Patient and treatment related variables as predictors of length of stay in a Nigerian Neuropsychiatric hospital.

Abstract

Aim: The aim of this study was to assess the hospital length of stay (LOS) of patients discharged from the acute wards of a psychiatric hospital in Nigeria and to determine its relationship with demographic, illnessrelated and treatment related variables. Methods: This was a retrospective cross-sectional study involving case note review of patients discharged from the acute psychiatric ward of the hospital during 1-year period. A questionnaire was used in collecting data about the socio-demographic variables (e.g. age, gender, distance of place of abode from hospital), clinical characteristics (diagnosis, co-morbid physical illness etc.) and clinical practice or treatment related factors (e.g. frequency of review by consultant psychiatrists, administration of electroconvulsive therapy etc.). Results: A total of 93 patients' case notes were analyzed, comprising 87.7% of the total number of discharges during the study period. The hospital LOS was 55 days. Using the median LOS as the cutoff , 49.5% had short LOS (LOS <55 days), while 50.5% had prolonged LOS (LOS ≥55 days). LOS was significantly associated with employment status (χ 2 = 3.871, P = 0.049), distance of patients' residence from the hospital (χ 2 = 4.300, P = 0.038), reported medication side effects while on admission (χ 2 = 3.986, P = 0.046), previous psychiatric hospitalizations (χ 2 = 4.748, P = 0.029) and duration of current illness before admission (Z = −4.020, P < 0.001). The result of the binary logistic regression analysis showed that only previous psychiatric hospitalizations made a unique statistically significant contribution to the model (beta = 1.021, wald = 4.433, P = 0.035, odds ratio = 2.775, 95% confidence interval = 1.073-7.174). Conclusion: Despite their significant association with hospital LOS, socio-demographic, illness and treatment related factors explained only a minimal variation in hospital LOS. It is possible that variables "external" to either patients' characteristics or physicians' practice style, are more significant predictors of long hospital LOS. These findings may help guide policy makers in improving the efficiency mental health service delivery in Nigeria.

Factors Influencing Drug Use Information Received at Primary Healthcare Centre Pharmacies in Ghana

“…This type of communication is most important for patients with low educational levels and limited functional health literacy because such patients are likely to make medication errors and act inappropriately in response to the side effects of the drugs. 34 Such quality communication helps to meet therapeutic goals, eventually promoting recovery from illness and achieving a better quality of life. In this regard, a meta-analytic review concluded that health professionals who adopt a warm and act friendly are more effective than those who keep consultations formal and do not offer reassurance to their clients.…”

The Impact of Legal Procedures on Hospital Length of Stay: Balancing Legal and Clinical Concerns

“…bles of primary interest. In contrast, most previous studies focused on patient-related factors including sociodemographic and clinical factors [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22], hospital or regional characteristics [6,[15][16][17]21], or provider-or service-related factors [18][19][20][21][22], less on legal factors. For example, some studies included legal status as a predictor of LOS but did not show the actual day information [6,21]; specifically, Compton et al reviewed legal status at admission and at discharge, not court-ordered treatment.…”

“…Balancing Legal and Clinical Concerns also been associated with LOS [6][7][8][9][10][11][12][13][14]. Clinical factors such as a primary diagnosis of schizophrenia and a greater number of previous admissions predicted longer LOS [5][6][7][8][9][10].…”