Discharge management strategies and post-discharge care interventions for depression – Systematic review and meta-analysis

Holzinger, Felix; Fahrenkrog, Sandra; Roll, Stephanie; Kleefeld, Felix; Adli, Mazda; Heintze, Christoph

doi:10.1016/j.jad.2017.07.026

Cited by 10 publications

(15 citation statements)

References 38 publications

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“…Our results corroborate other reviews on discharge interventions that summarize the evidence of a wide range of interventions (7,21) or focus on either specific patient groups (e.g., depression) (22), settings, or services (e.g., forensic psychiatric services and early discharge) (23,24). Holzinger et al (22) found no significant effects of these interventions on readmission; however, included studies showed a tendency toward intervention effectiveness. Similarly, Vigod et al (7) identified slightly lower readmission rates in the intervention groups of the included studies at 3 and 12 months; however, a quantitative meta-analysis was not possible due to substantial clinical heterogeneity.…”

Section: Discussionsupporting

confidence: 88%

“…To classify the intensity of the interventions, we adapted the intervention intensity score developed by Holzinger et al (22). The score (low/moderate/high intensity) considers the length of intervention, number of intervention components (e.g., psychoeducation, cognitive behavioral therapy [CBT], case management, and peer support), and number of contacts with the patient.…”

Section: Data Extraction and Risk Of Bias Assessmentmentioning

confidence: 99%

“…Interventions aiming to improve the transition from hospital to home have been tested in studies and partly summarized in systematic reviews. These systematic reviews have either focused on a wide range of interventions, including preintervention and postintervention components (7,21), specific patient groups (22), and settings or services (23,24). For example, Vigod et al (7) found evidence from nonrandomized trials indicating that psychoeducational interventions help to improve disease management and everyday skills, which may reduce readmission rates of psychiatric patients.…”

Section: Introductionmentioning

confidence: 99%

“…For example, Vigod et al (7) found evidence from nonrandomized trials indicating that psychoeducational interventions help to improve disease management and everyday skills, which may reduce readmission rates of psychiatric patients. Alternatively, discharge interventions for patients with severe depression demonstrated no significant effects on readmission rates or the improvement of depressive symptoms (22); however, patients have reported that discharge planning and follow-up after discharge are essential to prevent readmission (15).…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness of Transitional Interventions in Improving Patient Outcomes and Service Use After Discharge From Psychiatric Inpatient Care: A Systematic Review and Meta-Analysis

et al. 2020

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Background: The transition from psychiatric hospital to community is often hindered by challenges that influence community adjustment and continuity of care. Transitional interventions with bridging components are provided prior to discharge and continue beyond inpatient care. They provide continuity of care and may be effective in preventing readmission. We aimed to assess the effectiveness of transitional interventions with predischarge and postdischarge components in reducing readmissions and improving health-related or social outcomes of patients discharged from psychiatric hospitals. Methods:We conducted a systematic review by searching electronic databases (MEDLINE, Embase, Cochrane Library, CINAHL, PsycINFO, and Psyndex) and included randomized, nonrandomized, and one-group study designs. A random effects metaanalysis was conducted with randomized controlled trials (RCTs) reporting data on readmission rates. Other study designs were synthesized qualitatively.Results: After screening 2,673 publications, 16 studies (10 RCTs, three quasiexperimental, and three cohort studies) were included and nine RCTs were included in the meta-analysis. The tested interventions included components from case management, psychoeducation, cognitive behavioral therapy, and peer support. All studies with significant improvements in at least one outcome provided elements of case management, most frequently in combination with cognitive behavioral therapy and psychoeducation. Readmission rates during follow-up ranged between 13% and 63% in intervention groups and 19% and 69% in control groups. Overall, we found an odds ratio of 0.76 (95% confidence interval = 0.55-1.05) for readmission due to transitional Frontiers in Psychiatry | www.frontiersin.org January 2020 | Volume 10 | Article 969 1

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Section: Discussionsupporting

confidence: 88%

Section: Data Extraction and Risk Of Bias Assessmentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effectiveness of Transitional Interventions in Improving Patient Outcomes and Service Use After Discharge From Psychiatric Inpatient Care: A Systematic Review and Meta-Analysis

et al. 2020

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“…However, Holzinger et al. () recently conducted a meta‐analysis of postdischarge interventions for people with depression and did not find a significant reduction in readmission in the intervention groups.…”

Section: Introductionmentioning

confidence: 98%

Evaluation of the transitional discharge model on use of psychiatric health services: An interrupted time series analysis

