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Heekeren K, Antoniadis S, Habermeyer B, Obermann C, Kirschner M, Seifritz E, Rössler W, Kawohl W. Psychiatric Acute Day Hospital as an Alternative to Inpatient Treatment. Front Psychiatry 2020; 11:471. [PMID: 32523556 PMCID: PMC7261862 DOI: 10.3389/fpsyt.2020.00471] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 05/07/2020] [Indexed: 11/13/2022] Open
Abstract
For the first time in the Swiss health care system, this evaluation study examined whether patients with acute psychiatric illness who were admitted for inpatient treatment could be treated in an acute day hospital instead. The acute day hospital is characterized by the possibility of direct admission of patients without preliminary consultation or waiting time and is open every day of the week. In addition, it was examined whether and to what extent there are cost advantages for day hospital treatment. Patients who were admitted to the hospital with a referral to an inpatient admission were treated randomly either fully inpatient or in the acute day hospital. As a pilot study, 44 patients were admitted to the study. Evidence of efficacy could be provided for both treatment settings based on significant reduction in psychopathological symptoms and improvement in functional level in the course of treatment. There were no significant differences between the two settings in terms of external assessment of symptoms, subjective symptom burden, functional level, quality of life, treatment satisfaction, and number of treatment days. Treatment in the day hospital was about 45% cheaper compared to inpatient treatment. The results show that acutely ill psychiatric patients of different symptom severity can be treated just as well in an acute day hospital instead of being admitted to the hospital. In addition, when direct treatment costs are considered, there are clear cost advantages for day hospital treatment.
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Affiliation(s)
- Karsten Heekeren
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland.,Department of Psychiatry and Psychotherapy I, LVR-Hospital Cologne, Cologne, Germany
| | - Sofia Antoniadis
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland.,Department of Psychiatry and Psychotherapy, Psychiatric Services Aargau, Brugg, Switzerland
| | - Benedikt Habermeyer
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland.,Department of Psychiatry and Psychotherapy, Psychiatric Services Aargau, Brugg, Switzerland
| | - Caitriona Obermann
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Matthias Kirschner
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland.,McConnell Brain Imaging Centre, Montréal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Wulf Rössler
- Department of Psychiatry and Psychotherapy, Charité University Medicine, Berlin, Germany
| | - Wolfram Kawohl
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland.,Department of Psychiatry and Psychotherapy, Psychiatric Services Aargau, Brugg, Switzerland
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Pausch K, Nordt C, Pichler EM, Warnke I, Seifritz E, Kawohl W. [Acute day hospital as a cost-effective alternative to inpatient therapy]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2017; 31:63-69. [PMID: 28265867 DOI: 10.1007/s40211-017-0221-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 02/20/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND This is a study of the cost-benefit advantage of the model project acute day hospital (ATK) compared to inpatient care. METHODS The study was performed retrospectively and examined the direct costs and the Global Assessment of Functioning (GAF) in a matched sample. RESULTS The day clinic treatment compared to inpatient therapy showed at a cost benefit of 2.68: 1 at a slightly delayed increase in GAF-value. CONCLUSION The treatment in ATK is more than twice as cheap compared to inpatient treatment, but at a slightly slower improvement in symptoms.
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Affiliation(s)
- Kunigunde Pausch
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik/Zentrum für Soziale Psychiatrie, Psychiatrische Universitätsklinik Zürich, Militärstrasse 8, 8021, Zürich, Schweiz.
