Patient‐controlled hospital admission for patients with severe mental disorders: a nationwide prospective multicentre study

Thomsen, Christoffer Torgaard; Benros, Michael E.; Maltesen, Thomas; Hastrup, Lene Halling; Andersen, Per Kragh; Giacco, Domenico; Nordentoft, Merete

doi:10.1111/acps.12868

Cited by 24 publications

(36 citation statements)

References 23 publications

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“…The resulting reduction in inpatient days was 44.7%. These reductions are similar to several previous reports of PCA schemes [1], but much larger than those reported in Denmark [9]. Few patients in the current study had involuntary inpatient days and the dispersion in involuntary care before and after the PCA contract was large.…”

Section: Discussionsupporting

confidence: 91%

“…In a larger Danish study, 422 patients used 1037 PCAs (with a mean of 2.5) in the year following the signing of PCA contracts, and the reduction in inpatient days from the previous year was 17. The study found no important differences between PCA patients and a propensity-matched, register-based sample of 2110 patients drawn from all Danish mental health inpatients in the same period [9].…”

Section: Introductionmentioning

confidence: 64%

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When patients decide the admission – a four year pre-post study of changes in admissions and inpatient days following patient controlled admission contracts

Nyttingnes

Ruud

2020

BMC Health Serv Res

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Background: Mental health professionals usually decide patients' access to inpatient care to ensure the rational and fair distribution of care based on need and prognosis. The purpose of the current study is to investigate the effects of increasing patients' influence on admission by enabling patients to initiate brief inpatient stays of up to five days at a community mental health center. Patients can initiate admission according to their own discretion, outside the existing referral and gatekeeping system. Methods: Patient-controlled admission (PCA) contracts were offered to eligible patients for inpatient stays in four community mental health centers in one health trust in Norway. Data on included patients' inpatient stays at any of the hospitals' mental health or addiction wards were collected by hospital electronic journal data extraction specialists for the two years before PCA contracts were introduced and the first two years after PCA contracts were introduced for the included patients. Results: The included patients (n = 57) had 406 PCAs in the two years following signing PCA contracts. When comparing the periods before and after the introduction of the contracts, the total number of admissions increased from 203 to 498 (p < .001), while the number of inpatient days decreased from 7172 to 3178 (p < .001). No significant change in involuntary care was observed. A comparison of box plots of inpatient day use in the eight half-year periods of the study indicates a gradual increase in median inpatient days up to the signing of a PCA contract for the sample, and an abrupt reduction to a stable median level of inpatient days after signing a contract. Conclusions: The included patients' use of inpatient days changed profoundly after signing PCA contracts, similar to what previous studies of PCAs have indicated. In spite of the marked reductions in inpatient days, the pre-post design makes it impossible to rule out that the reductions were caused by regression toward the mean. No study of PCAs has reported negative effects, indicating that giving patients control over very short admissions is a feasible and potentially positive scheme in mental health care wards.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 64%

When patients decide the admission – a four year pre-post study of changes in admissions and inpatient days following patient controlled admission contracts

Nyttingnes

Ruud

2020

BMC Health Serv Res

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“…It is proposed that a lower retinal sensitivity to light in combination with the reduced light levels in winter leads to subthreshold light input to neural circuitry and consequently to the development of seasonally occurring depressive episodes. Roecklein et al were the first to present pupillometric evidence that the melanopsin-driven pupillary responses were attenuated in patients with SAD compared to healthy controls during depressed winter phase (2). The same group showed that this impairment was not present in the remitted summer state but only in depressive winter state (4).…”

Section: Investigations Of Pupillary Responses In Depressionmentioning

confidence: 99%

“…The recent study of Berman et al published in Acta Psychiatrica Scandinavica (1) adds to a list of reports of quantifiable attenuations in the pupillary responses to blue light in persons with depressive disorder (2)(3)(4). With pupillometry, the pupillary contraction and dilatation in response to different wavelength light stimuli are recorded and quantified.…”

Section: Investigations Of Pupillary Responses In Depressionmentioning

confidence: 99%

Is it time for a more nuanced view on self‐admission to in‐patient treatment in psychiatry?

Strand

Hausswolff-Juhlin

2018

Acta Psychiatr Scand

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“…Brief self-referral initiatives (also called brief admission, self-admission, or patient-controlled admission) have evolved as a promising alternative to lengthy and unstructured psychiatric admissions for those diagnosed with BPD (Helleman, Goossens, Kaasenbrood, & van Achterberg, 2014a), eating disorders (Strand, Gustafsson, Bulik, von, & Juhlin, 2015); schizophrenia, and bipolar disorder (Moljord et al, 2017;Sigrunarson, Moljord, Steinsbekk, Eriksen, & Morken, 2017;Thomsen et al, 2018). These structured crisis management programs are founded on predefined agreements regulating admission length and services included.…”

Section: Introductionmentioning

confidence: 99%

Predictable, Collaborative and Safe: Healthcare Provider Experiences of Introducing Brief Admissions by Self-referral for Self-harming and Suicidal Persons with a History of Extensive Psychiatric Inpatient Care

Lindkvist

Landgren

Liljedahl

et al. 2019

Issues in Mental Health Nursing

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People with severe self-harming behavior and histories of lengthy psychiatric inpatient admissions can represent a challenge to care providers. This interview-based study illuminates healthcare provider experiences (n ¼ 12) of Brief Admission (BA) among self-harming individuals, with >180 days of psychiatric admission the previous year. Qualitative content analysis revealed that providers experienced benefits of increased predictability, and a shift from trigger and conflict to collaboration with individuals admitted to BA. Staff participants expressed an increased sense of safety and a strengthened link between inpatient and outpatient caregiving. Results indicated that BA is a promising intervention for self-harming individuals with extensive psychiatric histories.

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Patient‐controlled hospital admission for patients with severe mental disorders: a nationwide prospective multicentre study

Cited by 24 publications

References 23 publications

When patients decide the admission – a four year pre-post study of changes in admissions and inpatient days following patient controlled admission contracts

When patients decide the admission – a four year pre-post study of changes in admissions and inpatient days following patient controlled admission contracts

Is it time for a more nuanced view on self‐admission to in‐patient treatment in psychiatry?

Predictable, Collaborative and Safe: Healthcare Provider Experiences of Introducing Brief Admissions by Self-referral for Self-harming and Suicidal Persons with a History of Extensive Psychiatric Inpatient Care

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