Local inpatient units may increase patients' utilization of outpatient services: a comparative cohort-study in Nordland County, Norway

Abstract

ObjectivesIn the last few decades, there has been a restructuring of the psychiatric services in many countries. The complexity of these systems may represent a challenge to patients that suffer from serious psychiatric disorders. We examined whether local integration of inpatient and outpatient services in contrast to centralized institutions strengthened continuity of care.MethodsTwo different service-systems were compared. Service-utilization over a 4-year period for 690 inpatients was extracted from the patient registries. The results were controlled for demographic variables, model of service-system, central inpatient admission or local inpatient admission, diagnoses, and duration of inpatient stays.ResultsThe majority of inpatients in the area with local integration of inpatient and outpatient services used both types of care. In the area that did not have beds locally, many patients that had been hospitalized did not receive outpatient follow-up. Predictors of inpatients’ use of outpatient psychiatric care were: Model of service-system (centralized vs decentralized), a diagnosis of affective disorder, central inpatient admission only, and duration of inpatient stays.ConclusionPsychiatric centers with local inpatient units may positively affect continuity of care for patients with severe psychiatric disorders, probably because of a high functional integration of inpatient and outpatient care.

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

“… 18 , 26 , 27 Here, a growing body of research highlights care systems’ ability to facilitate continuous clinical alliances between health personnel and patients. 19 , 28 A close and positive relationship between patients and providers is held by the patients themselves as central for efficient recovery. 29 – 36 This may certainly be easier in a model with high levels of integration, where patients often can relate to the same clinician regardless whether they are temporarily treated in an inpatient ward or at an outpatient clinic.…”

“…To repeatedly have to establish new clinical relationships in different units may be a particularly negative factor for mental health patients, and lead to high dropout rates from treatment. 19 , 37 …”

“…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 …”

“…These two models of psychiatric mental health services may be termed a “locally institutionalized model” in Vesterålen, in contrast to the “deinstitutionalized model” in Lofoten. 16 – 19 …”