Linking Primary and Secondary Care after Psychiatric Hospitalization: Comparison between Transitional Case Management Setting and Routine Care for Common Mental Disorders

Abstract

ObjectivesTo improve engagement with care and prevent psychiatric readmission, a transitional case management intervention has been established to link with primary and secondary care. The intervention begins during hospitalization and ends 1 month after discharge. The goal of this study was to assess the effectiveness of this short intervention in terms of the level of engagement with outpatient care and the rate of readmissions during 1 year after discharge.MethodsIndividuals hospitalized with common mental disorders were randomly assigned to be discharged to routine follow-up by private psychiatrists or general practitioners with (n = 51) or without (n = 51) the addition of a transitional case management intervention. Main outcome measures were number of contacts with outpatient care and rate of readmission during 12 months after discharge.ResultsTransitional case management patients reported more contacts with care service in the period between 1 and 3 months after discharge (p = 0.004). Later after discharge (3–12 months), no significant differences of number of contacts remained. The transitional case management intervention had no statistically significant beneficial impact on the rate of readmission (hazard ratio = 0.585, p = 0.114).ConclusionThe focus on follow-up after discharge during hospitalization leads to an increased short-term rate of engagement with ambulatory care despite no differences between the two groups after 3 months of follow-up. This short transitional intervention did, however, not significantly reduce the rate of readmissions during the first year following discharge.Trial registration number: Identifier NCT02258737.

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

“…Predischarge interventions included components from case management, such as needs assessments (28,29,32,34,35,(40)(41)(42)(43), discharge or care planning (e.g., crisis planning) (28,31,35), scheduling or preparing for follow-up appointments (39,42), and family or carer involvement (28,44); psychoeducational components, such as individualized psychoeducation (33) and medication reconciliation elements (29,44); and elements of CBT, such as skills training (29,40,41,44) and peer support (38,43). Interventions were delivered in one-to-one sessions, except for the study conducted by Khaleghparast et al (41), where a family member was present and in Noda et al (44), where skills training was delivered in groups.…”

“…Postdischarge components aimed to support patients during a transition period and were most frequently delivered through phone calls, home visits, or letters. Components associated with case management included: efforts to ensure timely follow-up with outpatient care providers (28,32,34,39,42), treatment coordination (28,31,39), timely communication between inpatient staff and outpatient care or community service provider after discharge (29,34), monitoring of health status or implementation of postdischarge plan (31,33,35), and activation of resources in the social network (32). Elements of CBT consisted of therapeutic meetings with staff (30, 37) and skills training (33,40,41,44).…”

“…Control groups received treatment as usual, which included aftercare or treatment planning (39,40), referral to outpatient treatment (28,29,33,37,39), arrangements from community mental health services (38), and case and medication management (31). Treatment as usual in the study by Puschner et al (35) was delivered without a manualized or structured discharge plan.…”

“…From the 10 RCTs included, only the study by Hengartner et al (32) proved to have a low risk of bias. Five RCTs were rated to have some concerns (28,29,31,33,35) and four studies (30,34,37,38) were rated with high risk of bias. Khaleghparast et al (41) did not describe a randomization process and was therefore included and rated as a study using a quasi-experimental design.…”

Responding to the needs of the population suffering from severe mental disorders by a multifaceted territorial approach: Reorganization of the French mental health system

“…It reduces the recourse to hospitalization . The question of the nature of the care to be implemented following hospitalization to improve engagement with outpatient care is currently under consideration . The possibilities include transitional case management or quick switching to more specialized structures such as rehabilitation centers that are capable of rapidly allowing users to identify their competences and strengthen their decision‐making capacities.…”