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final report PRÄVENT (German)

 

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Prof. Dr. Hans Joachim Salize
Arbeitsgruppe Versorgungsforschung
Zentralinstitut für Seelische Gesundheit
J5, 68159 Mannheim
Tel. 0621 1703 6401

Fax. 0621 1703 6405
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Effectiveness and cost effectiveness of reducing compulsory retention in inpatient psychiatric clinics through intensive support, training and preventative monitoring

Salize HJ, Dressing H, Arnold M, Gallas C, Kief S, Zentralinstitut für Seelische Gesundheit Mannheim

 

In the framework of a controlled, prospective intervention study, the project examines the effectiveness and cost effectiveness of a targeted intervention measure for reducing compulsory admissions to inpatient psychiatric treatment. Compulsory retention and compulsory treatment are a central component of psychiatric practice and serve to ensure a needs-oriented treatment of the patient and the simultaneous defence against the patient endangering him/herself or others. Despite the ethical, health-political and social-political significance of the problem, preventative measures prior to a psychiatric crisis, which could possibly prevent or reduce compulsory retention, are not sufficiently tested or studied. The study addresses this issue.

 

The study was conducted from 1.2.2008 to 31.1.2011. The project plan was to recruit chronically psychologically ill persons with a risk of future compulsory retention using a randomised allocation to an intervention group (IG) and a control group (CG), and following discharge from a psychiatric index hospitalisation, to follow them over a period of at least one year in terms of the target criteria (see below). Besides the standard psychiatric treatment, patients in the IG received a package of measures which consisted of a problem-specific training, the compilation of an emergency card with a list of the individual risk factors for involuntary hospitalisations and a close-meshed preventative monitoring in terms of these risk factors. The monitoring consisted of telephone conversations at three-week intervals between study personnel and patients, in which the current situation and situation regarding the risk factors were discussed and advice was given regarding potential relapse prevention measures. The patients of the CG received "treatment as usual", i.e. their standard psychiatric care, but none of the specific study measures. Primary target criteria of the study were number, duration and status (voluntary or involuntary) of re-admissions to inpatient psychiatric treatment during the follow-up as well as the time until this admission. Subjective target criteria included treatment satisfaction, quality of life and empowerment on the part of the patients.

 

In total, 204 patients in 5 participating psychiatric hospitals and departments were recruited, included in the study and randomly allocated to the intervention or control group (n=104 in each group). 38 patients (37.3%) in the IG prematurely ended their study participation in the course of the follow-up. In the CG, the dropout rate amounted to 28.4% (29 patients). The average post-observation time of the patients who ended the study at the regular time lay at 609 days in the IG and 601 days in the CG.

 

In the initial analyses, it was apparent that patients in the IG and CG did not differ with in the main target criteria of number, duration and time to first compulsory readmission after discharge from the index hospitalisation. They were also equal in terms of non-compulsory inpatient episodes. However, the intervention evidently shows a subgroup-specific effect. Patients of the CG with clear and severe productive symptoms (PANNS) showed a trend for a longer inpatient psychiatric stay (voluntary and compulsory) during the follow-up compared to the IG patients with the same degree of severity. Equally, the hospital frequency (i.e. the number of inpatient psychiatric readmissions in 12 months) was increased in the CG. Further findings point to a significant influence of the degree of treatment compliance on the survival time until the first inpatient psychiatric readmission. Further analyses were still ongoing at the time of compiling this report.

 

The patients were recruited in a total of five study centres (psychiatric clinics):

a) Zentralinstitut für Seelische Gesundheit, Mannheim,
b) Zentrum für Psychiatrie Nordbaden, Wiesloch,
c) Abteilung für Psychiatrie und Psychotherapie, Krankenhaus Zum Guten Hirten, Ludwigshafen,
d) Walter-Picard-Klinik, Zenrum für Soziale Psychiatrie Phillipshospital, Riedstadt,
e) Klinik für Psychiatrie und Psychotherapie Sonnenwende, Bad Dürkheim.




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