Revolving-door Patients in Public Psychiatric Hospital in Israel: Cross Sectional Study

Abstract

AIM. To study social, demographic, clinical, and forensic profiles of frequently re-hospitalized (revolving-door) psychiatric patients. METHODS. The study included all patients (n=183) who were admitted to our hospital 3 or more times during a 2-year period from 1999 through 2000. We compared these patients to 2 control groups of patients who were admitted to our hospital in the same period. For comparison of forensic data, we compared them with all non revolving-door patients (n=1056) registered in the computerized hospital database and for comparison of medical and clinical data we compared them with a random sample of non revolving-door patients (n=98). The sample was sufficiently large to yield high statistical power (above 98%). We collected data on the legal status of the hospitalizations (voluntary or involuntary) and social, demographic, clinical, and forensic information from the forensic and medical records of revolving-door and non revolving-door patients. RESULTS. In the period 1999-2000, 183 revolving-door patients accounted for 771 (37.8%, 4.2 admissions per patient) and 1056 non revolving-door patients accounted for 1264 (62.5%, 1.2 admissions per patient) of the 2035 admissions to our hospital. Involuntary hospitalizations accounted for 23.9% of revolving-door and 76.0% of non revolving-door admissions. Revolving-door patients had significantly shorter mean interval between hospitalizations, showed less violence, and were usually discharged contrary to medical advice. We found no differences in sex, marital status, age, ethnicity, diagnoses, illegal drug and alcohol use, or previous suicide-attempts between the groups. CONCLUSIONS. Revolving-door patients are not necessarily hospitalized for longer time periods and do not have more involuntarily admissions. The main difference between revolving-door and non revolving-door patients is greater self-management of the hospitalization process by shortening the time between voluntary re-admission and discharge against medical advice.

Factors Associated with Psychiatric Readmissions: A Systematic Review

“…The variables that presented contradictory results were gender, occupation and education. On the other hand, what appeared consistently in the results was that younger and single people are more prone to frequent readmissions, associations pointed out in previous studies, in which being single was considered a risk factor (Oyffe et al, 2009, Parente et al, 2007, while being married seems to be a protective factor for readmissions (Donisi et al, 2016).…”

“…Internationally, the revolving door phenomenon is characterized by repeated and frequent psychiatric readmissions shortly after discharge. Studies associate their occurrence with difficulties in the compliance with and continuity of extra-hospital treatment, both outpatient and inpatient, or to insufficient substitutive services in the community (Dimenstein et al, 2012;Oyffe, Kurs, Gelkopf, Melamed & Bleich, 2009;Ramos, Guimarães & Enders, 2011).…”

“…Frequent readmissions are characterized according to different frequency criteria (number of readmissions and interval between readmissions), and there is no consensus on the criterion among the authors (Gastal et al, 2000;Oyffe et al, 2009;Ramos et al, 2011Roick et al, 2004. Among the associated factors, the literature points to the following predictors: male users (Parente et al, 2007;Roick et al, 2004); single and living alone (Oyffe et al, 2009, Parente et al, 2007; first long-term hospitalization (Gastal et al, 2000); large number of previous admissions and request for discharge against medical evaluation (Oyffe et al, 2009) and less contact with the family (Bezerra & Dimenstein, 2011;Roick et al, 2004).…”

“…Although there is evidence on the occurrence of the phenomenon in different locations (Bezerra&Dimenstein, 2011, Gastal et al, 2000, Oyffe et al, 2009, Parente et al, 2007, Brazilian studies on the theme remain scarce, and none were included in this review (Donisi et al, 2016). Thus, this systematic review is proposed to analyze the criteria that define frequent psychiatric readmissions and associated factors: sociodemographic, clinical data and care network.…”

Preventing involuntary admissions: special needs for distinct patient groups

“…Germany was also shown to have the second highest rate of involuntary admission per 100,000 inhabitants, with Portugal, France and Denmark having the lowest. According to this study, the most frequent diagnosis was schizophrenia (29.5–52.7%), followed by affective disorders (9.2–13.7%), then substance abuse (5.2–24.5%) and then dementia (2.2–12.6%) [ 7 ], which was similar for smaller regions [ 8 – 10 ]; sociodemographic risk factors were suggested to be a married status and living alone. Even in different German hospitals, there was a great variety of coercive measures (1.9–16.2%); also depending on the diagnosis [ 11 ], this could also been demonstrated for Switzerland [ 12 ].…”