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Chevreul K, Gandré C, Gervaix J, Thillard J, Alberti C, Meurs D. Gender and access to professorships in academic medical settings in France. Med Educ 2018; 52:1073-1082. [PMID: 30125395 DOI: 10.1111/medu.13633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 12/21/2017] [Accepted: 05/02/2018] [Indexed: 06/08/2023]
Abstract
CONTEXT Previous studies, mainly originating from North America, suggest that women are less likely than men to obtain professorships in academic medical settings. However, research providing a comprehensive picture of such gender disparities in other national contexts and addressing associated contextual factors is lacking. OBJECTIVES Our objectives were to assess gender differences in access to professorships in academic medical settings in France, to determine their evolution across regions and medical specialties and over time, and to identify the factors associated with the likelihood of a professor being a woman. METHODS We carried out a national administrative cohort study of all new professors appointed during 1989-2015 in all medical specialties in the whole of France. We first conducted a descriptive analysis of the percentage of professorships awarded to women and its variations by time, region and specialty. We then ran a logistic regression model to determine factors significantly associated with the likelihood of a professor being a woman. RESULTS Between 1989 and 2015, 3950 professors were appointed, of whom fewer than one in five were women. Female professors consistently represented a minority in all French regions and specialties over the study period. Although a small increase was observed over the years, women never represented more than 29% of newly appointed professors. After adjustments for other factors, the likelihood of a professor being a woman was significantly higher in specialties with a higher percentage of women among hospital practitioners, in regions with higher numbers of appointed professors and in recent years. CONCLUSIONS Gender inequalities in career evolution exist in academic medical settings in France and have continued over time despite moderate improvements. Increased awareness based on scientific evidence is a first step towards reducing such inequalities.
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Affiliation(s)
- Karine Chevreul
- UMRS 1123, Clinical Epidemiology and Economic Evaluation applied to Vulnerable Populations (Epidémiologie Clinique et Évaluation Économique appliquée aux Populations Vulnérables [ECEVE]), Paris Diderot University, Paris, France
- French National Institute of Health and Medical Research (Institut National de la Santé et de la Recherche Médicale [Inserm]), U1123, ECEVE, Paris, France
- URC-Eco, Public Service Hospitals of Paris (Assistance Publique-Hopitaux de Paris [AP-HP]), Paris, France
| | - Coralie Gandré
- UMRS 1123, Clinical Epidemiology and Economic Evaluation applied to Vulnerable Populations (Epidémiologie Clinique et Évaluation Économique appliquée aux Populations Vulnérables [ECEVE]), Paris Diderot University, Paris, France
- French National Institute of Health and Medical Research (Institut National de la Santé et de la Recherche Médicale [Inserm]), U1123, ECEVE, Paris, France
- URC-Eco, Public Service Hospitals of Paris (Assistance Publique-Hopitaux de Paris [AP-HP]), Paris, France
| | - Jeanne Gervaix
- UMRS 1123, Clinical Epidemiology and Economic Evaluation applied to Vulnerable Populations (Epidémiologie Clinique et Évaluation Économique appliquée aux Populations Vulnérables [ECEVE]), Paris Diderot University, Paris, France
- French National Institute of Health and Medical Research (Institut National de la Santé et de la Recherche Médicale [Inserm]), U1123, ECEVE, Paris, France
- URC-Eco, Public Service Hospitals of Paris (Assistance Publique-Hopitaux de Paris [AP-HP]), Paris, France
| | - Julien Thillard
- UMRS 1123, Clinical Epidemiology and Economic Evaluation applied to Vulnerable Populations (Epidémiologie Clinique et Évaluation Économique appliquée aux Populations Vulnérables [ECEVE]), Paris Diderot University, Paris, France
