Stationsäquivalente Behandlung (StäB) im Vergleich mit vollstationärer Behandlung: 12-Monats-Follow-up einer gematchten Kohortenstudie

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Zusammenfassung

Ziel der Studie Überprüfung der Wirksamkeit einer stationsäquivalenten psychiatrischen Behandlung (StäB) im Vergleich mit einer vollstationären psychiatrischen Routinebehandlung.

Methodik Im Rahmen einer retrospektiven Verlaufsstudie wurden 43 Patient*innen aus der StäB (Interventionsgruppe/IG, n = 43) mit einer gematchten vollstationären Kontrollgruppe (KG, n = 43) hinsichtlich vollstationärer Wiederaufnahmerate und Behandlungstage im 12-Monats-Follow-up verglichen.

Ergebnisse Bei den Patient*innen der IG zeigte sich eine um etwa 9 % geringere Wiederaufnahmerate in die vollstationäre Behandlung. Im 12-Monats-Follow-up zeigte sich in dieser Gruppe eine um etwa 30 % längere vollstationäre Behandlungsdauer. Beide Gruppenunterschiede waren statistisch nicht signifikant.

Schlussfolgerung Die vorliegende Studie deutet darauf hin, dass StäB hinsichtlich des Wiederaufnahmerisikos einer stationären Behandlung nicht unterlegen ist.

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Most cited references 26

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Home treatment for acute mental healthcare: randomised controlled trial

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Home treatment has been proposed as an alternative to acute in-patient care for mentally ill patients. However, there is only moderate evidence in support of home treatment. To test whether and to what degree home treatment services would enable a reduction (substitution) of hospital use. A total of 707 consecutively admitted adult patients with a broad spectrum of mental disorders (ICD-10: F2–F6, F8–F9, Z) experiencing crises that necessitated immediate admission to hospital, were randomly allocated to either a service model including a home treatment alternative to hospital care (experimental group) or a conventional service model that lacked a home treatment alternative to in-patient care (control group) (trial registration at ClinicalTrials.gov: NCT02322437). The mean number of hospital days per patient within 24 months after the index crisis necessitating hospital admission (primary outcome) was reduced by 30.4% (mean 41.3 v. 59.3, P <0.001) when a home treatment team was available (intention-to-treat analysis). Regarding secondary outcomes, average overall treatment duration (hospital days + home treatment days) per patient (mean 50.4 v. 59.3, P = 0.969) and mean number of hospital admissions per patient (mean 1.86 v. 1.93, P = 0.885) did not differ statistically significantly between the experimental and control groups within 24 months after the index crisis. There were no significant between-group differences regarding clinical and social outcomes (Health of the Nation Outcome Scales: mean 9.9 v. 9.7, P = 0.652) or patient satisfaction with care (Perception of Care questionnaire: mean 0.78 v. 0.80, P = 0.242). Home treatment services can reduce hospital use among severely ill patients in acute crises and seem to result in comparable clinical/social outcomes and patient satisfaction as standard in-patient care.

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Although present findings about frequent users of psychiatric inpatient services vary from study to study, some potentially important predictors of frequent use were extracted. The purpose of this study was to examine the potentially contributory factors of frequent use of psychiatric inpatient services by schizophrenia patients and to test the influence single factors have in an overall model. A total of 307 schizophrenia patients were interviewed five times with intervals of 6 months. Data were collected about service receipt and health care costs, strength of primary diagnosis and comorbidities, as well as about patients' needs for care and satisfaction with care. Patients with three or more psychiatric admissions within a 30-month period were defined as frequent users. According to this criterion, 12% of the study population were frequent users. Compared with ordinary users, these patients accounted for significantly higher costs in hospital- and community-based care. Important predictors for frequent use of psychiatric inpatient services were the number of previous hospitalizations and current scores of psychopathology. In addition, a longitudinal analysis showed the importance of social factors for the use of psychiatric inpatient care. Therefore, a number of the frequent users' multiple admissions could also be caused by social problems. The mental health system should, thus, provide well-directed community-based resources, which give frequent users support to solve their social problems.

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Author and article information

Journal

Title: Psychiatrische Praxis

Abbreviated Title: Psychiatr Prax

Publisher: Georg Thieme Verlag KG

ISSN (Print): 0303-4259

ISSN (Electronic): 1439-0876

Publication date Created: November 10 2022

Publication date Created: November 2022

Publication date (Electronic): October 21 2021

Publication date (Print): November 2022

Volume: 49

Issue: 08

Pages: 405-410

Affiliations

[1 ]Psychiatrie, Universitätsspital Basel, Schweiz

[2 ]Vivantes Klinikum Am Urban, Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Berlin

[3 ]Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf

[4 ]Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Köln

[5 ]ORYGEN, National Center of Excellence of Youth Mental Health, University of Melbourne, Australien

Article

DOI: 10.1055/a-1615-8763

PubMed ID: 34674201

SO-VID: 7d52ac98-e27a-44ae-867f-ea0682720195

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