Impact on continuity of care of decentralized versus partly centralized mental health care in Northern Norway

Abstract

BackgroundThe issue of continuity of care is central in contemporary psychiatric services research. In Norway, inpatient admissions are mainly to take place locally, in a system of small bed-units that represent an alternative to traditional central psychiatric hospitals. This type of organization may be advantageous for accessibility and cooperation, but has been given little scientific attention.AimsTo study whether inpatients’ utilization of outpatient services differ between an area with a decentralized care model in comparison to an adjacent area with a partly centralized model.MethodThe study was based on data from a one-year registered prevalence sample, drawing on routinely sampled data supplemented with data from medical records. Service-utilization for 247 inpatients was analyzed. The results were controlled for diagnosis, demographic variables, type of service system, localization of inpatient admissions, and length of hospitalization.ResultsMost inpatients in the area with the decentralized care model also utilized outpatient consultations, whereas a considerable number of inpatients in the area with a partly centralized model did not enter outpatient care at all. Type of service system, localization of inpatient admission, and length of hospitalization predicted inpatients’ utilization of outpatient consultations. The results are discussed in the light of systems integration, particularly management-arrangements and clinical bridging over the transitional phase from inpatient to outpatient care.ConclusionInpatients’ utilization of outpatient services differed between an area with a decentralized care model in comparison to an adjacent area with a partly centralized care model. In the areas studied, extensive decentralization of the psychiatric services positively affected coordination of inpatient and outpatient services for people with severe psychiatric disorders. Small, local-bed units may therefore represent a favourable alternative to traditional central psychiatric hospitals.

Regional Correlates of Psychiatric Inpatient Treatment

“…Previously Myklebust et al [40] reported that in Norway outpatient and day-hospital services may be filters in the pathway to inpatient care. They underlined that this depends on the structure of the whole service system, since decentralized psychiatric beds may hinder the development of various local psychiatric services.…”

“…In addition to the structural deinstitutionalization of mental health care, there has been a call for greater service coordination between inpatient and outpatient services [40]. Intensive case management can reduce the provision of hospitalization if the hospitalization level is high, but the effect is limited if inpatient treatment is already at a low level [7].…”

Continuity Across Inpatient and Outpatient Mental Health Care or Specialisation of Teams? A Systematic Review

“…Overall, nine of the studies were at high risk of selection bias [2,1,14,[20][21][22]27,30,29,31,36] due to uncontrolled confounders or, for before and after studies, due to having no control group for comparison. All studies were also unclear [20,30,29,31,40] or at high risk [2,1,14,16,19,21,22,26,27,[36][37][38] of performance bias due to an imbalance in treatment intensity or the existence of additional co-occurring interventions -such as one treatment group receiving extended 24-hour-care, assertive engagement, or home treatment whilst the other does not. Design specific issues, such as having only one site per intervention group in cluster-level studies or a lack of an appropriate concurrent control altogether, means all the studies were also at high risk of other potential sources of bias.…”

How mental health service systems are organized may affect the rate of acute admissions to specialized care: Report from a natural experiment involving 5338 admissions

“…Such organizational varieties may have implications for patients’ patterns of care, and we have earlier studied how the general structure of mental health systems may affect various outcomes such as coercion, continuity of care, and utilization of beds. 4 , 16 – 19 …”

“…Consequently, 70% of the total inpatient stays in Vesterålen are at the local community level at the DPC; only about 30% are referred further to the CMH. 16 – 19 …”