| | - Carlos Nordt
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik/Zentrum für Soziale Psychiatrie, Psychiatrische Universitätsklinik Zürich, Militärstrasse 8, 8021, Zürich, Schweiz
| | | | - Ingeborg Warnke
- Forensisch-Psychiatrischer Dienst (FPD), Institut für Rechtsmedizin, Universität Bern, Bern, Schweiz
| | - Erich Seifritz
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik/Zentrum für Soziale Psychiatrie, Psychiatrische Universitätsklinik Zürich, Militärstrasse 8, 8021, Zürich, Schweiz
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Marshall M, Crowther R, Sledge WH, Rathbone J, Soares‐Weiser K. Day hospital versus admission for acute psychiatric disorders. Cochrane Database Syst Rev 2011; 2011:CD004026. [PMID: 22161384 PMCID: PMC4160006 DOI: 10.1002/14651858.cd004026.pub2] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Inpatient treatment is an expensive way of caring for people with acute psychiatric disorders. It has been proposed that many of those currently treated as inpatients could be cared for in acute psychiatric day hospitals. OBJECTIVES To assess the effects of day hospital versus inpatient care for people with acute psychiatric disorders. SEARCH METHODS We searched the Cochrane Schizophrenia Group Trials Register (June 2010) which is based on regular searches of MEDLINE, EMBASE, CINAHL and PsycINFO. We approached trialists to identify unpublished studies. SELECTION CRITERIA Randomised controlled trials of day hospital versus inpatient care, for people with acute psychiatric disorders. Studies were ineligible if a majority of participants were under 18 or over 65, or had a primary diagnosis of substance abuse or organic brain disorder. DATA COLLECTION AND ANALYSIS Two review authors independently extracted and cross-checked data. We calculated risk ratios (RR) and 95% confidence intervals (CI) for dichotomous data. We calculated weighted or standardised means for continuous data. Day hospital trials tend to present similar outcomes in slightly different formats, making it difficult to synthesise data. We therefore sought individual patient data so that we could re-analyse outcomes in a common format. MAIN RESULTS Ten trials (involving 2685 people) met the inclusion criteria. We obtained individual patient data for four trials (involving 646 people). We found no difference in the number lost to follow-up by one year between day hospital care and inpatient care (5 RCTs, n = 1694, RR 0.94 CI 0.82 to 1.08). There is moderate evidence that the duration of index admission is longer for patients in day hospital care than inpatient care (4 RCTs, n = 1582, WMD 27.47 CI 3.96 to 50.98). There is very low evidence that the duration of day patient care (adjusted days/month) is longer for patients in day hospital care than inpatient care (3 RCTs, n = 265, WMD 2.34 days/month CI 1.97 to 2.70). There is no difference between day hospital care and inpatient care for the being readmitted to in/day patient care after discharge (5 RCTs, n = 667, RR 0.91 CI 0.72 to 1.15). It is likely that there is no difference between day hospital care and inpatient care for being unemployed at the end of the study (1 RCT, n = 179, RR 0.88 CI 0.66 to 1.19), for quality of life (1 RCT, n = 1117, MD 0.01 CI -0.13 to 0.15) or for treatment satisfaction (1 RCT, n = 1117, MD 0.06 CI -0.18 to 0.30). AUTHORS' CONCLUSIONS Caring for people in acute day hospitals is as effective as inpatient care in treating acutely ill psychiatric patients. However, further data are still needed on the cost effectiveness of day hospitals.
