The gravitational force of mental health services: distance decay effects in a rural Swiss service area

Stulz, Niklaus; Pichler, E.; Kawohl, Wolfram

doi:10.1186/s12913-018-2888-1

Cited by 23 publications

(34 citation statements)

References 36 publications

(43 reference statements)

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“…"Distance to the hospital" has been known for more than 50 years to in uence the hospital admission rate in mental disorders (43,44) or service utilization in outpatient facilities (45). We could con rm in our dataset that lower travelling distances between residence and hospital are associated with a higher readmission risk.…”

Section: Discussionmentioning

confidence: 78%

Stress and the City: Living in Rural Environment has a Protective Effect on Hospital Readmission Rates in Chronic Psychiatric Disorders

Langguth

Frick

2020

Preprint

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Background:Living in urban environment represents a well-known risk factor for the development of mental disorders. Here we aimed to investigate whether urbanicity has also an effect on the trajectories of psychiatric disorders. For this purpose, we analyzed the relationship between urbanization and hospital readmission risk. Method:We analysed the impact of geospatial, demographic, clinical and socioeconomic data on hospital readmission risk in a sample of 17’145 patients observed during a 12 years period starting from 1996 and leading to 37’697 psychiatric hospitalizations by using a frailty model Results:Living in more urbanized regions was related to an increasing risk for earlier rehospitalization. The impact of urbanicity was less pronounced in patients with affective disorders and more pronounced in patients with co-morbid substance abuse disorder. Shorter distance to the hospital and change of residence increased the readmission risk. Population density, proportion of non-german citizens, local population growth tendency, and local unemployment rate were not associated with readmission risk. Conclusion:A clear impact of urban living environment on the course of mental disorders was demonstrated. In metropolitan regions of our sample it took one year till 50% of discharged patients had been readmitted to the psychiatric clinic, whereas this took 6 years in rural regions.

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Section: Discussionmentioning

confidence: 78%

Stress and the City: Living in Rural Environment has a Protective Effect on Hospital Readmission Rates in Chronic Psychiatric Disorders

Langguth

Frick

2020

Preprint

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“…Several studies have shown that increase in distance decreases the likelihood of service utilization in mental health. [8][9][10][12][13][14] Similarly, there was significant association of proximity to hospital with LoS, those from same and nearby districts had shorter LoS as compared to others. In our clinical experience, those from nearby places, who could follow up regularly to OPD are discharged earlier as compared to those from faraway places who could have difficulty in following up regularly.…”

Section: Discussionmentioning

confidence: 93%

“…This was done as literature have shown the role of proximity to the service in mental health service utilization. [8][9][10] The data were entered into MS Excel and analysed using the SPSS version 20.0. For descriptive statistics, percentage, mean, range and standard deviation were calculated.We used bivariate and multiple logistic regression analysis to find the strength of association of LoS with variables of interest and adjusted Odds Ratio (aOR) were calculated with 95% confidence interval (CI).…”

Section: Methodsmentioning

confidence: 99%

Length of Stay of Psychiatric Admissions in a Tertiary Care Hospital

et al. 2018

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Introduction:The length of stay among psychiatric in-patients is usually longer than that of others. Inpatient management is costly and longer length of stay can lead to catastrophic costs. We conducted this study to explore about the length of stay of psychiatric admissions and factors affecting it. Methods:We collected the data of all the patients admitted to the psychiatric ward of B. P. Koirala Institute of Health Sciences from 1 st January 2007 to 31 st December 2016 from the database of the medical records section after ethical approval. The sociodemographic and clinical variables were analyzed using SPSS 20.0 version. Length of stay more than 3 weeks was considered as long stay. Bivariate and multivariable logistic regression analyses were conducted to identify factors associated with length of stay.Results: There were 3687 admissions during the study period. The average length of stay was 19.36 (±13.14) days. On logistic regression, the factors associated with shorter length of stay were: male gender (aOR= 0.79, 95%CI: 0.68-0.93), being self employed (aOR= 0.17, 95%CI: 0.12-0.22), homemakers (aOR= 0.18, 95%CI: 0.14-0.24), farmers (aOR= 0.20, 95%CI: 0.15-0.27) and students (aOR= 0.23, 95%CI:0.17-0.32). Similarly, factors associated with longer length of stay were: being from other Eastern Terai districts(aOR=1.37, 95%CI: 1.11-1.70), other Eastern Hill districts (aOR= 1.68; 95%CI: 1.29-2.20), diagnosis of schizophrenia and related disorders (aOR=4.01, 95%CI: 1.34-12.0), having medical co-morbidity (aOR= 3.47; 95%CI: 2.49-4.84) and being readmitted (aOR= 1.23, 95%CI: 1.03-1.47). Conclusions:There was significant association of length of stay with gender, age, address, occupation, diagnosis and readmission. _______________________________________________________________________________________