- French National Institute of Health and Medical Research (Institut National de la Santé et de la Recherche Médicale [Inserm]), U1123, ECEVE, Paris, France
- URC-Eco, Public Service Hospitals of Paris (Assistance Publique-Hopitaux de Paris [AP-HP]), Paris, France
| | - Corinne Alberti
- UMRS 1123, Clinical Epidemiology and Economic Evaluation applied to Vulnerable Populations (Epidémiologie Clinique et Évaluation Économique appliquée aux Populations Vulnérables [ECEVE]), Paris Diderot University, Paris, France
- French National Institute of Health and Medical Research (Institut National de la Santé et de la Recherche Médicale [Inserm]), U1123, ECEVE, Paris, France
- Clinical Epidemiology Unit, Robert-Debré Hospital, AP-HP, Paris, France
| | - Dominique Meurs
- EconomiX, University of Paris Nanterre, Paris, France
- National Institute for Demographic Studies (Institut National d'Études Démographiques [INED]), Paris, France
- Centre for Applied Economic Research (Centre pour la Recherche Économique et ses Applications [CEPREMAP]), Paris, France
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Gandré C, Gervaix J, Thillard J, Macé JM, Roelandt JL, Chevreul K. Understanding geographic variations in psychiatric inpatient admission rates: width of the variations and associations with the supply of health and social care in France. BMC Psychiatry 2018; 18:174. [PMID: 29871613 PMCID: PMC5989448 DOI: 10.1186/s12888-018-1747-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 05/15/2018] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Inpatient care accounts for the majority of mental health care costs and is not always beneficial. It can indeed have detrimental consequences if not used appropriately, and is unpopular among patients. As a consequence, its reduction is supported by international recommendations. Varying rates of psychiatric inpatient admissions therefore deserve to draw attention of researchers, clinicians and policy makers alike as such variations can challenge quality, equity and efficiency of care. In this context, our objectives were first to describe variations in psychiatric inpatient admission rates across the whole territory of mainland France, and second to identify their association with characteristics of the supply of care, which can be targeted by dedicated health policies. METHODS Our study was carried out in French psychiatric sectors' catchment areas for the year 2012. Inpatient admission rates per 100,000 adult inhabitants were calculated using data from the national psychiatric discharge database. Their variations were described numerically and graphically. We then carried out a negative binomial regression to identify characteristics of the supply of care (public and private care, health and social care, hospital and community-based care, specialised and non-specialised care) which were associated with these variations while adjusting our analysis for other relevant factors, in particular epidemiological differences. RESULTS Considerable variations in inpatient admission rates were observed between psychiatric sectors' catchment areas and were widespread on the French territory. Institutional characteristics of the hospital to which each sector was linked (private non-profit status, specialisation in psychiatry and participation to teaching activities and to emergency care) were associated with inpatient admission rates. Similarly, an increase in the availability of community-based private psychiatrists was associated with a decrease in the inpatient admission rate while an increase in the capacity of housing institutions for disabled individuals was associated with an increase in this rate. CONCLUSIONS Our results advocate for a homogenous repartition of health and social care for mental disorders in lines with the health needs of the population served. This should apply particularly to community-based private psychiatrists, whose heterogeneity of repartition has often been underscored.