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Affiliation(s)
- Max Marshall
- The Lantern CentreUniversity of ManchesterVicarage LaneOf Watling Street Road, FulwoodPreston.LancashireUK
| | - Ruth Crowther
- University of QueenslandSchool of Population HealthHerston RoadHerstonQueenslandAustralia4006
| | - William Hurt Sledge
- Yale UniversityYale New Haven Psychiatric Hospital131 Underhill RoadHamdenConnecticuttUSACT 06517
| | - John Rathbone
- The University of SheffieldHEDS, ScHARRRegent Court30 Regent StreetSheffieldUKS1 4DA
| | - Karla Soares‐Weiser
- Enhance Reviews LtdCentral Office, Cobweb BuildingsThe Lane, LyfordWantageUKOX12 0EE
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Larivière N, Desrosiers J, Tousignant M, Boyer R. Multifaceted impact evaluation of a day hospital compared to hospitalization on symptoms, social participation, service satisfaction and costs associated to service use. Int J Psychiatry Clin Pract 2011; 15:228-40. [PMID: 22121934 DOI: 10.3109/13651501.2011.572170] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study compared clinical and functional changes, satisfaction with services and costs associated to service use, in participants treated in a day hospital for adults and seniors organized by diagnostic groups, with clients hospitalised. METHODS A quasi-experimental design was used. The experimental group was composed of clients (N = 40) treated in a day hospital. The comparison group included clinically and demographically similar clients hospitalised in the same institution (N = 13). Outcomes were symptoms, social participation, self-esteem, service satisfaction, utilization and associated costs. RESULTS During the index intervention, the level of improvement was significantly greater in the day hospital group regarding symptoms (P = 0.047), self-esteem (P = 0.01) and social participation (accomplishment: P = 0.02; satisfaction: P = 0.008). Following discharge, there was no significant difference in the level of change between the two groups on all variables. Day hospital participants were significantly more satisfied of several dimensions of services (P ≤ 0.01). Comparison of total mean costs of services used 6 months before and after index treatment showed a cost reduction of 38% in the day hospital group and 7% in the hospitalisation group. CONCLUSIONS Day hospitals organized by diagnostic groups lead to positive clinical and economical outcomes over time.
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Affiliation(s)
- Nadine Larivière
- École de Réadaptation, Université de Sherbrooke and Centre de recherche Fernand-Seguin, Hôpital Louis-H. Lafontaine, Québec, Canada.
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Larivière N, Boyer R. [Revisiting the therapeutic experience in a psychiatric day hospital six months after discharge: path and perceptions of people with mental disorders]. SANTE MENTALE AU QUEBEC 2011; 36:75-97. [PMID: 21983906 DOI: 10.7202/1005815ar] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This article presents a qualitative study on the therapeutic experience in a psychiatric day hospital six months after discharge. The study explores the impact of this experience on the lives of people with mental disorders. A qualitative design using semi-structured individual interviews was completed with 18 participants six months after their discharge of a day hospital. Results showed that the day hospital experience was particularly helpful to improve symptoms and relationship with self. It activated a self-transformational process that continued afterwards. Termination created for many, an abrupt void. Issues at stake during the first six months were continuity of care, social support and maintaining skills and knowledge acquired.
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Affiliation(s)
- Nadine Larivière
- École de Réadaptation, Université de Sherbrooke, Centre Affilié Universitaire CSSS-IUGS, Centre de Recherche Fernand-Seguin, Hôpital Louis-H. Lafontaine
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Abstract
Comparison of the effects of psychiatric day hospital programs between homogenous clinical groups is an important issue that requires more attention. One group of day hospital patients who have not been included in most studies are people with cluster B personality disorders. The purpose of this study was to compare clinical and social participation outcomes in three groups of individuals treated in a psychiatric day hospital: patients with psychotic disorders, patients with mood and anxiety disorders, and patients with cluster B personality disorders. A pre-experimental, pre-test post-test design was used. During the first and last week of treatment, as well as 6 months after discharge, 20 participants in each group completed questionnaires on severity of symptoms, distress, accomplishment, satisfaction with social participation, and self-esteem. During the intervention, there was significant improvement in all groups on all variables, except for self-esteem in people with psychotic disorders, which remained stable. The patients with psychotic disorders showed significantly less improvement than the two other groups in severity of symptoms, distress, and self-esteem. Following discharge, the degree of change was comparable in the three groups on all variables based on between-groups analyses. However, based on within-group analyses, patients in the mood and anxiety disorders group continued to show significant improvement over time after discharge on self-esteem, accomplishment, and satisfaction with social participation, while no significant changes were seen in the other two groups. Although all three clinical groups made significant gains during their participation at the day hospital and maintained these gains after discharge, those with mood and anxiety disorders benefited the most from their day hospital experience.
