Post-inpatient Attrition from Care “As Usual” in Veterans with Multiple Psychiatric Admissions

Abstract

Disengagement from outpatient care following psychiatric hospitalization is common in high-utilizing psychiatric patients and contributes to intensive care utilization. To investigate variables related to treatment attrition, a range of demographic, diagnostic, cognitive, social, and behavioral variables were collected from 233 veterans receiving inpatient psychiatric services who were then monitored over the following 2 years. During the follow-up period, 88.0 % (n = 202) of patients disengaged from post-inpatient care. Attrition was associated with male gender, younger age, increased expectations of stigma, less short-term participation in group therapy, and poorer medication adherence. Of those who left care, earlier attrition was predicted by fewer prior-year inpatient psychiatric days, fewer lifetime psychiatric hospitalizations, increased perceived treatment support from family, and less short-term attendance at psychiatrist appointments. Survival analyses were used to analyze the rate of attrition of the entire sample as well as the sample split by short-term group therapy attendance. Implications are discussed.

Treatment of dissociative disorders and reported changes in inpatient and outpatient cost estimates

“…For example, only 20% of veterans remained in a national study of methadone maintenance at one year (Mansfield et al, 2010). Another study of veterans who had had repeated hospitalizations found that only 12% of the patients remained in outpatient treatment two years after being hospitalized (Bowersox, Saunders, & Berger, 2013). Furthermore, most trauma treatment studies exclude patients with complex and severe presentations including those with suicidality (Roberts, Roberts, Jones, & Bisson, 2016), although the present study did not exclude any patients based on symptomatology or chronicity (Brand et al, 2009).…”

The Post-Discharge Network Coordination Programme: A Randomized Controlled Trial to Evaluate the Efficacy of an Intervention Aimed at Reducing Rehospitalizations and Improving Mental Health

“…The time immediately after hospital discharge and the transition from inpatient to outpatient treatment is a pivotal time period for psychiatric patients, characterized by high risk of suicide and self-harm ( 2 , 3 ). Rehospitalization is frequent because, unfortunately, many persons with mental disorders do not comply with appointments in outpatient services ( 4 , 5 ), do not adhere to medication ( 6 , 7 ), or disengage from outpatient care ( 8 , 9 ). These findings emphasize the need for a rigorously planned and coordinated transition from inpatient to outpatient care and for continuity of care ( 10 ).…”

Introduction of a Psychosocial Post-Discharge Intervention Program Aimed at Reducing Psychiatric Rehospitalization Rates and at Improving Mental Health and Functioning

“…The PDNC‐P was designed to address various interrelated issues common after hospital discharge, such as increased risk of suicidality and noncompliance with aftercare (Bowersox et al., ; Boyer et al., ; Qin & Nordentoft, ; Weiden et al., ). Based on the premises of ACT (Meisler et al., ) and the CTI program (Susser et al., ), the main objective of this intervention is to provide continuity of care and to promote integration among a supportive and caring social network.…”

“…Therefore, hospital discharge and the transition from inpatient to outpatient treatment should be carefully planned and monitored. The most pressing issues after hospital discharge that contribute to the high rehospitalization rates are noncompliance with appointments in outpatient services (Boyer, McAlpine, Pottick, & Olfson, ; Mitchell & Selmes, ), nonadherence to medication (Haywood et al., ; Weiden, Kozma, Grogg, & Locklear, ), or disengagement from outpatient care (Bowersox, Saunders, & Berger, ; Kreyenbuhl, Nossel, & Dixon, ). To counteract those detrimental factors, pre‐ and post‐discharge interventions that promote continuity of care and that are aimed at reducing early readmissions have legitimately gained increased interest in psychiatric research (Vigod et al., ).…”