Does deinstitutionalisation work? Relationships between psychiatric outpatient and inpatient care provision in a rural German catchment area

Abstract

Objective: We intended to find out whether an intensification of outpatient care after conclusion of the deinstitutionalization era in the year 2001 had an influence on number of hospitalizations, readmission figures, length of inpatient -stay (LOS), cumulative length of inpatient-stay (cumulative LOS) and coercive measures. Method:We investigated the development of 17 inpatient and outpatient variables for 2002-10 within a district psychiatric hospital responsible for a rural catchment area of 320,000 inhabitants. The sample consisted of 31,537 inpatient admissions and 35,372 outpatients accounted on an annual basis. Some figures were compared with those at state and federal levels. Associations between aggregated hospitalization and outpatient care variables were assessed by means of robust bivariate Prais-Winsten regression models for time series.Results: Over the surveyed period, number of admissions, admitted individuals, and hospitalization rates remained stable, contrary to state and federal tendencies. Cumulative LOS and readmission figures decreased, whereas average LOS increased. Number of admissions, cumulative LOS, and readmission figures were negatively associated with number of outpatients treated which increased over the surveyed period. Number of coercive measures decreased, numbers of involuntary admissions under the guardianship law remained lower than at federal and state levels, and ambulatory activity remained three times higher than in the state in which the surveyed catchment area is located. Conclusions:Community-oriented ambulatory care on the basis of multi-disciplinary assertive teams seems to be able to reduce readmissions and cumulative length of inpatient-stay, while keeping at the same time the number of admissions and coercive measures stable. Economic and clinical effects on real inpatient care, however, cannot be definitively evaluated as long as bed provision does not decrease proportionally with the increase of ambulatory activity.

Is the level of institutionalisation found in psychiatric housing services associated with the severity of illness and the functional impairment of the patients? A patient record analysis

“…Data were collected in a rural catchment area in southern Germany. Psychiatric in- and outpatient services for the catchment are provided by one psychiatric hospital with 180 beds and an outpatient clinic which treats about 1000 patients annually [ 16 , 17 ].…”

Evaluating a multimodal, clinical and work-directed intervention (RTW-PIA) to support sustainable return to work among employees with mental disorders: study protocol of a multicentre, randomised controlled trial

“…gradual RTW [39]) have been ad hoc and not structurally supported across the various interfaces [40]. In a conservative welfare state regime like Germany [41], the national health care system is instituted on dichotomous principles which rest on different statutory, management and funding structures: medical vs. social services; hospital vs. ambulatory care; rehabilitation vs. acute treatment [42]. Since RTW is seen as a developmental process that begins with the onset of treatment, the topic of work or RTW-related components should be an integral part of therapy [16,43,44].…”

“…To date, therapeutic efforts to get people with MDs into the labour market or keep them in the workplace have primarily taken place in the traditional vocational rehabilitation sector and thus outside the acute psychiatric treatment context [46]. With respect to the latter, psychiatric outpatient clinics (POCs), situated within general hospitals and networked with psychiatric hospitals and departments [42], are considered to be a cornerstone of psychiatric care in Germany [47]. Their multidisciplinary care approaches are aimed at patients who are not adequately reached by other contract medical care services within the mental health care system, especially in emergencies or after discharge [48].…”

“…Their multidisciplinary care approaches are aimed at patients who are not adequately reached by other contract medical care services within the mental health care system, especially in emergencies or after discharge [ 48 ]. Unlike English-speaking or Scandinavian countries, the labels outpatient clinics and community mental health teams are used interchangeably in Germany [ 42 ].…”