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Shek E, Stein AT, Shansis FM, Marshall M, Crowther R, Tyrer P. Day hospital versus outpatient care for people with schizophrenia. Cochrane Database Syst Rev 2009; 2009:CD003240. [PMID: 19821303 PMCID: PMC7003561 DOI: 10.1002/14651858.cd003240.pub2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND This review considers the use of day hospitals as an alternative to outpatient care. Two types of day hospital are covered by the review: 'day treatment programmes' and 'transitional' day hospitals. Day treatment programmes offer more intense treatment for people who have failed to respond to outpatient care. Transitional day hospitals offer time-limited care to people who have just been discharged from inpatient care. OBJECTIVES To assess effects of day hospital care as an alternative to continuing outpatient care for people with schizophrenia and and other similar severe mental illness. SEARCH STRATEGY We searched the Cochrane Schizophrenia Group Trials Register (May 2009) and references of all identified studies for further citations. If necessary, we also contacted authors of trials for further information. SELECTION CRITERIA Randomised controlled trials comparing day hospital care with outpatient care for those with schizophrenia and other similar severe mental illness. DATA COLLECTION AND ANALYSIS We extracted and cross-checked data independently. We analysed dichotomous data using fixed-effect relative risk (RR) and estimated the 95% confidence interval (CI). If continuous data were included, we analysed this data using the random-effects weighted mean difference (MD) with a 95% confidence interval. MAIN RESULTS We identified four relevant trials all dating from before 1986 (total n=309 participants); all but one of which (n=37) evaluated day treatment centres. Across time less people allocated to day hospital care tend to be admitted to hospital (beyond one year: n=242, 2 RCTs, RR 0.71 CI 0.56 to 0.89 day treatment centres) but data are heterogeneous (I(2) =74% P=0.05) and should not be taken into account. Data on time spent as an inpatient seem to support this finding but are poorly reported. We found no clear difference between day hospital and outpatient care for the outcome of 'lost to follow up' (at six months: n=147, 3 RCTs, RR 0.97 CI 0.48 to 1.95; at 12 months: n=117, 2 RCTs, RR 0.97 CI 0.48 to 1.95 day treatment centres / transitional day hospital). Scale derived findings on social functioning are equivocal (SAS: n=37, 1 RCT, MD 0.36 CI -0.07 to 0.79 transitional day hospital) but there was some suggestion from small studies that day hospital care may decrease the risk of unemployment (at 12 months: n=80, 1 RCT, RR 0.86 CI 0.69 to 1.06 day treatment centre). Different measures of mental state showed no convincing effect (Symptom Check List: n=30, 1 RCT, MD -90 0.31 CI -0.20 to 0.82 day treatment centre). Poorly reported economic data from decades ago suggested that day hospitals were more costly to establish and run than outpatient care but took no account of other costs such as inpatient stay. AUTHORS' CONCLUSIONS Evidence is limited and dated. Day hospital care may help avoid inpatient care but data are lacking on missing on a raft of outcomes that are now considered important, such as quality of life, satisfaction, healthy days, and cost.