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Affiliation(s)
- Coralie Gandré
- ECEVE, UMRS 1123, Université Paris Diderot, Sorbonne Paris Cité, INSERM, Paris, France
- AP-HP, URC-Eco, DHU PePSY, Paris, France
| | - Jeanne Gervaix
- ECEVE, UMRS 1123, Université Paris Diderot, Sorbonne Paris Cité, INSERM, Paris, France
- AP-HP, URC-Eco, DHU PePSY, Paris, France
| | - Julien Thillard
- ECEVE, UMRS 1123, Université Paris Diderot, Sorbonne Paris Cité, INSERM, Paris, France
- AP-HP, URC-Eco, DHU PePSY, Paris, France
| | - Jean-Marc Macé
- National Conservatory of Arts and Crafts, LIRSA, EA 4603 Paris, France
| | - Jean-Luc Roelandt
- ECEVE, UMRS 1123, Université Paris Diderot, Sorbonne Paris Cité, INSERM, Paris, France
- World Health Organization Collaborating Centre for Research and Training in Mental Health, Lille, France
| | - Karine Chevreul
- ECEVE, UMRS 1123, Université Paris Diderot, Sorbonne Paris Cité, INSERM, Paris, France
- AP-HP, URC-Eco, DHU PePSY, Paris, France
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Gandré C, Gervaix J, Thillard J, Macé JM, Roelandt JL, Chevreul K. Geographic variations in involuntary care and associations with the supply of health and social care: results from a nationwide study. BMC Health Serv Res 2018; 18:253. [PMID: 29625567 PMCID: PMC5889610 DOI: 10.1186/s12913-018-3064-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 03/27/2018] [Indexed: 11/17/2022] Open
Abstract
Background Involuntary psychiatric care remains controversial. Geographic disparities in its use can challenge the appropriateness of the care provided when they do not result from different health needs of the population. These disparities should be reduced through dedicated health policies. However, their association with the supply of health and social care, which could be targeted by such policies, has been insufficiently studied. Our objectives were therefore to describe geographic variations in involuntary admission rates across France and to identify the characteristics of the supply of care which were associated with these variations. Methods Involuntary admission rate per 100,000 adult inhabitants was calculated in French psychiatric sectors’ catchment areas using 2012 data from the national psychiatric discharge database. Its variations were first described numerically and graphically. Several factors potentially associated with these variations were then considered in a negative binomial regression with an offset term accounting for the size of catchment areas. They included characteristics of the supply of care (public and private care, health and social care, hospital and community-based care, specialised and non-specialised care) as well as adjustment factors related to epidemiological characteristics of the population of each sector’s catchment area and its level of urbanization. Such variables were extracted from complementary administrative databases. Supply characteristics associated with geographic variations were identified using a significance level of 0.05. Results Significant variations in involuntary admission rates were observed between psychiatric sectors’ catchment areas with a coefficient of variation close to 80%. These variations were associated with some characteristics of the supply of health and social care in the sectors’ catchment areas. Notably, an increase in the availability of community-based private psychiatrists and the capacity of housing institutions for disabled individuals was associated with a decrease in involuntary admission rates while an increase in the availability of general practitioners was associated with an increase in those rates. Conclusions There is evidence of considerable variations in involuntary admission rates between psychiatric sectors’ catchment areas. Our results provide lines of thoughts to reduce such variations, in particular by supporting an increase in the availability of upstream and downstream care in the community. Electronic supplementary material The online version of this article (10.1186/s12913-018-3064-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Coralie Gandré
- ECEVE, UMRS 1123, Université Paris Diderot, Sorbonne Paris Cité, INSERM, Paris, France. .,AP-HP, URC Eco, Paris, France.
| | - Jeanne Gervaix
- ECEVE, UMRS 1123, Université Paris Diderot, Sorbonne Paris Cité, INSERM, Paris, France.,AP-HP, URC Eco, Paris, France
| | - Julien Thillard
- ECEVE, UMRS 1123, Université Paris Diderot, Sorbonne Paris Cité, INSERM, Paris, France.,AP-HP, URC Eco, Paris, France
| | - Jean-Marc Macé
- National Conservatory of Arts and Crafts, LIRSA, 4603, Paris, EA, France
| | - Jean-Luc Roelandt
- ECEVE, UMRS 1123, Université Paris Diderot, Sorbonne Paris Cité, INSERM, Paris, France.,World Health Organization Collaborating Centre for Research and Training in Mental Health, Lille, France
| | - Karine Chevreul
- ECEVE, UMRS 1123, Université Paris Diderot, Sorbonne Paris Cité, INSERM, Paris, France.,AP-HP, URC Eco, Paris, France