Lam¹,

Li²,

Anderson

et al. 2019

Psychiatric Ment Health Nurs

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Accessible Summary What is known on the subject? The period between hospital discharge and community reintegration is a vulnerable time for people with mental illness due to a lack of continuity of care. They are at a high risk of undesired outcomes, including return to hospital. Many transitional models have been developed. It is important to continue evaluating models for improvement and adaptability to different contexts. The transitional discharge model (TDM) is an intervention that incorporates both continued support from hospital staff after discharge and peer support to facilitate a smooth transition. Previous studies have reported positive outcomes such as increased discharges, decreased readmissions, reduced inpatient length of stay and improved quality of life. What the paper adds to existing knowledge? Health service use outcomes were examined separately for acute and tertiary care psychiatric units. Previous TDM studies in Canada only examined tertiary care units, but many patients also receive care in acute care units. Although recent studies of different interventions generally reported decreased readmissions, the current study found readmissions increased after TDM and then decreased over time for acute care units, whereas no change was observed for tertiary care units. What are the implications for practice? Transitional discharge model evidence supports nursing practice based on interpersonal relations and strategies. Nurses need to be aware of peer support resources to facilitate this part of the model. The effectiveness of TDM may be increased by considering the differences in needs of distinct patient groups, such as those discharged from acute versus tertiary care units. Abstract IntroductionThe transitional discharge model (TDM) bridges hospital discharge and community living for people receiving psychiatric services. TDM, based on Peplau's theory of interpersonal relations, ensures continued support from hospital staff until a therapeutic relationship is established with community providers and formal peer support. AimTo compare temporal trends in psychiatric health services use before and after TDM implementation within acute and tertiary care psychiatric units in Ontario, Canada. MethodUsing health administrative databases, monthly discharges from psychiatric units 3 years prior to 2 years after TDM implementation were identified. Median inpatient length of stay (LOS), psychiatric readmission rates and mental health‐related emergency department visit rates were compared using segmented regression analyses. ResultsAmong acute care units, median LOS decreased significantly below the projected historical trend following TDM implementation, while readmissions increased significantly and declined thereafter. No significant changes were found for tertiary care units. DiscussionStudies on various interventions have shown decreased readmission rates, whereas the trend differed between acute and tertiary care units in this study. Possible reasons include different patient needs and st...

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Effectiveness of continuity of care in reducing depression symptoms in elderly: A systematic review and meta‐analysis

Qiao

et al. 2023

Int J Geriat Psychiatry

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Background Depression affects 10%–20% of older adults worldwide. The course of late‐life depression (LLD) is often chronic, with a poor long‐term prognosis. Lower treatment adherence, stigma, and suicide risk lead to significant challenges in the continuity of care (COC) for patients with LLD. Elderly patients with chronic diseases can benefit from COC. As a common chronic disease of the elderly, whether depression can also benefit from COC has not been systematically reviewed. Methods Systematic literature search in Embase, Cochrane Library, Web of Science, Ovid, PubMed and Medline. Randomized Controlled Trials (RCTs) on the intervention effects of COC and LLD, published on 12 April 2022, were selected. Two independent researchers made research choices based on consensus. An RCT with COC as an intervention measure for the elderly with depression 60 years old was the inclusion criteria. Results A total of 10 RCTs involving 1557 participants were identified in this study. The findings showed that: (1) COC significantly reduced depressive symptoms compared to usual care (standardized mean difference [SMD] = −0.47, 95% confidence interval: −0.63 to −0.31), with the best improvement at 3‐ to 6‐month follow‐up; (2) The reduction in depressive symptoms was more pronounced for patients with comorbid chronic conditions with LLD (SMD = −0.93, 95% CI: −1.18 to −0.68); (3) COC was more effective than other regions for LLD in Europe and the Americas (SMD = −0.84, 95% CI: −1.07 to −0.61); and (4) COC had a positive impact on the quality of life of patients with LLD (SMD = 0.21, 95% CI: 0.02–0.40). Limitations The included studies included several multi‐component interventions with widely varying methods. Therefore, it was almost impossible to analyze which of these interventions had an impact on the assessed outcomes. Conclusions This meta‐analysis shows that COC can significantly reduce depressive symptoms and improve quality of life in patients with LLD. However, when treating and caring for patients with LLD, health care providers should also pay attention to timely adjustments of intervention plans according to follow‐up, synergistic interventions for multiple co‐morbidities, and actively learning from advanced COC programs at home and abroad to improve the quality and effectiveness of services.

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Discharge management strategies and post-discharge care interventions for depression – Systematic review and meta-analysis

Cited by 10 publications

References 38 publications

Effectiveness of Transitional Interventions in Improving Patient Outcomes and Service Use After Discharge From Psychiatric Inpatient Care: A Systematic Review and Meta-Analysis

Effectiveness of Transitional Interventions in Improving Patient Outcomes and Service Use After Discharge From Psychiatric Inpatient Care: A Systematic Review and Meta-Analysis

Evaluation of the transitional discharge model on use of psychiatric health services: An interrupted time series analysis

Effectiveness of continuity of care in reducing depression symptoms in elderly: A systematic review and meta‐analysis

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