Patient-controlled Admissions in Inpatient Mental Health Services
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 58
- 主要终点
- Number of inpatient days during the 24 months period with a contract for patient-controlled admissions compared to the previous 24 months
研究概览
简要总结
Patient-controlled admissions are short self-referred inpatient admissions in mental health services without approval by clinicians. The intention is to reduce a high use of inpatient care. Patients are signing a contract for a specified period with stays limited to a maximum number of days and with a minimum number of weeks between stays. The few studies so far show tendencies to a possible effect, but additional studies are needed.
The aims of the study are to describe the use and experiences of patient-controlled admissions, compare the use of inpatient admissions and inpatient days during the 24 months before and after baseline, and to identify subgroups who may benefit from the model.
The study is a pre-post prospective intervention study where the use of inpatient admissions in the contract period is compared to a similar period before baseline so that the patients are their own controls. The study is done in inpatient wards in four community mental health centers of Akershus University Hospital, Norway.
The study aims to recruit 120 patients. The eligible patients have a severe mental illness, high use of inpatient mental health care the last two years and are expected to benefit from patient-controlled admissions. The patients will be followed for 24 months from baseline.
Data at baseline includes socio-demographics, diagnoses, type and severity of psychiatric problems, and use of alcohol and drugs. Data on admissions and experience of these are collected during the contract period, Data on patients' and relatives' experience of the model are collected at the end of the period. Data on total inpatient admissions/stays during the 24 months before and after baseline are extracted from the hospital patient records.
Data analyses will include descriptive statistics on the sample and the use of inpatient care, testing of differences of inpatient care between 24 months before and after baseline, multiple regression of associations between baseline characteristics and the use of inpatient care, and analyses to identify subgroups who benefit from the model.
The study protocol in Norwegian was approved by the Regional Committee on Medical and Health Research Ethics in Norway South East 29 April 2011 (reg.no. 2011/790).
The inclusion period was 2011-2012. Data collection were done 2011-2014. Data extraction from the patient records was done 2015-2016. Quality control and organization of data was done 2017-2018. Data analysis will start in August 2018.
详细描述
BACKGROUND
Patient-controlled admissions are short self-referred inpatient admissions in mental health services without approval by clinicians (Heskestad & Tytlandsvik 2008). The intention is to reduce a high use of inpatient care. Patients are signing a contract for a specified period with such stays limited to a maximum number of days per stay and with a minimum number of weeks between stays.
A systematic review on patient-controlled hospital admissions identified six small studies which had all been done in Norway and including patients with schizophrenia, affective disorders, anxiety disorder, personality disorder and substance abuse (Strand et al 2015). The review showed a tendency towards a reduction in involuntary inpatient care and use of inpatient days, but it could not conclude on effect due to small sample sizes and methodological limitations. A later and larger study in Denmark showed a reduction in involuntary admissions and inpatient days compared to historical controls, but not compared to another matched group with treatment as usual (Thomsen et al 2018). The model is line with research on the positive influence of shared decision-making, where the patient has a major influence on decisions on choice of treatment (Wills & Holmes-Rovner 2006) and research on the use of low-threshold crisis units as an alternative to stay at psychiatric hospital departments (Lloyd-Evans et al 2009). But more studies are needed to explore the usefulness of patient-controlled admissions for different patient groups.
CONTEXT
The current study is being done in inpatient wards in four community mental health centers of Akershus University Hospital, Norway, after a smaller pilot study that indicated potential effect for patients with affective illness, but less for patients with psychosis (Støvind et al 2012). Based on the pilot project and earlier studies, it was estimated that two patient-controlled beds in each center would be enough to meet the needs for patient-controlled hospital admissions for approximately 120 patients within the target group. Each of the 19 health trust in Norway has 2-5 community mental health centers, and 40 % of the beds in mental health services in Norway are in community mental health centers.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Patient with a severe mental illness
- •Many and/or long inpatient stays in mental health services last two years
- •Is expected to benefit from a contract about patient-controlled admissions
- •Have signed a contract about patient-controlled admissions
- •Give written consent to participate in the study
排除标准
- •No exclusion criteria
结局指标
主要结局
Number of inpatient days during the 24 months period with a contract for patient-controlled admissions compared to the previous 24 months
时间窗: 24 months
Number of inpatient days during the 24 months period with a contract for patient-controlled admissions compared to the previous 24 months
次要结局
- Number of involuntary inpatient admissions during the 24 months period with a contract about patient-controlled admissions compared to the previous 24 months(24 months)
- Number of inpatient admissions during the 24 months period with a contract about patient-controlled admissions compared to the previous 24 months(24 months)
- Number of inpatient days under coercion during the 24 months period with a contract about patient-controlled admissions compared to the previous 24 months(24 months)
- Patients' experience of patient-controlled admissions as reported at the end of the period with contract about patient-controlled admissions(24 months)
- Relatives' experience of patient-controlled admissions as reported at the end of the period with contract about patient-controlled admissions(24 months)
- Patients' experience of patient-controlled admissions as reported at the end of the stay(24 months)
研究者
Torleif Ruud
Senior Researcher
University Hospital, Akershus