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Gandré C, Gervaix J, Thillard J, Macé JM, Roelandt JL, Chevreul K. Thirty-day Readmission Rates and Associated Factors: A Multilevel Analysis of Practice Variations in French Public Psychiatry. J Ment Health Policy Econ 2018; 21:17-28. [PMID: 29643265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 01/22/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Inpatient psychiatric readmissions are often used as an indicator of the quality of care and their reduction is in line with international recommendations for mental health care. Research on variations in inpatient readmission rates among mental health care providers is therefore of key importance as these variations can impact equity, quality and efficiency of care when they do not result from differences in patients' needs. AIMS OF THE STUDY Our objectives were first to describe variations in inpatient readmission rates between public mental health care providers in France on a nationwide scale, and second, to identify their association with patient, health care providers and environment characteristics. METHODS We carried out a study for the year 2012 using data from ten administrative national databases. 30-day readmissions in inpatient care were identified in the French national psychiatric discharge database. Variations were described numerically and graphically between French psychiatric sectors and factors associated with these variations were identified by carrying out a multi-level logistic regression accounting for the hierarchical structure of the data. RESULTS Significant practice variations in 30-day inpatient readmission rates were observed with a coefficient of variation above 50%. While a majority of those variations was related to differences within sectors, individual patient characteristics explained a lower part of the variations resulting from differences between sectors than the characteristics of sectors and of their environment. In particular, an increase in the mortality rate and in the acute admission rate for somatic disorders in sectors' catchment area was associated with a decrease in the probability of 30-day readmission. Similarly, an increase in the number of psychiatric inpatient beds in private for-profit hospitals per 1,000 inhabitants in sectors' catchment area was associated with a decrease in this probability, which also varied with overall sectors' case-mix characteristics and with the level of urbanisation of the area. DISCUSSION The extent of the variations and the factors associated with it question the adequacy of care and suggest that some of them may be unwarranted. Our findings should however be interpreted in consideration of several limits inherent to data quality and availability as we relied on information from administrative databases. While we considered a wide range of factors potentially associated with variations in 30-day readmissions, our model indeed only explained a limited part of the variations resulting from differences between sectors. IMPLICATIONS FOR HEALTH POLICIES Our findings underscored that practice variations in psychiatry are a reality that merits the full attention of decision makers as they can impact the quality, equity and efficiency of care. A specific data system should be established to monitor practice variations in routine to promote transparency and accountability. IMPLICATIONS FOR FURTHER RESEARCH Few associations were found between variations in 30-day inpatient readmissions and the supply of care. The routine collection of detailed organizational characteristics of health care providers at a national level should be supported to facilitate additional research work, both in France and in other contexts.
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Affiliation(s)
- Coralie Gandré
- URC Eco, Hotel Dieu, 1 place du Parvis Notre-Dame, 75004 Paris, France,
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Robin C, Hémery F, Dindorf C, Thillard J, Cabanne L, Redjoul R, Beckerich F, Rodriguez C, Pautas C, Toma A, Maury S, Durand-Zaleski I, Cordonnier C. Economic burden of preemptive treatment of CMV infection after allogeneic stem cell transplantation: a retrospective study of 208 consecutive patients. BMC Infect Dis 2017; 17:747. [PMID: 29207952 PMCID: PMC5717816 DOI: 10.1186/s12879-017-2854-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 11/24/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cytomegalovirus (CMV) infection and disease (CMV episodes) are global concerns after allogeneic hematopoietic stem cell transplantation (HSCT). They affect survival, both by direct and indirect effects. Due to safety issues of current anti-CMV antivirals, long-term CMV prophylaxis is poorly tolerated and the most common strategy to decrease the incidence of CMV disease is preemptive. New, less toxic, molecules are currently being assessed for CMV prophylaxis which should replace or considerably decrease the preemptive approach. The aim of this study was to assess the economic burden of CMV episodes after HSCT with a preemptive approach. METHODS We analyzed data from 208 consecutive adults transplanted in our institution, between 2008 and 2013. Hospital resource utilization was retrieved via the linked hospital admissions and Diagnostic Related Groups for the period of conditioning to 12 months after transplant. RESULTS CMV episodes occurred in 70 patients (34%) over the first 12 months following HSCT, after a mean of 75 days (median: 46 (7-334)). The mean total length of stay was significantly associated with the occurrence of a CMV episode (113.9 vs. 87.5 days, p = 0.0002) but was associated neither with the pre-transplant CMV serology of donors/recipients nor with survival. The mean cost of transplant was €104,016 (SD = €37,281) after 12 months. Bivariate and multivariate analyses indicated that the occurrence of >1 CMV episode increased the costs of allogeneic HSCT by 25-30% (p < 0.0001). CONCLUSION Our study, which is the largest, single-institution cost study of allogeneic HSCT in Europe, shows that two or more CMV episodes significantly increased the transplant cost. New prophylactic strategies to prevent CMV infection and disease should decrease transplant costs.
