessed. RESULTS A total of 87 patients were included and 33.3% of them were rehospitalized within 6 months after discharge. The variables that predicted rehospitalization were duration of hospitalization, patients' attitude towards medicine use, and healthcare-professional-rated assessment with an AUCROC of 0.82. Rehospitalization for patients with schizophrenia could be predicted (AUCROC = 0.71) by the Global Assessment of Functioning score, age, and harm score. Rehospitalization was predicted (AUCROC = 0.73) for nonschizophrenia patients with, for example rehospitalization predicted by the nurse. CONCLUSIONS Rehospitalization was predicted by a combination of variables from the patient/disease and medication characteristics, patients' attitude towards medicine use, and healthcare-professional-rated assessment. These variables can be assessed relatively easily at discharge to predict rehospitalization within 6 months.
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Affiliation(s)
- Heshu Abdullah-Koolmees
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, The Netherlands
| | - Helga Gardarsdottir
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, The Netherlands
| | - Lotte A Minnema
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, The Netherlands
| | - Kamjar Elmi
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, The Netherlands
| | - Lennart J Stoker
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, The Netherlands
| | - Judith Vuyk
- Altrecht Mental Health Care, Utrecht, The Netherlands
| | | | - Toine C G Egberts
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, The Netherlands
| | - Eibert R Heerdink
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, The Netherlands
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Huang XF, Weston-Green K, Yu Y. Decreased 5-HT2cR and GHSR1a interaction in antipsychotic drug-induced obesity. Obes Rev 2018; 19:396-405. [PMID: 29119689 DOI: 10.1111/obr.12638] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 09/20/2017] [Accepted: 10/01/2017] [Indexed: 12/19/2022]
Abstract
Second generation antipsychotics (SGAs), notably atypical antipsychotics including olanzapine, clozapine and risperidone, can cause weight gain and obesity side effects. Antagonism of serotonin 2c receptors (5-HT2cR) and activation of ghrelin receptor type 1a (GHSR1a) signalling have been identified as a main cause of SGA induced obesity. Here we review the pivotal regulatory role of the 5-HT2cR in ghrelin-mediated appetite signalling. The 5-HT2cR dimerizes with GHSR1a to inhibit orexigenic signalling, while 5-HT2cR antagonism reduces dimerization and increases GHSR1a-induced food intake. Dimerization is specific to the unedited 5-HT2cR isoform. 5-HT2cR antagonism by SGAs may disrupt the normal inhibitory tone on the GHSR1a, increasing orexigenic signalling. The 5-HT2cR and its interaction with the GHSR1a could serve as the basis for discovering novel approaches to preventing and treating SGA-induced obesity.
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Affiliation(s)
- X-F Huang
- School of Medicine, University of Wollongong and Illawarra Health and Medical Research Institute, NSW, Australia.,Jiangsu Key Laboratory for Immunity and Metabolism, Xuzhou Medical University, Jiangsu, China.,Centre for Medical and Molecular Biosciences, Faculty of Science, Medicine and Health, University of Wollongong, NSW, Australia
| | - K Weston-Green
- School of Medicine, University of Wollongong and Illawarra Health and Medical Research Institute, NSW, Australia.,Centre for Medical and Molecular Biosciences, Faculty of Science, Medicine and Health, University of Wollongong, NSW, Australia
| | - Y Yu
- School of Medicine, University of Wollongong and Illawarra Health and Medical Research Institute, NSW, Australia.,Jiangsu Key Laboratory for Immunity and Metabolism, Xuzhou Medical University, Jiangsu, China
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Fu DJ, Turkoz I, Walling D, Lindenmayer JP, Schooler NR, Alphs L. Paliperidone palmitate once-monthly maintains improvement in functioning domains of the Personal and Social Performance scale compared with placebo in subjects with schizoaffective disorder. Schizophr Res 2018; 192:185-193. [PMID: 28454922 DOI: 10.1016/j.schres.2017.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 03/17/2017] [Accepted: 04/01/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Evaluate the effect of paliperidone palmitate once-monthly (PP1M) injectable on the specific functioning domains of the Personal and Social Performance (PSP) scale in patients with schizoaffective disorder (SCA) participating in a long-term study. METHODS This study (NCT01193153) included both in- and outpatient subjects with SCA experiencing an acute exacerbation of psychotic and mood symptoms. Subjects were treated with PP1M either as monotherapy or in combination with antidepressants or mood stabilizers during a 25-week open-label (OL) phase. Stabilized subjects were randomly assigned 1:1 (PP1M or placebo) into a 15-month double-blind (DB) relapse-prevention period. Functioning of the randomized subjects during OL and DB phases was evaluated using the PSP scale (four domains: socially useful activities, personal/social relationships, self-care, and disturbing/aggressive behaviors). Three statistical approaches were utilized to analyze PSP scores to assess robustness and consistency of findings. No adjustments were made for multiplicity. RESULTS 334 of 667 enrolled subjects were stabilized with PP1M, randomly assigned to PP1M (n=164) or placebo (n=170) in the DB phase, and included in this analysis. Improvements in all PSP domain scores were observed during the OL phase and were maintained during the DB phase with PP1M, but decreased with placebo. Differences compared to placebo were significant in all four PSP domains during the DB phase (P≤0.008). CONCLUSION The analysis in this study showed that PP1M improves functioning, as measured by the four PSP domain scores, in symptomatic subjects with SCA. Functioning was maintained compared with placebo.
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Affiliation(s)
- Dong-Jing Fu
- Janssen Research & Development, LLC, Titusville, NJ 08560, USA.
| | - Ibrahim Turkoz
- Janssen Research & Development, LLC, Titusville, NJ 08560, USA
| | - David Walling
- Collaborative Neuroscience Network, Inc, Garden Grove, CA, USA
| | | | | | - Larry Alphs
- Janssen Scientific Affairs, LLC, Titusville, NJ, 08560, USA
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Kadra G, Stewart R, Shetty H, MacCabe JH, Chang CK, Kesserwani J, Taylor D, Hayes RD. Antipsychotic polypharmacy prescribing and risk of hospital readmission. Psychopharmacology (Berl) 2018; 235:281-289. [PMID: 29080904 PMCID: PMC5748404 DOI: 10.1007/s00213-017-4767-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 10/17/2017] [Indexed: 11/02/2022]
Abstract
OBJECTIVES The aim of this study was to determine if there was an association between being discharged on antipsychotic polypharmacy (APP) and risk of readmission into secondary mental health care. METHODS Using data from the South London and Maudsley (SLAM) case register, service users with serious mental illness (SMI), discharged between 1st January 2007 and 31th December 2014, were followed up for 6 months. Patients were classified as receiving either monotherapy or polypharmacy at index discharge. Multivariable Cox regression models were constructed, adjusting for sociodemographic, socioeconomic, clinical and service use factors. RESULTS We identified 5523 adults who had been admitted at least once to SLAM, of whom 1355 (24.5%) were readmitted into secondary mental health care. In total, 15% (n = 826) of patients were discharged on APP and 85% (n = 4697) on monotherapy. Of these, 30.9% (n = 255) and 23.4% (n = 1100) were readmitted respectively. Being discharged on APP was associated with a significantly increased risk of readmission, in comparison to patients discharged on monotherapy (HR = 1.4, 1.2-1.7, p < 0.001). This association was maintained in the fully adjusted model and following several sensitivity analyses. We further established that patients receiving clozapine APP (n = 200) were at a significantly increased risk for readmission in comparison to patients on clozapine monotherapy (HR = 1.8, 1.2-2.6, p = 0.008). CONCLUSIONS Our results suggest that patients discharged on APP are more likely to be readmitted into hospital within 6 months in comparison to those discharged on monotherapy. This needs to be considered in treatment decisions and the reasons for the association clarified.
