Bed utilization in two differently organized community mental health services in Northern Norway: the VELO-project

Sørgaard

Wynn

2014

BMC Health Serv Res

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BackgroundStudies on the effect of organizational factors on the involuntary admission of psychiatric patients have been few and yielded inconclusive results. The objective was to examine the importance of type of service-system, level of care, length of inpatient stay, gender, age, and diagnosis on rates of involuntary admission, by comparing one deinstitutionalized and one locally institutionalized service-system, in a naturalistic experiment.Methods5538 admissions to two specialist psychiatric service-areas in North Norway were studied, covering a four-year period (2003-2006). The importance of various predictors on involuntary admission were analyzed in a logistic regression model.ResultsInvoluntary admission to the services was associated with the diagnosis of psychosis, male sex, being referred to inpatient treatment, as well as type of service-system. Patients from the deinstitutionalized system were more likely to be involuntarily admitted.ConclusionsSeveral factors predicted involuntary status, including male sex, the diagnosis of psychosis, and type of service-system. The results suggests that having psychiatric beds available locally may be more favourable than a traditional deinstitutionalized service system with local outpatient clinics and central mental hospitals, with respect to the use of involuntary admission.

Section: Methodsmentioning

confidence: 81%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Local psychiatric beds appear to decrease the use of involuntary admission: a case-registry study

Sørgaard

Wynn

2014

BMC Health Serv Res

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“…This approach may be especially applicable in countries where integrated inpatient and outpatient care is in place, such as parts of France [7] and Norway [26, 40]. …”

Section: Discussionmentioning

confidence: 99%

“…In Lofoten, this is reversed, with 90% of the inpatient stays at the hospital in Bodø, and only 10% are admitted locally (i.e. in the local somatic hospital) [26]. Consequently, the two systems may be termed a ‘decentralized care model’ (i.e.…”

Section: Methodsmentioning

confidence: 99%

Impact on continuity of care of decentralized versus partly centralized mental health care in Northern Norway

Olstad²,

Bjorbekkmo

et al. 2011

Int J Integr Care

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BackgroundThe issue of continuity of care is central in contemporary psychiatric services research. In Norway, inpatient admissions are mainly to take place locally, in a system of small bed-units that represent an alternative to traditional central psychiatric hospitals. This type of organization may be advantageous for accessibility and cooperation, but has been given little scientific attention.AimsTo study whether inpatients’ utilization of outpatient services differ between an area with a decentralized care model in comparison to an adjacent area with a partly centralized model.MethodThe study was based on data from a one-year registered prevalence sample, drawing on routinely sampled data supplemented with data from medical records. Service-utilization for 247 inpatients was analyzed. The results were controlled for diagnosis, demographic variables, type of service system, localization of inpatient admissions, and length of hospitalization.ResultsMost inpatients in the area with the decentralized care model also utilized outpatient consultations, whereas a considerable number of inpatients in the area with a partly centralized model did not enter outpatient care at all. Type of service system, localization of inpatient admission, and length of hospitalization predicted inpatients’ utilization of outpatient consultations. The results are discussed in the light of systems integration, particularly management-arrangements and clinical bridging over the transitional phase from inpatient to outpatient care.ConclusionInpatients’ utilization of outpatient services differed between an area with a decentralized care model in comparison to an adjacent area with a partly centralized care model. In the areas studied, extensive decentralization of the psychiatric services positively affected coordination of inpatient and outpatient services for people with severe psychiatric disorders. Small, local-bed units may therefore represent a favourable alternative to traditional central psychiatric hospitals.

The role of local inpatient psychiatric units and general practitioner on continuity of care in Northern Norway: A case‐register study

Int J Methods Psych Res

Lassemo

2020

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Objectives:The general practitioners' (GP) role in the care of mental health patients has received increased attention. The literature underlines the need for integration of primary and specialist services, but cross-boundary continuity for patients with severe conditions may be particularly poor. The aim of this study was to analyze the collaboration between primary care and different models of specialized psychiatric services for patients with severe conditions. Methods:We compared a local and a centralized model of mental health care.Service utilization over a 5-year period was studied.Results: Findings suggest that a local institution-based model of services positively affects the use of both GP and specialist outpatient care, with most inpatients utilizing both GP and specialist outpatient consultations. In the centralized model, a substantial proportion of inpatients only used GP outpatient care. Furthermore, inpatients that used both GP and specialist outpatient services received more of both services compared to those who did not enter specialist outpatient care at all. Conclusion:Local inpatient units may positively affect continuity of care and collaboration between general practitioners and specialist psychiatric services compared to more traditional hospital units, probably because better functional integration of services, better facilitation of clinical alliances/relationships, or a more network-oriented treatment philosophy. K E Y W O R D Scontinuity of care, general practitioners, mental health, psychiatry | INTRODUCTIONThe deinstitutionalization of psychiatry has in its essence been a downsizing of central psychiatric institutions in favor of more outpatient-and community-based services (Thornicroft & Bebbington, 1989). The early concept of community psychiatry was very much influenced by the American psychiatrist Alexander Leighton (1982) and his « Bristol Mental Health Center » characterized by rapid and exact diagnostics, pragmatic and systematic research, and identification of local resources and collaborating agencies (Leighton, 1982). In the light of current and broad healthcare reforms, the general practitioners have gradually been given a more important role in such localThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.