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Affiliation(s)
- Christine Robin
- Department of Hematology, Assistance Publique-Hopitaux de Paris (APHP), Henri Mondor Teaching Hospital, 94010, Créteil, France.,University Paris-Est Créteil (UPEC), 94000, Créteil, France
| | - François Hémery
- Department of Medical Information, APHP, Henri Mondor Teaching Hospital, Créteil, France
| | | | | | - Ludovic Cabanne
- Department of Hematology, Assistance Publique-Hopitaux de Paris (APHP), Henri Mondor Teaching Hospital, 94010, Créteil, France
| | - Rabah Redjoul
- Department of Hematology, Assistance Publique-Hopitaux de Paris (APHP), Henri Mondor Teaching Hospital, 94010, Créteil, France
| | - Florence Beckerich
- Department of Hematology, Assistance Publique-Hopitaux de Paris (APHP), Henri Mondor Teaching Hospital, 94010, Créteil, France.,University Paris-Est Créteil (UPEC), 94000, Créteil, France
| | - Christophe Rodriguez
- University Paris-Est Créteil (UPEC), 94000, Créteil, France.,Department of Virology, and INSERM U955 Team 18, APHP, Henri Mondor Teaching Hospital, 94000, Créteil, France
| | - Cécile Pautas
- Department of Hematology, Assistance Publique-Hopitaux de Paris (APHP), Henri Mondor Teaching Hospital, 94010, Créteil, France
| | - Andrea Toma
- Department of Hematology, Assistance Publique-Hopitaux de Paris (APHP), Henri Mondor Teaching Hospital, 94010, Créteil, France
| | - Sébastien Maury
- Department of Hematology, Assistance Publique-Hopitaux de Paris (APHP), Henri Mondor Teaching Hospital, 94010, Créteil, France.,University Paris-Est Créteil (UPEC), 94000, Créteil, France
| | - Isabelle Durand-Zaleski
- University Paris-Est Créteil (UPEC), 94000, Créteil, France.,Department of Public Health, APHP, Henri Mondor Teaching Hospital, 94000-, Créteil, France
| | - Catherine Cordonnier
- Department of Hematology, Assistance Publique-Hopitaux de Paris (APHP), Henri Mondor Teaching Hospital, 94010, Créteil, France. .,University Paris-Est Créteil (UPEC), 94000, Créteil, France.
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Gandré C, Gervaix J, Thillard J, Macé JM, Roelandt JL, Chevreul K. Involuntary Psychiatric Admissions and Development of Psychiatric Services as an Alternative to Full-Time Hospitalization in France. Psychiatr Serv 2017; 68:923-930. [PMID: 28502245 DOI: 10.1176/appi.ps.201600453] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The development of alternatives to full-time hospitalization in psychiatry is limited because consensus about the benefits of such alternatives is lacking. This study assessed whether the development of such alternatives in French psychiatric sectors was associated with a reduction in involuntary inpatient care, taking into account other factors that are potentially associated with involuntary admission. METHODS Data on whether a patient had at least one involuntary full-time admission in 2012 were extracted from the French national discharge database for psychiatric care. The development of alternatives to full-time hospitalization was estimated as the percentage of human resources allocated to these alternatives out of all human resources allocated to psychiatry, measured at the level of the hospital hosting each sector. Other factors potentially associated with involuntary admission (characteristics of patients, health care providers, and the environment) were extracted from administrative databases, and a multilevel logistic model was carried out to account for the nested structure of the data. RESULTS Significant variations were observed between psychiatric sectors in rates of involuntary inpatient admissions. A large portion of the variation was explained by characteristics of the sectors. A significant negative association was found between involuntary admissions and the development of alternatives to full-time hospitalization, after adjustment for other factors associated with involuntary admissions. CONCLUSIONS Findings suggest that the development of alternatives to full-time hospitalization is beneficial for quality of care, given that it is negatively associated with involuntary full-time admissions. The reduction of such admissions aligns with international recommendations for psychiatric care.