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Affiliation(s)
- Giouliana Kadra
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, BRC Neucleus, Mapother House, De Crespigny Park, London, SE5 8AF, UK.
| | - Robert Stewart
- 0000 0001 2322 6764grid.13097.3cInstitute of Psychiatry, Psychology and Neuroscience, King’s College London, BRC Neucleus, Mapother House, De Crespigny Park, London, SE5 8AF UK ,0000 0000 9439 0839grid.37640.36South London and Maudsley NHS Foundation Trust, London, UK
| | - Hitesh Shetty
- 0000 0000 9439 0839grid.37640.36South London and Maudsley NHS Foundation Trust, London, UK
| | - James H. MacCabe
- 0000 0001 2322 6764grid.13097.3cInstitute of Psychiatry, Psychology and Neuroscience, King’s College London, BRC Neucleus, Mapother House, De Crespigny Park, London, SE5 8AF UK ,0000 0000 9439 0839grid.37640.36South London and Maudsley NHS Foundation Trust, London, UK
| | - Chin-Kuo Chang
- 0000 0001 2322 6764grid.13097.3cInstitute of Psychiatry, Psychology and Neuroscience, King’s College London, BRC Neucleus, Mapother House, De Crespigny Park, London, SE5 8AF UK
| | - Jad Kesserwani
- 0000 0001 2322 6764grid.13097.3cInstitute of Psychiatry, Psychology and Neuroscience, King’s College London, BRC Neucleus, Mapother House, De Crespigny Park, London, SE5 8AF UK
| | - David Taylor
- 0000 0000 9439 0839grid.37640.36South London and Maudsley NHS Foundation Trust, London, UK
| | - Richard D. Hayes
- 0000 0001 2322 6764grid.13097.3cInstitute of Psychiatry, Psychology and Neuroscience, King’s College London, BRC Neucleus, Mapother House, De Crespigny Park, London, SE5 8AF UK
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Lora A, Monzani E, Ibrahim B, Soranna D, Corrao G. Routine quality care assessment of schizophrenic disorders using information systems. Int J Qual Health Care 2017; 28:728-733. [PMID: 27578632 DOI: 10.1093/intqhc/mzw096] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 07/19/2016] [Indexed: 12/18/2022] Open
Abstract
Objective To assess the quality of mental healthcare provided to patients with schizophrenic disorders in the Italian region of Lombardy. Design Forty-one clinical indicators were applied to Lombardy's healthcare databases containing data on mental health treatments, hospital admissions, somatic health treatments and pharmaceutical prescriptions. Setting All public departments of mental health and private residential facilities in Lombardy. Participants All 28 227 patients with schizophrenic disorders that were under the care of Lombardy mental health services in 2009. Interventions N/A. Main outcome measures N/A. Results The care that was delivered to patients and family members was more frequent for first-episode cases than for prevalent ones. Seven out of ten patients made use of continuing care and, after hospitalization, more than half of the discharged patients received a follow-up visit by community mental health centre staff within 2 weeks of their discharge. Psychotherapeutic and psychoeducative treatments, such as employment and independent living support, were not widespread among these discharged patients. Antipsychotic drug dosage was usually within the recommended range. The adherence of first-episode patients to antipsychotic treatment was lower than that of prevalent patients, and the monitoring of metabolic side effects was not always consistent. Inappropriateness of hospital care, in terms of longer admission, readmission, compulsory admission and restraint, was limited. Mortality during the period was significant. Conclusions Clinical indicators demonstrate the strengths and weaknesses of the mental health system in Lombardy and they can be useful tools in the routine assessment of mental healthcare quality.
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Affiliation(s)
- Antonio Lora
- Department of Mental Health, Azienda Ospedaliera della Provincia di Lecco, Via dell'Eremo 9/11, 23900 Lecco, Italy
| | - Emiliano Monzani
- Department of Mental Health, Azienda Ospedaliera Niguarda Ca Granda, Piazza dell'Ospedale Maggiore 3, 20162 Milano, Italy
| | - Bussy Ibrahim
- Department of Statistics and Quantitative Methods, University of Milano Bicocca, Via BIcocca degli Arcinboldi 8, 20126 Milano, Italy
| | - Davide Soranna
- Department of Statistics and Quantitative Methods, University of Milano Bicocca, Via BIcocca degli Arcinboldi 8, 20126 Milano, Italy.,Istituto Auxologico Italiano, Milan, Italy
| | - Giovanni Corrao
- Department of Statistics and Quantitative Methods, University of Milano Bicocca, Via BIcocca degli Arcinboldi 8, 20126 Milano, Italy
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29
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Sfetcu R, Musat S, Haaramo P, Ciutan M, Scintee G, Vladescu C, Wahlbeck K, Katschnig H. Overview of post-discharge predictors for psychiatric re-hospitalisations: a systematic review of the literature. BMC Psychiatry 2017; 17:227. [PMID: 28646857 PMCID: PMC5483311 DOI: 10.1186/s12888-017-1386-z] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND High levels of hospital readmission (rehospitalisation rates) is widely used as indicator of a poor quality of care. This is sometimes also referred to as recidivism or heavy utilization. Previous studies have examined a number of factors likely to influence readmission, although a systematic review of research on post-discharge factors and readmissions has not been conducted so far. The main objective of this review was to identify frequently reported post-discharge factors and their effects on readmission rates. METHODS Studies on the association between post-discharge variables and readmission after an index discharge with a main psychiatric diagnosis were searched in the bibliographic databases Ovid Medline, PsycINFO, ProQuest Health Management, OpenGrey and Google Scholar. Relevant articles published between January 1990 and June 2014 were included. A systematic approach was used to extract and organize in categories the information about post-discharge factors associated with readmission rates. RESULTS Of the 760 articles identified by the initial search, 80 were selected for this review which included a total number of 59 different predictors of psychiatric readmission. Subsequently these were grouped into four categories: 1) individual vulnerability factors, 2) aftercare related factors, 3) community care and service responsiveness, and 4) contextual factors and social support. Individual factors were addressed in 58 papers and were found to be significant in 37 of these, aftercare factors were significant in 30 out of the 45 papers, community care and social support factors were significant in 21 out of 31 papers addressing these while contextual factors and social support were significant in all seven papers which studied them. CONCLUSIONS This review represents a first attempt at providing an overview of post-discharge factors previously studied in association with readmission. Hence, by mapping out the current research in the area, it highlights the gaps in research and it provides guidance future studies in the area.
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Affiliation(s)
- R. Sfetcu
- National School of Public Health, Management and Professional Development, Bucharest, Romania ,grid.445726.6Psychology Department, Spiru Haret University, Bucharest, Romania
| | - S. Musat
- National School of Public Health, Management and Professional Development, Bucharest, Romania
| | - P. Haaramo
- National Institute for Health and Welfare, Mental Health Unit, Helsinki, Finland
| | - M. Ciutan
- National School of Public Health, Management and Professional Development, Bucharest, Romania
| | - G. Scintee
- National School of Public Health, Management and Professional Development, Bucharest, Romania
| | - C. Vladescu
- National School of Public Health, Management and Professional Development, Bucharest, Romania ,0000 0001 0504 4027grid.22248.3eVictor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - K. Wahlbeck
- National Institute for Health and Welfare, Mental Health Unit, Helsinki, Finland
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Sands N, Elsom S, Corbett R, Keppich-Arnold S, Prematunga R, Berk M, Considine J. Predictors for clinical deterioration of mental state in patients assessed by telephone-based mental health triage. Int J Ment Health Nurs 2017; 26:226-237. [PMID: 27779363 DOI: 10.1111/inm.12267] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/07/2016] [Indexed: 11/30/2022]
Abstract
Patient safety research focussing on recognizing and responding to clinical deterioration is gaining momentum in generalist health, but has received little attention in mental health settings. The focus on early identification and prompt intervention for clinical deterioration enshrined in patient safety research is equally relevant to mental health, especially in triage and crisis care contexts, yet the knowledge gap in this area is substantial. The present study was a controlled cohort study (n = 817) that aimed to identify patient and service characteristics associated with clinical deterioration of mental state indicated by unplanned admission to an inpatient psychiatric unit following assessment by telephone-based mental health triage. The main objective of the research was to produce knowledge to improve understandings of mental deterioration that can be used to inform early detection, intervention, and prevention strategies at the point of triage. The results of the study found that the clinical profile of admitted patients was one of complexity and severity. Admitted patients were more likely to have had complex psychiatric histories with multiple psychiatric admissions, severe psychotic symptoms, a history of treatment non-adherence, and poorer social functioning than non-admitted patients.
