The Nordic Comparative Study on Sectorized Psychiatry: continuity of care related to characteristics of the psychiatric services and the patients

Abstract

The problem addressed in this paper is how continuity of care is related to characteristics of psychiatric services, previous events in a patient's pattern of care and patient characteristics. The present paper is a part of a Nordic Comparative Study on Sectorized Psychiatry in seven catchment areas in four Nordic countries. One-year-treated-incidence cohorts were used. Each patient was followed for 1 year after the first contact with the psychiatric service. Continuity of care was measured by the time from discharge from hospital to the first subsequent day-patient or outpatient contact. Notable findings were large differences in the continuity of care in the seven services, high proportions of discharges without any aftercare contacts and long time lags between discharges and aftercare contacts in most of the catchment areas. A Cox regression analysis revealed that aftercare following hospitalisation seems to be more probable if the outpatient services are located geographically close to the patients, if the hospitalisation lasted between 2 and 4 weeks, if there was a community care contact shortly before the hospital admission and if the patient is not retired and not divorced. Staff resources were not related to continuity of care.

Community psychiatry in the Sub-Arctic. Experiences with the shift from hospital-based to community-based psychiatric services in Northern Norway

“…Continuity of care was negatively correlated to distance from services (Saarento et al, 1998a). This is in accordance with the finding that the proportion of psychotic patients receiving inpatient care only, was highest in the rural areas, while the proportion receiving outpatient care was lowest (Saarento et al, 1996b). Regarding utilisation parameters, such as emergency admissions to inpatient care (Saarento et al, 1998a), proportion of patients who use only inpatient care.…”

What is the Lived Experience of Being Discharged From a Psychiatric Inpatient Stay?

“…Studies suggest that this contact can help prevent crisis and admissions (Fallon, 2003;Mind, 2011). However, research indicates that support is not always consistent and some patients experience a delay between discharge and their first appointment (Saarento, et al, 1998), something that participants here found difficult to cope with. Findings here support research stating that failure to link patients with community services post-discharge increases the risk of readmission, relapse and lowers quality of life (Rosenfield, et al, 1986).…”

“…Substantial delays between discharge and a patient's first community appointment can occur (Saarento et al, 1998). This is particularly alarming given the aforementioned research regarding self-harm and suicide rates during this period indicating that it is a critical time.…”

Mental Health Service Utilization Among Patients with Severe Mental Disorders

“…Frequent specialized service users are generally male (Sullivan et al 1993), young or middleaged (Spooren et al 1997), and live alone (Saaranto et al 1998). In addition, they lack social support (Ledoux and Minner 2006;Pasic et al 2005) and are often unemployed (Sullivan et al 1993) and homeless (Pasic et al 2005).…”