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Affiliation(s)
- Coralie Gandré
- Ms. Gandré, Ms. Gervaix, Mr. Thillard, Dr. Roelandt, and Pr. Chevreul are with the Épidémiologie Clinique et Évaluation Économique Appliquées aux Populations Vulnérables team, Unité Mixte de Recherche, Université Paris Diderot, Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale, Paris. With the exception of Dr. Roelandt, they are also with the Parisian Health Economics and Health Services Research Unit, URC Eco, AP-HP, Paris. Dr. Roelandt is also with the World Health Organization Collaborative Centre, Lille, France. Pr. Macé is with the Laboratoire Interdisciplinaire de Recherches en Sciences de l'Action, National Conservatory of Arts and Crafts, Paris
| | - Jeanne Gervaix
- Ms. Gandré, Ms. Gervaix, Mr. Thillard, Dr. Roelandt, and Pr. Chevreul are with the Épidémiologie Clinique et Évaluation Économique Appliquées aux Populations Vulnérables team, Unité Mixte de Recherche, Université Paris Diderot, Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale, Paris. With the exception of Dr. Roelandt, they are also with the Parisian Health Economics and Health Services Research Unit, URC Eco, AP-HP, Paris. Dr. Roelandt is also with the World Health Organization Collaborative Centre, Lille, France. Pr. Macé is with the Laboratoire Interdisciplinaire de Recherches en Sciences de l'Action, National Conservatory of Arts and Crafts, Paris
| | - Julien Thillard
- Ms. Gandré, Ms. Gervaix, Mr. Thillard, Dr. Roelandt, and Pr. Chevreul are with the Épidémiologie Clinique et Évaluation Économique Appliquées aux Populations Vulnérables team, Unité Mixte de Recherche, Université Paris Diderot, Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale, Paris. With the exception of Dr. Roelandt, they are also with the Parisian Health Economics and Health Services Research Unit, URC Eco, AP-HP, Paris. Dr. Roelandt is also with the World Health Organization Collaborative Centre, Lille, France. Pr. Macé is with the Laboratoire Interdisciplinaire de Recherches en Sciences de l'Action, National Conservatory of Arts and Crafts, Paris
| | - Jean-Marc Macé
- Ms. Gandré, Ms. Gervaix, Mr. Thillard, Dr. Roelandt, and Pr. Chevreul are with the Épidémiologie Clinique et Évaluation Économique Appliquées aux Populations Vulnérables team, Unité Mixte de Recherche, Université Paris Diderot, Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale, Paris. With the exception of Dr. Roelandt, they are also with the Parisian Health Economics and Health Services Research Unit, URC Eco, AP-HP, Paris. Dr. Roelandt is also with the World Health Organization Collaborative Centre, Lille, France. Pr. Macé is with the Laboratoire Interdisciplinaire de Recherches en Sciences de l'Action, National Conservatory of Arts and Crafts, Paris
| | - Jean-Luc Roelandt
- Ms. Gandré, Ms. Gervaix, Mr. Thillard, Dr. Roelandt, and Pr. Chevreul are with the Épidémiologie Clinique et Évaluation Économique Appliquées aux Populations Vulnérables team, Unité Mixte de Recherche, Université Paris Diderot, Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale, Paris. With the exception of Dr. Roelandt, they are also with the Parisian Health Economics and Health Services Research Unit, URC Eco, AP-HP, Paris. Dr. Roelandt is also with the World Health Organization Collaborative Centre, Lille, France. Pr. Macé is with the Laboratoire Interdisciplinaire de Recherches en Sciences de l'Action, National Conservatory of Arts and Crafts, Paris
| | - Karine Chevreul