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Affiliation(s)
- Natisha Sands
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
| | - Stephen Elsom
- Centre for Psychiatric Nursing, The University of Melbourne, Melbourne, Victoria, Australia
| | | | | | - Roshani Prematunga
- Centre for Psychiatric Nursing, The University of Melbourne, Melbourne, Victoria, Australia
| | - Michael Berk
- School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Julie Considine
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
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Abstract
Data from a multiphase schizoaffective disorder study (NCT01193153) were used to examine the effects of paliperidone palmitate once-monthly (PP1M) by subjects' illness duration, defined as recent onset (≤5 years since first psychiatric diagnosis; n = 206) and chronic illness (>5 years; n = 461). Symptom and functioning scores, as measured during open-label PP1M acute and stabilization treatment phases, improved in both subpopulations, with greater improvements in recent onset than chronic illness subjects (p ≤ 0.022). Relapse rates, examined during the double-blind, placebo-controlled phase, were higher with placebo than PP1M: 30.0% vs. 10.2% (p = 0.014; hazard ratio [HR]: 2.8; 95% confidence interval [CI]: 1.11-7.12; p = 0.029) in the recent onset subpopulation and 35.5% vs. 18.1% (p = 0.001; HR: 2.38; 95% CI: 1.37-4.12; p = 0.002) in the chronic illness subpopulation. Growing evidence in the treatment of schizophrenia and schizoaffective disorder supports early intervention with long-acting antipsychotics.
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Wallerstedt SM, Hoffmann M. Evaluating beneficial drug effects in a non-interventional setting: a review of effectiveness studies based on Swedish Prescribed Drug Register data. Br J Clin Pharmacol 2017; 83:1309-1318. [PMID: 27928842 PMCID: PMC5427236 DOI: 10.1111/bcp.13206] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 12/02/2016] [Accepted: 12/02/2016] [Indexed: 12/15/2022] Open
Abstract
Aims To describe and assess current effectiveness studies published up to 2014 using Swedish Prescribed Drug Register (SPDR) data. Methods Study characteristics were extracted. Each study was assessed concerning the clinical relevance of the research question, the risk of bias according to a structured checklist, and as to whether its findings contributed to new knowledge. The biases encountered and ways of handling these were retrieved. Results A total of 24 effectiveness studies were included in the review, the majority on cardiovascular or psychiatric disease (n = 17; 71%). The articles linked data from four (interquartile range: three to four) registers, and were published in 21 different journals with an impact factor ranging from 1.58 to 51.66. All articles had a clinically relevant research question. According to the systematic quality assessments, the overall risk of bias was low in one (4%), moderate in eight (33%) and high in 15 (62%) studies. Overall, two (8%) studies were assessed as contributing to new knowledge. Frequently occurring problems were selection bias making the comparison groups incomparable, treatment bias with suboptimal handling of drug exposure and an intention‐to‐treat approach, and assessment bias including immortal time bias. Good examples of how to handle bias problems included propensity score matching and sensitivity analyses. Conclusion Although this review illustrates that effectiveness studies based on dispensed drug register data can contribute to new evidence of intended effects of drug treatment in clinical practice, the expectations of such data to provide valuable information need to be tempered due to methodological issues.
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Affiliation(s)
- Susanna M Wallerstedt
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Pharmacology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mikael Hoffmann
- The NEPI foundation - Swedish Network for Pharmacoepidemiology, Linköping University, Linköping, Sweden
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Time to Discontinuation of Second-Generation Antipsychotics Versus Haloperidol and Sulpiride in People With Schizophrenia: A Naturalistic, Comparative Study. J Clin Psychopharmacol 2017; 37:13-20. [PMID: 27977467 DOI: 10.1097/jcp.0000000000000623] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE A retrospective study was conducted to evaluate the time to discontinuation (TTD) of the first- (FGAs) and second-generation antipsychotics (SGAs). METHODS In total, 918 treatment episodes of patients with schizophrenia, initiated on one of the investigated drugs on an outpatient basis during 2004-2006, were entered into the study. The primary outcome was the duration of the investigated treatment episode. Discontinuation was defined when either patients were admitted or the investigated drug had been stopped for more than 28 days. We used the Cox proportional hazard model to compare hazards of discontinuations among 8 SGAs versus 2 FGAs (haloperidol and sulpiride). The follow-up period was up to 18 months. RESULTS During the follow-up period, clozapine had the highest rate of continuous treatment in the primary analysis: clozapine, 40.6%; olanzapine, 23.4%; aripiprazole, 22.9%; amisulpride, 21.9%; zotepine, 21.3%; sulpiride, 17.0%; risperidone, 12.8%; quetiapine, 12.5%; haloperidol, 10.6%; and ziprasidone, 10.4%. Compared with haloperidol, 5 SGAs had significantly longer TTD (adjusted hazard ratios and 95% confidence intervals): clozapine (0.403, 0.267-0.607), olanzapine (0.611, 0.439-0.849), aripiprazole (0.570, 0.407-0.795), amisulpride (0.680, 0.487-0.947), and zotepine (0.687, 0.497-0.948), but only clozapine had significantly longer TTD compared with sulpiride (0.519, 0.342-0.786). The sensitivity analysis showed similar results. IMPLICATIONS/CONCLUSIONS The current findings suggested that SGAs or FGAs are not homogeneous groups. Clozapine has the highest rate of continuous treatment among SGAs, and haloperidol is not the representative drug for all FGAs. Furthermore, antipsychotics dropout rate is high in naturalistic situation. A good service model needs to be constructed to enhance antipsychotic treatment adherence of people with schizophrenia.
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Savitz AJ, Xu H, Gopal S, Nuamah I, Ravenstijn P, Hough D, Mathews M, Feng Y, Yu L, Takahashi M, Liu D, Wang G, Yoon JS, Chen JJ. Efficacy and safety of paliperidone palmitate three-monthly formulation in East Asian patients with schizophrenia: subgroup analysis of a global, randomized, double-blind, Phase III, noninferiority study. Neuropsychiatr Dis Treat 2017; 13:2193-2207. [PMID: 28860777 PMCID: PMC5566420 DOI: 10.2147/ndt.s134287] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To demonstrate the efficacy and safety of paliperidone palmitate three-monthly (PP3M) formulation in an East Asian population with schizophrenia by subgroup analysis of a double-blind (DB), multicenter, noninferiority study. PATIENTS AND METHODS Of 1,429 patients who entered the open-label (OL) phase, 510 were East Asian (China: 296 [58%], Japan: 175 [34%], South Korea: 19 [4%] and Taiwan: 20 [4%]). In the 17-week OL phase, patients received paliperidone palmitate once-monthly (PP1M) formulation on day 1 (150 mg eq.), day 8 (100 mg eq.) and once-monthly thereafter (50-150 mg eq., flexible). Following the OL phase, patients (n=344 East Asian) entered DB phase and were randomized (1:1) to PP1M (n=174) or PP3M (n=170). Primary efficacy endpoint was the percentage of patients who remained relapse free at the end of the 48-week DB phase, using Kaplan-Meier cumulative survival estimate. Secondary efficacy endpoints included change from DB baseline to endpoint in Positive and Negative Syndrome Scale, Clinical Global Impression Severity, Personal and Social Performance scores and symptomatic remission. Additional assessments included caregiver burden and safety. RESULTS A total of 285/344 (83%) randomized East Asian patients completed the DB phase. The percentage of patients who had a relapse event was similar on comparing PP3M (17 [10.2%]) to PP1M (20 [11.8%]), and also for Japan (PP3M: 9 [17.6%], PP1M: 13 [23.2%]) and China (PP3M: 6 [5.9%], PP1M: 7 [6.9%]). Mean change from baseline in secondary efficacy parameters was similar to the global population, regardless of treatment. Symptomatic remission was attained by 50% of the treated patients. Caregiver burden was significantly reduced (P<0.001) following treatment with PP3M/PP1M. Frequency of treatment-emergent adverse events in PP3M group during DB phase was greater in the East Asian subgroup (81%) than the global population (68%) and was higher in Japan (92%) than China (75%). CONCLUSION Results suggest that PP3M is efficacious in the East Asian subgroup. Although treatment-emergent adverse events were slightly higher in the East Asian subgroup versus the global population, no new safety signals were identified.
