Risk factors for readmission among a cohort of psychiatric inpatients in Lilongwe, Malawi

Influencing factors of medication adherence in schizophrenic patients: a meta-analysis

Medication adherence of schizophrenic patients is a growing public health problem. We conducted a meta-analysis on the influencing factors of medication compliance in schizophrenic patients. We searched PubMed, Embase, Cochrane Library, and Web Of Science for relevant articles published up to December 22, 2022. Combined odds ratios (ORs) and 95% confidence intervals (CIs) were used to assess influencing factors. Egger's test, funnel plot, the trim and fill method, and meta-regression analysis were used to assess publication bias. A total of 20 articles were included in the analysis. Twenty influencing factors were divided into seven categories: drug factors (OR = 1.96, 95% CI: 1.48-2.59), problem behavior (OR = 1.77, 95% CI: 1.43-2.19), income and quality of life (OR = 1.23, 95% CI: 1.08-1.39), personal characteristics (OR = 1.21, 95% CI: 1.14-1.30), disease factors (OR = 1.14, 95% CI: 1.98-1.21), support level (OR = 0.54, 95% CI: 0.42-0.70), and positive attitude and behavior (OR = 0.52, 95% CI: 0.45-0.62). This meta-analysis found that drug factors, disease factors, problem behavior, low income and quality of life, and factors related to personal characteristics appear to be risk factors for medication adherence in people with schizophrenia. And support level, positive attitude and behavior appear to be protective factors.

Readmission of Patients to Acute Psychiatric Hospitals: Influential Factors and Interventions to Reduce Psychiatric Readmission Rates

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.

Time to readmission in psychiatric inpatients with a therapeutic leave

AIMS

Interventions to decrease readmissions in psychiatric patients are urgently needed. In Switzerland therapeutic leave (TL) composes a cornerstone of inpatient treatment. TL is a planned time-limited absence from the inpatient ward giving patients the opportunity to test their resilience in their usual environment. Evidence of its applicability as an intervention reducing readmissions is lacking. Therefore, our objective was to examine the association between TL and readmission risk.

METHODS

Using the Kaplan-Meier curve we compared the time to readmission of 3'302 inpatients at the UPK Basel with and without TL. Cox regression was applied, integrating other covariates associated with readmission.

RESULTS

The Kaplan-Meier curve indicated longer cumulative survival in patients with TL. The log-rank test implied statistical significance (χ²(1) = 18.8, p < .05). The Cox regression showed a reduced hazard for patients with TL (HR = 0.735, CI 95% = [0.639, 0.846], p < .001) and for involuntarily hospitalized patients (HR = 0.760, CI 95% = [0.618, 0.934], p < .01). A higher readmission risk was found for a history of psychiatric admissions (HR = 1.005, CI 95% = [1.004, 1.005], p < .001), higher severity of symptoms at admission (HR = 1.029, CI 95% = [1.018, 1.040], p < .001), comorbidity (HR = 1.178, CI 95% [1.024, 1.355], p = .022), and a diagnosis with schizophrenia-spectrum disorders (HR = 1.401, CI 95% [1.164, 1.687], p = .001).

CONCLUSION

Linking TL with readmission risk, our results imply an easy way to improve quality of care, with possible implications for practice, policies and quality interventions. TL might be suitable to enhance recovery, reduce readmissions and health care costs. RCTs are needed for validation.

Disease-dependent variations in the timing and causes of readmissions in Germany: A claims data analysis for six different conditions

BACKGROUND

Hospital readmissions place a major burden on patients and health care systems worldwide, but little is known about patterns and timing of readmissions in Germany.

METHODS

We used German health insurance claims (AOK, 2011-2016) of patients ≥ 65 years hospitalized for acute myocardial infarction (AMI), heart failure (HF), a composite of stroke, transient ischemic attack, or atrial fibrillation (S/AF), chronic obstructive pulmonary disease (COPD), type 2 diabetes mellitus, or osteoporosis to identify hospital readmissions within 30 or 90 days. Readmissions were classified into all-cause, specific, and non-specific and their characteristics were analyzed.

RESULTS

Within 30 and 90 days, about 14-22% and 27-41% index admissions were readmitted for any reason, respectively. HF and S/AF contributed most index cases, and HF and COPD accounted for most all-cause readmissions. Distributions and ratios of specific to non-specific readmissions were disease-specific with highest specific readmissions rates among COPD and AMI.

CONCLUSION

German claims are well-suited to investigate readmission causes if longer periods than 30 days are evaluated. Conditions closely related with the primary disease are the most frequent readmission causes, but multiple comorbidities among readmitted cases suggest that a multidisciplinary care approach should be implemented vigorously addressing comorbidities already during the index hospitalization.

Characterization of the medication regimen complexity index in high-utilizer, adult psychiatric patients

Introduction

Few studies have examined the role of medication-related factors in psychiatric readmissions. Our objective was to characterize the medication regimen complexity index (MRCI) and assess its association with psychiatric hospital readmission frequency and time to readmission in a high-utilizer psychiatric cohort.

Methods

Adult patients admitted between July 2012 and March 2014 were identified if discharged from an inpatient psychiatry service with greater than or equal to 5 psychiatric readmissions or at least one 30-day readmission. Complexity of the medication regimen was determined using a validated MRCI electronic capture tool.

Results

One hundred sixty-eight patients were included. Average MRCI for all readmissions was 7.09 for psychotropic medications, 5.90 for other prescription medications, 2.98 for over the counter, and 16.00 for total medications. Ages greater than 65 years old and female sex were associated with higher total MRCI scores. Average MRCI for psychotropic medications and average psychotropic medication count, along with depression diagnosis, were found to be significantly associated with average time between each readmission but not with readmission frequency. An average total MRCI score greater than 19.7, when broken down by percentiles, was associated with a shorter time to readmission.

Discussion

Psychotropic regimen complexity, psychotropic medication count, total MRCI greater than 19.7, and a diagnosis of depression may contribute to a shorter time to readmission in adult psychiatric patients with a history of frequent readmissions. Future studies are needed to confirm findings and evaluate clinical significance and impact.