- Ms. Gandré, Ms. Gervaix, Mr. Thillard, Dr. Roelandt, and Pr. Chevreul are with the Épidémiologie Clinique et Évaluation Économique Appliquées aux Populations Vulnérables team, Unité Mixte de Recherche, Université Paris Diderot, Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale, Paris. With the exception of Dr. Roelandt, they are also with the Parisian Health Economics and Health Services Research Unit, URC Eco, AP-HP, Paris. Dr. Roelandt is also with the World Health Organization Collaborative Centre, Lille, France. Pr. Macé is with the Laboratoire Interdisciplinaire de Recherches en Sciences de l'Action, National Conservatory of Arts and Crafts, Paris
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Gandré C, Gervaix J, Thillard J, Macé JM, Roelandt JL, Chevreul K. The Development of Psychiatric Services Providing an Alternative to Full-Time Hospitalization Is Associated with Shorter Length of Stay in French Public Psychiatry. Int J Environ Res Public Health 2017; 14:E325. [PMID: 28335580 PMCID: PMC5369161 DOI: 10.3390/ijerph14030325] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 03/03/2017] [Accepted: 03/17/2017] [Indexed: 01/14/2023]
Abstract
International recommendations for mental health care have advocated for a reduction in the length of stay (LOS) in full-time hospitalization and the development of alternatives to full-time hospitalizations (AFTH) could facilitate alignment with those recommendations. Our objective was therefore to assess whether the development of AFTH in French psychiatric sectors was associated with a reduction in the LOS in full-time hospitalization. Using data from the French national discharge database of psychiatric care, we computed the LOS of patients admitted for full-time hospitalization. The level of development of AFTH was estimated by the share of human resources allocated to those alternatives in the hospital enrolling the staff of each sector. Multi-level modelling was carried out to adjust the analysis on other factors potentially associated with the LOS (patients', psychiatric sectors' and environmental characteristics). We observed considerable variations in the LOS between sectors. Although the majority of these variations resulted from patients' characteristics, a significant negative association was found between the LOS and the development of AFTH, after adjusting for other factors. Our results provide first evidence of the impact of the development of AFTH on mental health care and will provide a lever for policy makers to further develop these alternatives.
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Affiliation(s)
- Coralie Gandré
- ECEVE, UMRS 1123, Université Paris Diderot, Sorbonne Paris Cité, INSERM, 75010 Paris, France.
- AP-HP, URC Eco, DHU PePSY, 75004 Paris, France.
| | - Jeanne Gervaix
- ECEVE, UMRS 1123, Université Paris Diderot, Sorbonne Paris Cité, INSERM, 75010 Paris, France.
- AP-HP, URC Eco, DHU PePSY, 75004 Paris, France.
| | - Julien Thillard
- ECEVE, UMRS 1123, Université Paris Diderot, Sorbonne Paris Cité, INSERM, 75010 Paris, France.
- AP-HP, URC Eco, DHU PePSY, 75004 Paris, France.
| | - Jean-Marc Macé
- National Conservatory of Arts and Crafts, LIRSA, EA 4603, 75003 Paris, France.
| | - Jean-Luc Roelandt
- ECEVE, UMRS 1123, Université Paris Diderot, Sorbonne Paris Cité, INSERM, 75010 Paris, France.
- World Health Organization Collaborating Centre for Research and Training in Mental Health, 59000 Lille, France.
| | - Karine Chevreul
- ECEVE, UMRS 1123, Université Paris Diderot, Sorbonne Paris Cité, INSERM, 75010 Paris, France.
- AP-HP, URC Eco, DHU PePSY, 75004 Paris, France.
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