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Affiliation(s)
- Elena Shek
- Institute of Clinical Research India242A, 13th Cross, CMH RoadBangaloreKarnatakaIndia560038
| | - Airton T Stein
- Universidade Federal de Ciências da SaúdeDepartment of Public HealthUlbra and Grupo Hospitalar ConceiçãoPorto AlegreBrazil9
| | | | - Max Marshall
- The Lantern CentreUniversity of ManchesterVicarage LaneOf Watling Street Road, FulwoodPreston.LancashireUK
| | - Ruth Crowther
- University of QueenslandSchool of Population HealthHerston RoadHerstonQueenslandAustralia4006
| | - Peter Tyrer
- Imperial CollegeDepartment of PsychologicalSt Dunstan's RoadLondonUKW6 8RP
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8
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Larivière N, Melançon L, Fortier L, David P, Cournoyer J, Baril MC, Bisson J. A Qualitative Analysis of Clients' Evaluation of a Psychiatric Day Hospital. ACTA ACUST UNITED AC 2009. [DOI: 10.7870/cjcmh-2009-0013] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Nadine Larivière
- École de réadaption, Université de Sherbrooke, and Hôpital Louis-H. Lafontaine, Montréal, Québec
| | | | | | - Pierre David
- Hôpital Louis-H. Lafontaine, and Département de psychiatrie, Université de Montréal, Québec
| | - Jocelyne Cournoyer
- Hôpital Louis-H. Lafontaine, and Département de psychiatrie, Université de Montréal, Québec
| | - Marie-Claire Baril
- University of British Columbia, Université de Montréal, and British Columbia Neuropsychiatry Program and Geriatric Psychiatry Program, Hillside Centre, Kamloops
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9
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Marshall M, Crowther R, Almaraz-Serrano A, Creed F, Sledge W, Kluiter H, Roberts C, Hill E, Wiersma D. Day hospital versus admission for acute psychiatric disorders. Cochrane Database Syst Rev 2003:CD004026. [PMID: 12535505 DOI: 10.1002/14651858.cd004026] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Inpatient treatment is an expensive way of caring for people with acute psychiatric disorders. It has been proposed that many of those currently treated as inpatients could be cared for in acute psychiatric day hospitals. OBJECTIVES To assess the effects of day hospital versus inpatient care for people with acute psychiatric disorders. SEARCH STRATEGY We searched the Cochrane Controlled Trials Register (Cochrane Library, issue 4, 2000), MEDLINE (January 1966 to December 2000), EMBASE (1980 to December 2000), CINAHL (1982 to December 2000), PsycLIT (1966 to December 2000), and the reference lists of articles. We approached trialists to identify unpublished studies. SELECTION CRITERIA Randomised controlled trials of day hospital versus inpatient care, for people with acute psychiatric disorders. Studies were ineligible if a majority of participants were under 18 or over 65, or had a primary diagnosis of substance abuse or organic brain disorder. DATA COLLECTION AND ANALYSIS Data were extracted independently by two reviewers and cross-checked. Relative risks and 95% confidence intervals (CI) were calculated for dichotomous data. Weighted or standardised means were calculated for continuous data. Day hospital trials tend to present similar outcomes in slightly different formats, making it difficult to synthesise data. Individual patient data were therefore sought so that outcomes could be reanalysed in a common format. MAIN RESULTS Nine trials (involving 1568 people) met the inclusion criteria. Individual patient data were obtained for four trials (involving 594 people). Combined data suggested that, at the most pessimistic estimate, day hospital treatment was feasible for 23% (n=2268, CI 21 to 25) of those currently admitted to inpatient care. Individual patient data from three trials showed no difference in number of days in hospital between day hospital patients and controls (n=465, 3 RCTs, WMD -0.38 days/month CI -1.32 to 0.55). However, compared to controls, people randomised to day hospital care spent significantly more days in day hospital care (n=265, 3 RCTs, WMD 2.34 days/month CI 1.97 to 2.70) and significantly fewer days in inpatient care (n=265, 3 RCTs, WMD -2.75 days/month CI -3.63 to -1.87). There was no significant difference in readmission rates between day hospital patients and controls (n=667, 5 RCTs, RR 0.91 CI 0.72 to 1.15). For patients judged suitable for day hospital care, individual patient data from three trials showed a significant time-treatment interaction, indicating a more rapid improvement in mental state (n=407, Chi-squared 9.66, p=0.002), but not social functioning (n=295, Chi-squared 0.006, p=0.941) amongst patients treated in the day hospital. Four of five trials found that day hospital care was cheaper than inpatient care (with cost reductions ranging from 20.9 to 36.9%). REVIEWER'S CONCLUSIONS Caring for people in acute day hospitals can achieve substantial reductions in the numbers of people needing inpatient care, whilst improving patient outcome.