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Affiliation(s)
| | - Haiyan Xu
- Department of Clinical Biostatistics, Janssen Research & Development, LLC, Titusville, NJ, USA
| | | | - Isaac Nuamah
- Department of Clinical Biostatistics, Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Paulien Ravenstijn
- Department of Clinical Pharmacology, Janssen Research & Development, Beerse, Belgium
| | | | - Maju Mathews
- Global Medical Affairs, Neurosciences, Janssen Research & Development, NY, USA
| | - Yu Feng
- Medical Affairs, Neurosciences, Janssen Pharmaceutical Companies of Johnson and Johnson, Singapore
| | - Lu Yu
- Department of Clinical Development, Janssen Research & Development, Beijing, China
| | - Masayoshi Takahashi
- Department of Central Nervous System, Janssen Pharmaceutical KK, Tokyo, Japan
| | - Dennis Liu
- Playford Community Team, Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Gang Wang
- National Clinical Research Center for Mental Disorders, Beijing Anding Hospital, Affiliated Capital University of Medical Science, Beijing, China
| | - Jin-Sang Yoon
- Department of Psychiatry, Chonnam National University Hospital, Gwangju, South Korea
| | - Jiahn-Jyh Chen
- Department of Geriatric Psychiatry, Taoyuan Mental Hospital, Taoyuan, Taiwan
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Factors Influencing Rehospitalisation of Patients with Schizophrenia in Japan: A 1-year Longitudinal Study. Hong Kong J Occup Ther 2016; 28:7-14. [PMID: 30186062 PMCID: PMC6091990 DOI: 10.1016/j.hkjot.2016.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 09/30/2016] [Accepted: 10/31/2016] [Indexed: 12/02/2022] Open
Abstract
Objective/Background This longitudinal study explored factors influencing the rehospitalisation of
patients with schizophrenia in Japan. Methods Participants comprised patients with schizophrenia who were discharged from a
psychiatric hospital in Japan. The investigations were conducted at the time
of discharge and one year later. Demographics and clinical characteristics
included the following: the type of occupational therapy (OT) interventions
(group and individualized or group only); the assessment scales’ scores on
hospitalisation; the community living conditions after discharge; and the
contents of outpatient treatment (outpatient OT, day-care treatment,
home-visit nursing, and adherence to outpatient treatment and medication).
All variables were examined in a binomial logistic regression analysis to
identify the factors for rehospitalisation. Results The rehospitalisation rate was 31.8%, as 14 of 44 participants were
rehospitalised within one year after discharge. The type of OT interventions
(OR = 7.05, 95% CI = 1.36 −36.69, p = .020) and the adherence to outpatient
treatment and medication (OR = 9.48, 95% CI = 1.82–49.33, p = .008) were
significant contributing factors to rehospitalisation. Conclusion This study provided preliminary support for the finding that individualized
occupational therapy and proper adherence to outpatient treatment and
medication are associated with reducing the rehospitalisation of patients
with schizophrenia in Japan.
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Abdel Aziz K, Elamin MH, El-Saadouni NM, El-Gabry DA, Barakat M, Alhayyas F, Moselhy HF. Schizophrenia: Impact of psychopathology, faith healers and psycho-education on adherence to medications. Int J Soc Psychiatry 2016; 62:719-725. [PMID: 27815512 DOI: 10.1177/0020764016676215] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Many patients suffering from psychosis are nonadherent to their medications. Nonadherence can range from treatment refusal to irregular use or partial change in daily medication doses. AIM To investigate whether symptom dimensions, post-discharge care plans and being involved with faith healer affect the adherence to treatment in patients with schizophrenia. METHOD A total of 121 patients with schizophrenia were examined 6 weeks post-discharge from the inpatient unit and assessed for full, partial or nonadherence to medication. RESULTS There was a significant association between family involvement and partial adherence and between community team involvement post-discharge and full adherence to medications. Psycho-education was a predictor for adherence to medications, persecutory delusions and lack of insight predicted partial adherence, while being involved with faith healers predicted nonadherence. CONCLUSION Adherence to medications and socio-demographic variables are independent. This study demonstrated that nonadherence or partial adherence to medications is associated with lack of insight and persecutory delusions. Psycho-education could improve the adherence to medication compliances.
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Affiliation(s)
- Karim Abdel Aziz
- College of Medicine, United Arab Emirates University, Al Ain, UAE
| | | | - Nisrin M El-Saadouni
- Psychiatry Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Dina Aly El-Gabry
- Institute of Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | | | - Hamdy F Moselhy
- College of Medicine, United Arab Emirates University, Al Ain, UAE
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Aref-Adib G, O’Hanlon P, Fullarton K, Morant N, Sommerlad A, Johnson S, Osborn D. A qualitative study of online mental health information seeking behaviour by those with psychosis. BMC Psychiatry 2016; 16:232. [PMID: 27400874 PMCID: PMC4940927 DOI: 10.1186/s12888-016-0952-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 06/20/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Internet and mobile technology are changing the way people learn about and manage their illnesses. Little is known about online mental health information seeking behaviour by people with psychosis. This paper explores the nature, extent and consequences of online mental health information seeking behaviour by people with psychosis and investigates the acceptability of a mobile mental health application (app). METHODS Semi-structured interviews were carried out with people with psychosis (n = 22). Participants were purposively recruited through secondary care settings in London. The main topics discussed were participants' current and historical use of online mental health information and technology. Interviews were audio-recorded, transcribed and analysed by a team of researchers using thematic analysis. RESULTS Mental health related Internet use was widespread. Eighteen people described searching the Internet to help them make sense of their psychotic experiences, and to read more information about their diagnosis, their prescribed psychiatric medication and its side-effects. Whilst some participants sought 'expert' online information from mental health clinicians and research journals, others described actively seeking first person perspectives. Eight participants used this information collaboratively with clinicians and spoke of the empowerment and independence the Internet offered them. However nine participants did not discuss their use of online mental health information with their clinicians for a number of reasons, including fear of undermining their clinician's authority. For some of these people concerns over what they had read led them to discontinue their antipsychotic medication without discussion with their mental health team. CONCLUSIONS People with psychosis use the Internet to acquire mental health related information. This can be a helpful source of supplementary information particularly for those who use it collaboratively with clinicians. When this information is not shared with their mental health team, it can affect patients' health care decisions. A partnership approach to online health-information seeking is needed, with mental health clinicians encouraging patients to discuss information they have found online as part of a shared decision-making process. Our research suggests that those with psychosis have active digital lives and that the introduction of a mental health app into services would potentially be well received.