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“…2004; Stulz et al . 2018; Wang & Luo 2005). Our findings corroborate these results and reflect the inequitable distribution of mental health nurses to provide quality and timely mental health services.…”

Section: Discussionmentioning

confidence: 99%

“…Access to community-based mental health services is influenced by: spatial factors such as physical availability and geographical distance, non-spatial determinants which include economic, cultural and social forces, and factors associated with the organization and arrangement of mental health systems (Wang & Luo 2005). Studies have consistently shown that the utilization of mental health services is reduced with increasing spatial distance and travel time (Almog et al 2004;Stulz et al 2018;Zulian et al 2011). These studies signal that people with mental health conditions in rural and remote areas are less likely to access mental health services due to distance and spatial availability.…”

Section: Introductionmentioning

confidence: 99%

Spatial inequities of mental health nurses in rural and remote Australia

Sutarsa

Banfield

Passioura

et al. 2020

Int J Mental Health Nurs

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Despite an increased burden from chronic mental health conditions, access to effective mental health services in rural and remote areas is limited, and these services remain spatially undefined. We examine the spatial availability of mental health nurses across local government areas in Australia and identify gaps in mental health service delivery capacity in a finer‐grained level than the state/territory data. A spatial distribution of mental health nurses was conducted. We utilized the 2017 National Health Workforce Dataset which was aggregated to LGA level based on the 2018 Australian Bureau Statistics (ABS) Data. The availability of mental health nurses was measured using the full time equivalent (FTE) rates per 100 000 population. We calculated the proportion of LGAs with zero total FTE rates based on remoteness categories. We also compared the mean of total FTE rates based on remoteness categories using analysis of variance. A spatial distribution of mental health nurses was visualized using GIS software for total FTE rates. Our analysis included 544 LGA across Australia, with 24.8% being defined as remote and very remote. The mean total FTE for mental health nurses per 100 000 populations is 56.6 (±132.2) with a median of 17.4 (IQR: 61.8). A wide standard deviation reflects unequal distribution of mental health nurses across LGAs. The availability of total FTE rates for mental health nurses per 100 000 populations is significantly lower in remote and very remote LGAs in comparison with major cities. As many as 35.1% of LGAs across Australia have no FTE for mental health nurses with 46% are remote and very remote. Our study reflects the existing unequal distribution of mental health nurses between metropolitan/urban setting and rural and remote areas. We suggest three broad strategies to address these spatial inequities: improving supply and data information systems; revisiting task‐shifting strategies, retraining the existing health workforce to develop skills necessary for mental health care to rural and remote communities; and incorporating the provision of mental health services within expanding innovative delivery models including consumer‐led, telemedicine and community‐based groups.

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The gravitational force of mental health services: distance decay effects in a rural Swiss service area

Cited by 23 publications

References 36 publications

Stress and the City: Living in Rural Environment has a Protective Effect on Hospital Readmission Rates in Chronic Psychiatric Disorders

Stress and the City: Living in Rural Environment has a Protective Effect on Hospital Readmission Rates in Chronic Psychiatric Disorders

Length of Stay of Psychiatric Admissions in a Tertiary Care Hospital

Spatial inequities of mental health nurses in rural and remote Australia

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