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Affiliation(s)
- M Marshall
- Department of Community Psychiatry, University of Manchester, Academic Unit, Royal Preston Hospital, Sharoe Green Lane, Fulwood, Preston., Lancashire, UK, PR2 4HT.
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Marshall M, Crowther R, Almaraz-Serrano AM, Tyrer P. Day hospital versus out-patient care for psychiatric disorders. Cochrane Database Syst Rev 2001:CD003240. [PMID: 11687059 DOI: 10.1002/14651858.cd003240] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND This review considers the use of day hospitals as an alternative to out-patient care. Three types of day hospital are covered by the review: 'day treatment programmes', 'day care centres' and 'transitional' day hospitals. Day treatment programmes offer more intense treatment for patients who have failed to respond to out-patient care (usually patients with affective or personality disorders). Day care centres offer structured support to patients with long-term severe mental disorders (mainly schizophrenia), who would otherwise be treated in the out-patient clinic. Transitional day hospitals offer time-limited care to patients who have just been discharged from in-patient care. OBJECTIVES The review had three objectives. First, to assess the effectiveness of day treatment programmes versus out-patient care for people with treatment-refractory disorders. Second, to assess the effectiveness of day care centres versus out-patient care for people with severe long term disorders. Third, to assess the effectiveness of transitional day hospital care for people who had just been discharged from hospital. SEARCH STRATEGY We searched the Cochrane Controlled Trials Register (Cochrane Library, issue 4, 2000), MEDLINE (January 1966 to December 2000), EMBASE (1980 to December 2000), CINAHL (1982 to December 2000), Psyc LIT (1966 to December 2000), and the reference lists of articles. Researchers were approached to identify unpublished studies. SELECTION CRITERIA Randomised controlled trials comparing day hospital care (including day treatment programme, day care centre, and transitional day hospital) against out-patient care. Studies were ineligible if a majority of participants were under 18 or over 65, or who had a primary diagnosis of substance abuse or organic brain disorder. DATA COLLECTION AND ANALYSIS Data were extracted independently by two reviewers and cross-checked. Relative risks and 95% confidence intervals (CI) were calculated for dichotomous data. Weighted or standardised means were calculated for continuous data. MAIN RESULTS There was evidence from one trial suggesting that day treatment programmes were superior to continuing out-patient care in terms of improving psychiatric symptoms. There was no evidence that day treatment programmes were better or worse than out-patient care on any other clinical or social outcome variable, or on costs. There was no evidence that day care centres were better or worse than out-patient care on any clinical or social outcome variable. There were some inconclusive data on costs suggesting that day care centres might be more expensive than out-patient care. There was evidence from one trial suggesting that transitional day hospital care was superior to out-patient care in keeping patients engaged in treatment, however there was insufficient evidence to judge whether it was better or worse on any other clinical or social outcome variable, or on costs. REVIEWER'S CONCLUSIONS There is only limited evidence to justify the provision of day treatment programmes and transitional day hospital care, and no evidence to support the provision of day care centres.
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Affiliation(s)
- M Marshall
- School of Psychiatry and Behavioural Sciences, University of Manchester, Academic Unit, Royal Preston Hospital, Sharoe Green Lane, Fulwood, Preston., Lancashire, UK, PR2 4HT.