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Affiliation(s)
- Golnar Aref-Adib
- Division of Psychiatry, University College London, 149 Tottenham Court Road, London, W1T 7NF, UK. .,Camden and Islington NHS Foundation Trust, 4th Floor, East Wing, St Pancras Hospital, 4 Saint Pancras Way, London, NW1 0PE, UK.
| | - Puffin O’Hanlon
- Division of Psychiatry, University College London, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Kate Fullarton
- Division of Psychiatry, University College London, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Nicola Morant
- Division of Psychiatry, University College London, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Andrew Sommerlad
- Division of Psychiatry, University College London, 149 Tottenham Court Road, London, W1T 7NF UK ,Camden and Islington NHS Foundation Trust, 4th Floor, East Wing, St Pancras Hospital, 4 Saint Pancras Way, London, NW1 0PE UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, 149 Tottenham Court Road, London, W1T 7NF UK ,Camden and Islington NHS Foundation Trust, 4th Floor, East Wing, St Pancras Hospital, 4 Saint Pancras Way, London, NW1 0PE UK
| | - David Osborn
- Division of Psychiatry, University College London, 149 Tottenham Court Road, London, W1T 7NF, UK. .,Camden and Islington NHS Foundation Trust, 4th Floor, East Wing, St Pancras Hospital, 4 Saint Pancras Way, London, NW1 0PE, UK.
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Hamilton JE, Passos IC, de Azevedo Cardoso T, Jansen K, Allen M, Begley CE, Soares JC, Kapczinski F. Predictors of psychiatric readmission among patients with bipolar disorder at an academic safety-net hospital. Aust N Z J Psychiatry 2016; 50:584-93. [PMID: 26377747 DOI: 10.1177/0004867415605171] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Even with treatment, approximately one-third of patients with bipolar disorder relapse into depression or mania within 1 year. Unfavorable clinical outcomes for patients with bipolar disorder include increased rates of psychiatric hospitalization and functional impairment. However, only a few studies have examined predictors of psychiatric hospital readmission in a sample of patients with bipolar disorder. The purpose of this study was to examine predictors of psychiatric readmission within 30 days, 90 days and 1 year of discharge among patients with bipolar disorder using a conceptual model adapted from Andersen's Behavioral Model of Health Service Use. METHODS In this retrospective study, univariate and multivariate logistic regression analyses were conducted in a sample of 2443 adult patients with bipolar disorder who were consecutively admitted to a public psychiatric hospital in the United States from 1 January to 31 December 2013. RESULTS In the multivariate models, several enabling and need factors were significantly associated with an increased risk of readmission across all time periods examined, including being uninsured, having ⩾3 psychiatric hospitalizations and having a lower Global Assessment of Functioning score. Additional factors associated with psychiatric readmission within 30 and 90 days of discharge included patient homelessness. Patient race/ethnicity, bipolar disorder type or a current manic episode did not significantly predict readmission across all time periods examined; however, patients who were male were more likely to readmit within 1 year. The 30-day and 1-year multivariate models showed the best model fit. CONCLUSION Our study found enabling and need factors to be the strongest predictors of psychiatric readmission, suggesting that the prevention of psychiatric readmission for patients with bipolar disorder at safety-net hospitals may be best achieved by developing and implementing innovative transitional care initiatives that address the issues of multiple psychiatric hospitalizations, housing instability, insurance coverage and functional impairment.
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Affiliation(s)
- Jane E Hamilton
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, USA UTHealth Harris County Psychiatric Center, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, USA
| | - Ives C Passos
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, USA Bipolar Disorder Program and Laboratory of Molecular Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil UTHealth Harris County Psychiatric Center, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, USA
| | - Taiane de Azevedo Cardoso
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, USA Graduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, RS, Brazil
| | - Karen Jansen
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, USA Graduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, RS, Brazil
| | - Melissa Allen
- UTHealth Harris County Psychiatric Center, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, USA
| | - Charles E Begley
- Center for Health Services Research, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA UTHealth Harris County Psychiatric Center, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, USA
| | - Jair C Soares
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, USA UTHealth Harris County Psychiatric Center, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, USA
| | - Flavio Kapczinski
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, USA Bipolar Disorder Program and Laboratory of Molecular Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil UTHealth Harris County Psychiatric Center, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, USA
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Lee EHM, Hui CLM, Lin JX, Ching EYN, Li SP, Leung WG, Chang WC, Chan SKW, Chen EYH. Incidence of hospitalization and its associated factors in first-episode psychosis in Hong Kong. Early Interv Psychiatry 2016; 10:263-6. [PMID: 25702936 DOI: 10.1111/eip.12231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 12/19/2014] [Indexed: 11/26/2022]
Abstract
AIM This study examined the incidence of hospitalization and its associated factors in patients with first-episode psychosis in Hong Kong. METHOD From 2009 to 2011, 360 patients were recruited consecutively as part of a controlled study of an early psychosis intervention service (the Jockey Club Early Psychosis project) in Hong Kong. Demographic and clinical information were obtained from face-to-face interviews and was reconfirmed using medical records. Factors relating to hospitalization during first episode were explored. RESULTS The incidence of hospitalization during first-episode psychosis was 57.2%. Patients who were hospitalized had higher antipsychotics chlorpromazine equivalent dosage, higher positive and negative syndrome scale total score, higher Udvalg for Kliniske Undersøgelser others mean score and were more likely to have an acute mode of onset compared with those who were not hospitalized. CONCLUSIONS Hospitalization was common in first-episode psychosis. Future studies are needed to explore possible programmes to prevent hospitalization in patients with first-episode psychosis.
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Affiliation(s)
- Edwin H M Lee
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Christy L M Hui
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - J X Lin
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Elaine Y N Ching
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - S P Li
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - W G Leung
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - W C Chang
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Sherry K W Chan
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Eric Y H Chen
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong.,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
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Lo TL, Warden M, He Y, Si T, Kalyanasundaram S, Thirunavukarasu M, Amir N, Hatim A, Bautista T, Lee C, Emsley R, Olivares J, Yang YK, Kongsakon R, Castle D. Recommendations for the optimal care of patients with recent-onset psychosis in the Asia-Pacific region. Asia Pac Psychiatry 2016; 8:154-71. [PMID: 27062665 PMCID: PMC4834614 DOI: 10.1111/appy.12234] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 12/29/2015] [Indexed: 12/31/2022]
Abstract
Providing optimal care to patients with recent-onset psychosis can improve outcomes and reduce relapse. However, there is a lack of consistency of the implementation of guidelines for such patients across the Asia-Pacific region. We determined a pragmatic set of recommendations for use on a day-to-day basis to help provide optimal care at this crucial stage of illness. The recommendations were developed over a series of meetings by an international faculty of 15 experts from the Asia-Pacific region, Europe, and South Africa. A structured search of the PubMed database was conducted. This was further developed based on the faculty's clinical experience and knowledge of the literature into 10 key aspects of optimal care for patients during the first five years of a diagnosis of a psychotic disorder, with particular relevance to the Asia-Pacific region. Several common principles emerged: adherence to antipsychotic medications is crucial; substance abuse, psychiatric and medical comorbidities should be addressed; psychosocial interventions play a pivotal role; and family members can play a vital role in overall patient care. By following these recommendations, clinicians may improve outcomes for patients with recent-onset psychosis.
