Comparison of hospital admission rates for psychiatric patients cared for by multidisciplinary outreach teams with and without peer specialist: a retrospective cohort study of Japanese Outreach Model Project 2011–2014

Abstract

ObjectiveThis study examined whether having peer specialists (PS) in psychiatric multidisciplinary outreach teams was associated with a lower risk of hospitalisation, improved social functioning and decreased problem behaviours.Design and settingThis study was a retrospective cohort study based on medical records. This study was conducted as a part of the Japanese Outreach Model Project 2011–2014, which provides services for persons diagnosed mainly as ICD-10 F0, F2 and F3, who have a high possibility of hospital admission/readmission with regular Japanese outpatient care.ParticipantsA total of 292 participants (clients) from 31 multidisciplinary outreach teams with and without PS (n=108 and 184, respectively) fulfilled the inclusion criteria and were included in the analysis.Outcome measuresThe primary outcome measure was hospitalisation during follow-up. The difference in hospitalisation during the follow-up between teams with and without PS was analysed by Kaplan-Meier survival curves and a Cox proportional hazards model. The secondary outcome measures were social functioning (Global Assessment of Functioning, GAF) and problem behaviours (Social Behaviour Schedule, SBS) of clients, and were assessed at baseline and at 6-month follow-up. Changes in social functioning and problem behaviours were compared between clients cared for by the two team types. Amount and content of the service were also compared.ResultsThe clients cared by teams with PS had a significantly decreased probability of hospitalisation in Cox proportional hazards models adjusting for baseline characteristics (HR=0.53, 95% CI 0.31 to 0.89). The 6-month change in GAF or SBS was not significantly different between the two groups.ConclusionThis is an observational study in which the presence of a PS appeared to be associated with a reduced rate of hospitalisation. A randomised study would be required to demonstrate a causal relationship.

Effectiveness of a peer-supported crisis intervention to reduce the proportion of compulsory admissions in acute psychiatric crisis interventions in an outreach and outpatient setting: study protocol for an exploratory cluster randomised trial combined with qualitative methods

“…For instance, it has been shown that peer support leads to increased self-efficacy and a lower rate of readmissions to acute care. [20][21][22][23] In addition, peer support can potentially improve recovery, 24 25 mental and physical health, 24 26 as well as quality of life, 24 reduce inpatient admissions 20 and increase the voluntary use of clinical, psychosocial and vocational support services. 27 There is also evidence that peer support is able to reduce the use of coercive measures.…”

Service intensity of community mental health outreach among people with untreated mental health problems in Japan: A retrospective cohort study

“…Also, a very small number of ACT and other programs for people with severe mental illness have been implemented in Japan, and have shown positive results in reducing psychiatric symptoms 23 and hospitalization 24 , 25 , 26 or improving functioning. 23 , 24 , 27 In particular, the services of medical support for psychiatric symptoms and assistance with daily living tasks were more common in previous studies of outreach focused mainly on people with a psychiatric diagnosis (severe mental illness) who discontinued or did not receive long‐term treatment. 26 , 27 However, these services seldom provide services to people with undiagnosed mental health problems.…”