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Averill PM, Hopko DR, Small DR, Greenlee HB, Varner RV. The role of psychometric data in predicting inpatient mental health service utilization. Psychiatr Q 2001; 72:215-35. [PMID: 11467156 DOI: 10.1023/a:1010396831037] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Inpatient mental health readmission rates have increased dramatically in recent years, with a subset of consumers referred to as revolving-door patients. In an effort to reduce the financial burden associated with these patients and increase treatment efficacy, researchers have begun to explore factors associated with increased service utilization. To date, predictors of increased service usage are remarkably discrepant across studies. Further exploration, therefore, is needed to better explicate the relevance of "traditional" predictors and also to identify alternate strategies that may assist in predicting rehospitalization. One method that may be helpful in identifying patients at high risk is the development of a psychometric screening procedure. As a means to this end, the present study was designed to assess the potential usefulness of psychometric data in predicting mental health service utilization. The sample consisted of 131 patients hospitalized during an index period of 8 months at an acute-care psychiatric hospital. Number of readmissions was recorded in a 9 month post-index period. Measures completed during the index admission included the Brief Psychiatric Rating Scale-Anchored (BPRS-A), Symptom Checklist-90-Revised (SCL-90-R), Kaufman Brief Intelligence Test (K-BIT), and the Beck Depression Inventory (BDI). Results indicated that psychometric data accounted for significant variance in predicting past, present and future mental health service utilization. The BPRS-A, SCL-90-R, and BDI show particular promise as time efficient psychometric screening instruments that may better enable practitioners to identify patients proactively who are at increased risk for rehospitalization. Implications are discussed with regard to patient-treatment matching and discharge planning.
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Affiliation(s)
- P M Averill
- University of Texas-Houston Medical School and the Harris County Psychiatric Center, Houston, TX 77021, USA
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12
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Potvin Kent M, Busby K, Johnston M, Wood J, Docherty C. Predictors of outcome in a short-term psychiatric day hospital program. Gen Hosp Psychiatry 2000; 22:184-94. [PMID: 10880713 DOI: 10.1016/s0163-8343(00)00061-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study assessed selected chronicity, social support, and personality variables as predictors of outcome in a 3-week psychiatric day hospital program. Measured outcome included pre- and post-treatment scores on the BDI, STAI, and SCL-90-R from 224 patients. A single outcome variable based on the average standardized residual changes scores for these measures was derived to assess whether symptom severity at discharge was greater or less than predicted. Predictor variables were analysed using multiple regression. Chronicity variables predicted outcome, with patients hospitalized more than once and those with personality disorders more symptomatic than expected after treatment. Social support and personality variables failed to predict outcome; however, patients who scored higher on the MMPI Si scale were more symptomatic than expected at discharge. Although these results possess marginal clinical utility in terms of accounting for symptom change variation, this study overcame some methodological difficulties seen in prior day hospital literature. Future research should consider a prospective approach, including random treatment assignment, comprehensive and diverse outcome measures, and exploration of specific diagnostic groups.
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Affiliation(s)
- M Potvin Kent
- Department of Psychiatry, Ottawa Hospital-General Campus, Ottawa, Canada
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Gillis K, Russell VR, Busby K. Factors associated with unplanned discharge from psychiatric day treatment programs. A multicenter study. Gen Hosp Psychiatry 1997; 19:355-61. [PMID: 9328780 DOI: 10.1016/s0163-8343(97)00052-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This study describes and evaluates the adequacy of sociodemographic and clinical descriptors as potential predictors of unplanned discharge from and completion of psychiatric day treatment programs. A 2-year retrospective chart review was completed on all patients (N = 327) attending three university-affiliated day treatment programs. Statistical comparisons were made between those patients who completed and those who had unplanned discharge. Logistic regression was used to generate a predictive model of unplanned discharge using identified variables. The rate of unplanned discharge was 54%. Factors associated with program completion were diagnoses of major depression or posttraumatic stress disorder, a history of completing a prior day treatment program, and higher education levels. Active substance abuse and a history of three or more inpatient admissions were associated with unplanned discharge. The predictive model was able to correctly classify 71% of patients completing day treatment programs and 43% of patients with unplanned discharges. Traditional demographic and clinical variables contribute differentially to program completion/noncompletion. Given the relatively poor predictability of unplanned discharge in this study, patient selection practices based on these factors alone may be somewhat limiting. Interactive effects of patient and program characteristics need to be addressed to improve program outcome.
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Affiliation(s)
- K Gillis
- Department of Psychiatry, University of Ottawa, Ontario, Canada
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