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Affiliation(s)
| | - Matthew Warden
- Hobart and Southern CMHTTasmanian Health Organisation – SouthTasmaniaAustralia
| | - Yanling He
- Department of Epidemiology Shanghai Mental Health CenterShanghai Jiao Tong UniversitySchool of MedicineShanghaiChina
| | - Tianmei Si
- Department of PsychopharmacologyPeking University Institute of Mental HealthPekingChina
| | | | | | - Nurmiati Amir
- Department of Psychiatry National General HospitalCiptomangunkusumo/Faculty of MedicineUniversity of IndonesiaJakartaIndonesia
| | - Ahmad Hatim
- Department of Psychological MedicineUniversity of MalayaKuala LumpurMalaya
| | - Tomas Bautista
- College of Medicine Philippine General HospitalUniversity of the PhilippinesManilaPhilippines
| | - Cheng Lee
- Department of Community PsychiatryInstitute of Mental HealthSingapore
| | - Robin Emsley
- Department of PsychiatryUniversity of StellenboschStellenboschSouth Africa
| | - Jose Olivares
- Department of PsychiatryComplejo Hospitalario Universitario de VigoVigoSpain
| | - Yen Kuang Yang
- Department of PsychiatryNational Cheng Kung University HospitalCollege of MedicineNational Cheng Kung UniversityTainan CityTaiwan
| | | | - David Castle
- Department of PsychiatrySt. Vincent's HospitalThe University of MelbourneMelbourneAustralia
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41
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Dikec G, Kutlu Y. Effectiveness of Adherence Therapy for People With Schizophrenia in Turkey: A Controlled Study. Arch Psychiatr Nurs 2016; 30:249-56. [PMID: 26992879 DOI: 10.1016/j.apnu.2015.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 11/02/2015] [Accepted: 11/13/2015] [Indexed: 01/19/2023]
Abstract
OBJECTIVE This study used a quasi-experimental design with a pretest-posttest control group and follow-up to determine the efficacy of adherence therapy in patients with schizophrenia in Turkey. METHODS The sample of this study consisted of patients with schizophrenia (n=30). The Questionnaire Form, Medication Adherence Rating Scale, Internalized Stigma of Mental Illness Scale, and Beck Cognitive Insight Scale were used. The patients were assigned to experimental (n=15) and control (n=15) groups using the randomization method. The experimental group received adherence therapy in eight sessions. RESULTS When the scores of the patients in the experimental and control groups were compared at the pretest, posttest, and 3- and 6-months follow ups, a significant difference was only found in the Medication Adherence Rating Scale posttest scores. CONCLUSION Adherence therapy is effective in improving adherence to treatment but is not effective with regard to insight and internalized stigma in patients with schizophrenia.
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Affiliation(s)
- Gul Dikec
- Izmir University, School of Health, Nursing Department, Izmir, Turkey.
| | - Yasemin Kutlu
- Istanbul University, Florence Nightingale Nursing Faculty, Mental Health and Psychiatric Nursing Department, İstanbul, Turkey.
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Zink M, Englisch S. Schizophrenia treatment: an obstacle course. Lancet Psychiatry 2016; 3:310-2. [PMID: 26922476 DOI: 10.1016/s2215-0366(16)00023-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 01/15/2016] [Accepted: 01/15/2016] [Indexed: 12/18/2022]
Affiliation(s)
- Mathias Zink
- Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, University of Heidelberg, D-68072 Mannheim, Germany.
| | - Susanne Englisch
- Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, University of Heidelberg, D-68072 Mannheim, Germany
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Ahmed AO, Murphy CF, Latoussakis V, McGovern KE, English J, Bloch A, Anthony DT, Savitz AJ. An examination of neurocognition and symptoms as predictors of post-hospital community tenure in treatment resistant schizophrenia. Psychiatry Res 2016; 236:47-52. [PMID: 26778628 DOI: 10.1016/j.psychres.2016.01.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 12/10/2015] [Accepted: 01/04/2016] [Indexed: 10/22/2022]
Abstract
Neurocognition and psychopathology are robust predictors of community functioning and relapse/rehospitalization in schizophrenia. Existing studies are however limited because they have ignored the most chronic, treatment-resistant patients. Moreover, the prediction of functional outcomes has yet to be extended to the duration of community tenure, an indicator of the capacity of chronically-hospitalized patients to gain traction in the community. The current study examined neurocognition and symptom severity at discharge as potential predictors of community tenure in chronically-hospitalized treatment-resistant patients. The study recruited 90 people with treatment-resistant schizophrenia who received services on an inpatient unit. Participants completed measures of psychopathology and neurocognition prior to discharge. Following discharge, participants were tracked at current residences six months and one year post-discharge to assess community tenure. The percentage of individuals who continued to live in the community at 12-month follow-up was 51%. Severe negative symptoms but not neurocognitive impairment or positive symptoms was a significant predictor of shorter post-hospital community tenure. Of the negative symptoms domain, anhedonia-asociality proved to be the most relevant predictor of community tenure in the sample. The capacity to elicit goal-directed behaviors in response to anticipated physical and social rewards may be an important treatment target for sustaining community tenure.
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Affiliation(s)
- Anthony O Ahmed
- Department of Psychiatry, Weill Cornell Medical College, 21 Bloomingdale Road, White Plains, NY 10605, USA.
| | - Christopher F Murphy
- Department of Psychiatry, Weill Cornell Medical College, 21 Bloomingdale Road, White Plains, NY 10605, USA
| | - Vassilios Latoussakis
- Department of Psychiatry, Weill Cornell Medical College, 21 Bloomingdale Road, White Plains, NY 10605, USA
| | - Kelly E McGovern
- Department of Psychiatry, Weill Cornell Medical College, 21 Bloomingdale Road, White Plains, NY 10605, USA
| | - Judith English
- Department of Psychiatry, Weill Cornell Medical College, 21 Bloomingdale Road, White Plains, NY 10605, USA
| | - Andrew Bloch
- Department of Psychiatry, Weill Cornell Medical College, 21 Bloomingdale Road, White Plains, NY 10605, USA
| | - Donna T Anthony
- Department of Psychiatry, Weill Cornell Medical College, 21 Bloomingdale Road, White Plains, NY 10605, USA
| | - Adam J Savitz
- Department of Psychiatry, Weill Cornell Medical College, 21 Bloomingdale Road, White Plains, NY 10605, USA
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44
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Chue P, Chue J. A critical appraisal of paliperidone long-acting injection in the treatment of schizoaffective disorder. Ther Clin Risk Manag 2016; 12:109-16. [PMID: 26869795 PMCID: PMC4737499 DOI: 10.2147/tcrm.s81581] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Schizoaffective disorder (SCA) is a chronic and disabling mental illness that presents with mixed symptoms of schizophrenia and affective disorders. SCA is recognized as a discrete disorder, but with greater heterogeneity and symptom overlap, leading to difficulty and delay in diagnosis. Although the overall prognosis is intermediate between schizophrenia and mood disorders, SCA is associated with higher rates of suicide and hospitalization than schizophrenia. No treatment guidelines exist for SCA, and treatment is frequently complex, involving off-label use and polypharmacy (typically combinations of antipsychotics, mood stabilizers, and antidepressants). Oral paliperidone extended-release was the first agent to be approved for the treatment of SCA. As in schizophrenia and bipolar disorder, adherence to oral medications is poor, further contributing to suboptimal outcomes. The use of an antipsychotic in a long-acting injection (LAI) addresses adherence issues, thus potentially reducing relapse. Paliperidone palmitate represents the LAI formulation of paliperidone. In a long-term, double-blind, randomized, controlled trial of adult patients (n=334; intent-to-treat [ITT]) with SCA, paliperidone long-acting injection (PLAI) significantly delayed risk of relapse compared to placebo (hazard ratio 2.49, 95% confidence interval, 1.55–3.99; P<0.001). This study demonstrated the efficacy and safety of PLAI when used as either monotherapy or adjunctive therapy for the maintenance treatment of SCA. The results are consistent with a similarly designed study conducted in patients with schizophrenia, which suggests a benefit in the long-term control of not only psychotic but also affective symptoms. No new safety signals were observed. When used in monotherapy, PLAI simplifies treatment by reducing complex pharmacotherapy and obviating the necessity for daily oral medications. PLAI is the second agent, and the first LAI, to be approved for the treatment of SCA; as an LAI formulation, there is the advantage of improved adherence and simplified treatment in the long-term management of SCA.
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Affiliation(s)
- Pierre Chue
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - James Chue
- Clinical Trials and Research Program, Edmonton, AB, Canada
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45
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Moran V, Jacobs R, Mason A. Variations in Performance of Mental Health Providers in the English NHS: An Analysis of the Relationship Between Readmission Rates and Length-of-Stay. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 44:188-200. [PMID: 26749002 DOI: 10.1007/s10488-015-0711-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Length-of-stay (LOS) for inpatient mental health care is a major driver of variation in resource use internationally. We explore determinants of LOS in England, focusing on the impact of emergency readmission rates which can serve as a measure of the quality of care. Data for 2009/2010 and 2010/2011 are analysed using hierarchical and non-hierarchical models. Unexplained residual variation among providers is quantified using Empirical Bayes techniques. Diagnostic, treatment and patient-level demographic variables are key drivers of LOS. Higher emergency readmission rates are associated with shorter LOS. Ranking providers by residual variation reveals significant differences, suggesting some providers can improve performance.
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Affiliation(s)
- Valerie Moran
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Rowena Jacobs
- Centre for Health Economics and Department of Economics and Related Studies, University of York, Alcuin A Block, Heslington, York, YO10 5DD, UK
| | - Anne Mason
- Centre for Health Economics and Department of Economics and Related Studies, University of York, Alcuin A Block, Heslington, York, YO10 5DD, UK
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46
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Xiao Y, Muser E, Fu DJ, Lafeuille MH, Pilon D, Emond B, Wu A, Duh MS, Lefebvre P. Comparison of Medicaid spending in schizoaffective patients treated with once monthly paliperidone palmitate or oral atypical antipsychotics. Curr Med Res Opin 2016; 32:759-69. [PMID: 26750639 DOI: 10.1185/03007995.2016.1140634] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Compared to oral atypical antipsychotics (OAAs), long-acting injectable antipsychotics require less frequent administration, and thus may improve adherence and reduce risk of relapse in schizoaffective disorder (SAD) patients. OBJECTIVE To evaluate the impact of once monthly paliperidone palmitate (PP) versus OAAs on healthcare resource utilization, Medicaid spending, and hospital readmission among SAD patients. METHODS Using FL, IA, KS, MS, MO, and NJ Medicaid data (January 2009-December 2013), adults with ≥2 SAD diagnoses initiated on PP or OAA (index date) were identified. Baseline characteristics and outcomes were assessed during the 12month pre- and post-index periods, respectively. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were used to reduce confounding and compare the estimated treatment effect for PP versus OAA. RESULTS A total of 10,778 OAA-treated patients and 876 PP-treated patients were selected. Compared to OAAs, PP was associated with significantly lower medical costs (PSM: mean monthly cost difference [MMCD] = -$383, p < 0.001; IPTW: MMCD = -$403, p = 0.016), which offset the higher pharmacy costs associated with PP (PSM: MMCD = $270, p < 0.001; IPTW: MMCD = $350, p < 0.001) and resulted in similar total healthcare cost (PSM: MMCD = -$113, p = 0.414; IPTW: MMCD = -$53, p = 0.697) for PP versus OAA. Reduced risk of hospitalization (PSM: incidence rate ratio [IRR] = 0.85, p = 0.128; IPTW: IRR = 0.96, p = 0.004) and fewer hospitalization days (PSM: IRR = 0.74, p = 0.008; IPTW: IRR = 0.85, p < 0.001) were observed in PP versus OAA patients. Among hospitalized patients, PP was associated with a lower risk of 30 day hospital readmission compared to OAA (IPTW: odds ratio = 0.89, p = 0.041). Limitations The Medicaid data may not be representative of the nation or other states, and includes pre-rebate pharmacy costs (potentially over-estimated). Also changes in treatment over time were possible. CONCLUSIONS Total healthcare costs associated with the use of once monthly PP versus OAAs appeared comparable; higher pharmacy costs for PP users were offset by lower medical costs related to fewer and shorter inpatients visits.
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Affiliation(s)
| | - Erik Muser
- b Janssen Scientific Affairs LLC , Titusville , NJ , USA
| | - Dong-Jing Fu
- b Janssen Scientific Affairs LLC , Titusville , NJ , USA
| | | | | | - Bruno Emond
- a Groupe d'analyse Ltée , Montréal , QC , Canada
| | - Allen Wu
- b Janssen Scientific Affairs LLC , Titusville , NJ , USA
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47
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Lee SY, Kim KH, Kim T, Kim SM, Kim JW, Han C, Song JY, Paik JW. Outpatient Follow-Up Visit after Hospital Discharge Lowers Risk of Rehospitalization in Patients with Schizophrenia: A Nationwide Population-Based Study. Psychiatry Investig 2015; 12:425-33. [PMID: 26508952 PMCID: PMC4620298 DOI: 10.4306/pi.2015.12.4.425] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 01/17/2015] [Accepted: 02/03/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Non-adherence to medication is a recognized problem in psychiatric patients and may be one of the most challenging aspects of treatment for patients with schizophrenia. Failure of follow-up care after discharge greatly increases non-adherence to prescribed medications, relapse and rehospitalization. However, it is still unknown whether and how much outpatient follow-up visits can mitigate the risk of rehospitalization. Therefore we sought to investigate the continuity and effectiveness of outpatient care after inpatient discharge and its effect on rehospitalization of patients with schizophrenia. METHODS Data were extracted from National Health Insurance Claim Database covering the period from 2007 through 2010. We identified 10,246 patients aged 18 years or older who were admitted in psychiatric facilities with the diagnosis of schizophrenia between January 1 and December 31 in 2007. The number of outpatient visits within 60 days after discharge from index admission was defined as the indicator for the continuous care and rehospitalization was inspected during the following 36-month period. Cox's proportional hazard model was used to examine the factors affecting the risk of rehospitalization including the number of outpatient visits, age, sex, comorbidities, antipsychotics, and characteristics of medical institution. RESULTS We found that 12.7% (n=1,327) of the patients visited psychiatric outpatient department once within 60 days after hospital discharge, 34.8% (n=3,626) twice, and 27.8% (n=2,900) more than three times. Patients taking atypical antipsychotics showed higher proportion in 2 or more outpatient visits, whereas patients taking typical antipsychotics showed higher proportion in one or no outpatient visits. Cox hazard ratios of rehospitalization for the factor of 3 or more outpatient visits referenced to that of no follow-up visit were 0.567 (0.428-0.750, 95% confidence interval) within 90 days, 0.673 (0.574-0.789) within 180 days, 0.800 (0.713-0.898) within a year, 0.906 (0.824-0.997) within 2 years, and 0.993 (0.910-1.084) within 3 years. CONCLUSION Although continuous outpatient treatment is important for relapse prevention, patients with schizophrenia showed a low rate of outpatient visit as 62.6% of total patients in 2 or more visits within 60 days after discharge. Lack of follow-up treatment might lead to increase psychotic symptoms and raised risk of relapse and rehospitalization. Our data suggest that the number of outpatient visits within 60 days after discharge in patients with schizophrenia is an important indicator of rehospitalization within a year. Therefore, further efforts to examine factors affecting failure of outpatient follow-up after discharge are warranted.
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Affiliation(s)
- Seung Yup Lee
- Department of Neuropsychiatry, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Kyoung Hoon Kim
- Health Insurance Review & Assessment Service, Seoul, Republic of Korea
| | - Tae Kim
- Department of Neuropsychiatry, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Sun Min Kim
- Health Insurance Review & Assessment Service, Seoul, Republic of Korea
| | - Jong-Woo Kim
- Department of Neuropsychiatry, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Changsu Han
- Department of Psychiatry, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Ji Young Song
- Department of Neuropsychiatry, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jong-Woo Paik
- Department of Neuropsychiatry, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
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48
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Hamilton JE, Rhoades H, Galvez J, Allen M, Green C, Aller M, Soares JC. Factors differentially associated with early readmission at a university teaching psychiatric hospital. J Eval Clin Pract 2015; 21:572-8. [PMID: 25756751 DOI: 10.1111/jep.12335] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2015] [Indexed: 11/27/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES The rate of psychiatric readmissions within 30 days of discharge is a well-established behavioural health system performance measure linked to the quality of inpatient hospital care as well as to access to community-based aftercare services. The purpose of this study was to examine the factors differentially associated with earlier readmission among a sample of patients (n = 588) readmitted within 30 days of discharge to a university teaching psychiatric hospital from 2001 to 2010. METHODS Quality assurance interviews were conducted with patients readmitted within 30 days of discharge. The interview data were merged with clinical symptom and electronic medical record data. Multinomial logistic regression analysis was used to examine readmission within 7 days and from 8 to 14 days compared with 15-30 days after discharge while controlling for socio-demographic and treatment variables previously associated with psychiatric readmission. RESULTS Multiple clinical, treatment and patient-reported factors were differentially associated with earlier readmission. In particular, lack of engagement in post-discharge aftercare services was a strong predictor of earlier readmission. CONCLUSIONS Strategies are needed to improve patients' transition from inpatient psychiatric hospitalization to aftercare services. Psychiatric hospitals attempting to reduce very early readmissions should seek to implement innovative transitional care initiatives targeting both patient and treatment factors.
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Affiliation(s)
- Jane E Hamilton
- Department of Psychiatry, University of Texas Medical School at Houston, Houston, TX, USA
| | - Howard Rhoades
- University of Texas Harris County Psychiatric Center, Houston, TX, USA
| | - Juan Galvez
- Department of Psychiatry, University of Texas Medical School at Houston, Houston, TX, USA
| | - Melissa Allen
- Department of Psychiatry, University of Texas Medical School at Houston, Houston, TX, USA
| | - Charles Green
- Center for Clinical Research and Evidence-Based Medicine, University of Texas Medical School at Houston, Houston, TX, USA
| | - Mildred Aller
- University of Texas Harris County Psychiatric Center, Houston, TX, USA
| | - Jair C Soares
- Department of Psychiatry, University of Texas Medical School at Houston, Houston, TX, USA
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49
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Drake RJ, Nordentoft M, Haddock G, Arango C, Fleischhacker WW, Glenthøj B, Leboyer M, Leucht S, Leweke M, McGuire P, Meyer-Lindenberg A, Rujescu D, Sommer IE, Kahn RS, Lewis SW. Modeling determinants of medication attitudes and poor adherence in early nonaffective psychosis: implications for intervention. Schizophr Bull 2015; 41:584-96. [PMID: 25750247 PMCID: PMC4393703 DOI: 10.1093/schbul/sbv015] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We aimed to design a multimodal intervention to improve adherence following first episode psychosis, consistent with current evidence. Existing literature identified medication attitudes, insight, and characteristics of support as important determinants of adherence to medication: we examined medication attitudes, self-esteem, and insight in an early psychosis cohort better to understand their relationships. Existing longitudinal data from 309 patients with early Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, nonaffective psychosis (83% first episode) were analyzed to test the hypothesis that medication attitudes, while meaningfully different from "insight," correlated with insight and self-esteem, and change in each influenced the others. Rosenberg Self-Esteem Scale, Birchwood Insight Scale, and Positive and Negative Syndrome Scale insight were assessed at presentation, after 6 weeks and 3 and 18 months. Drug Attitudes Inventory (DAI) and treatment satisfaction were rated from 6 weeks onward. Structural equation models of their relationships were compared. Insight measures' and DAI's predictive validity were compared against relapse, readmission, and remission. Analysis found five latent constructs best fitted the data: medication attitudes, self-esteem, accepting need for treatment, self-rated insight, and objective insight. All were related and each affected the others as it changed, except self-esteem and medication attitudes. Low self-reported insight at presentation predicted readmission. Good 6-week insight (unlike drug attitudes) predicted remission. Literature review and data modeling indicated that a multimodal intervention using motivational interviewing, online psychoeducation, and SMS text medication reminders to enhance adherence without damaging self-concept was feasible and appropriate.
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Affiliation(s)
- Richard J Drake
- Manchester Academic Health Sciences Centre, Institute of Brain, Behaviour & Mental Health, University of Manchester, Manchester, UK; Manchester Academic Health Sciences Centre, Manchester Mental Health & Social Care NHS Trust, Manchester, UK;
| | - Merete Nordentoft
- Mental Health Centre Copenhagen, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen NV, Denmark
| | - Gillian Haddock
- Manchester Academic Health Sciences Centre, Manchester Mental Health & Social Care NHS Trust, Manchester, UK; Manchester Academic Health Sciences Centre, School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Birte Glenthøj
- Center for Neuropsychiatric Schizophrenia Research and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Psychiatric Hospital Center Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
| | - Marion Leboyer
- INSERM U955, Laboratoire Psychopathologie et génétique des maladies mentales, et AP-HP, DHU Pe-PSY, Pole de Psychiatrie et d'addictologie des Hôpitaux Universitaires Henri Mondor, Université Paris-Est, Créteil, France
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, Technische Universität München, München, Germany
| | - Markus Leweke
- Central Institute of Mental Health, Mannheim, Germany
| | | | | | - Dan Rujescu
- Psychiatry, Molecular and Clinical Neurobiology, Ludwig-Maximilians University, München, München, Germany; Department of Psychiatry, University of Halle, Halle, Germany
| | - Iris E Sommer
- Department of Psychiatry, Brain Center Rudolf Magnus, UMC Utrecht, Utrecht, The Netherlands
| | - René S Kahn
- Department of Psychiatry, Brain Center Rudolf Magnus, UMC Utrecht, Utrecht, The Netherlands
| | - Shon W Lewis
- Manchester Academic Health Sciences Centre, Institute of Brain, Behaviour & Mental Health, University of Manchester, Manchester, UK; Manchester Academic Health Sciences Centre, Manchester Mental Health & Social Care NHS Trust, Manchester, UK
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50
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Scheen L, Brandt L, Bodén R, Tiihonen J, Andersen M, Kieler H, Reutfors J. Predictors for initiation of pharmacological prophylaxis in patients with newly diagnosed bipolar disorder--A nationwide cohort study. J Affect Disord 2015; 172:204-10. [PMID: 25451419 DOI: 10.1016/j.jad.2014.09.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 09/24/2014] [Accepted: 09/25/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Treatment guidelines state that all patients with bipolar disorder should use pharmacological prophylaxis; however the actual use of prophylactic drugs after bipolar disorder diagnosis is unknown. Our aim was to assess the use of, and predictors for, pharmacoprophylaxis in newly diagnosed bipolar disorder patients. METHODS Data from three Swedish nationwide registers were obtained. We identified patients aged 18-75 with a first time diagnosis of bipolar disorder between 2006 and 2012 (n=31,770) and reviewed subsequent mood-stabilizer and antipsychotic prescription fills. In multivariable Cox regression models, we studied demographic and illness related factors as predictors of prescription fills after diagnosis. RESULTS In total, 72.2% (95% confidence interval [CI] 71.7-72.7%) of the patients filled a prescription of a prophylactic drug within 3 months after diagnosis. Pharmacological prophylaxis was mainly associated with a longer duration of hospitalization at bipolar disorder diagnosis (adjusted hazard ratio [AHR] 2.18; CI 2.02-2.35 for a hospitalization of ≥28 days compared to <7 days) and previous use of any mood-stabilizer or antipsychotic (inpatients: AHR 1.24; CI 1.17-1.31 and outpatients: AHR 1.78; CI 1.73-1.84). LIMITATIONS We had no information on drug prescriptions that were never filled. CONCLUSIONS The proportion of newly diagnosed bipolar disorder patients without pharmacological prophylaxis is substantial. Patients who are naïve to mood-stabilizers and antipsychotics and are hospitalized for a brief period at diagnosis are the ones least likely to initiate pharmacoprophylaxis, suggesting that this group deserves attention in order to improve the long term prognosis.
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Affiliation(s)
- Louise Scheen
- Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
| | - Lena Brandt
- Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Robert Bodén
- Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Jari Tiihonen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
| | - Morten Andersen
- Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Helle Kieler
- Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Johan Reutfors
- Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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