The impact of patient-controlled hospital admissions among patients with severe mental disorders on health care cost: A nationwide register-based cohort study using quasi-experimental design

Paaske, Louise Schubert; Sopina, Elizaveta; Olsen, Kim Rose; Thomsen, Christoffer Torgaard; Benros, Michael E.; Nordentoft, Merete; Hastrup, Lene Halling

doi:10.1016/j.jpsychires.2021.10.032

Cited by 5 publications

(7 citation statements)

References 24 publications

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“…Apart from studying the results of introducing PCA, this study will also assess its cost-effectiveness, similar to a newly published study from Denmark. 10 This includes determining the direct and total healthcare costs prior to and after being assigned PCA. Direct costs are the expenditures associated with each visit to a psychiatric emergency department, inpatient care and involuntary care.…”

Section: Discussionmentioning

confidence: 99%

“…Early attempts of implementation were done in the USA and Australia, but the first large-scale investigations were made in the Netherlands, Norway, Denmark and Sweden. [3][4][5][6][7][8][9][10] In sum, research indicates an increase in the number of admissions to inpatient care, but a decrease in the number of days in inpatient care. Meanwhile, both the admissions to and days in involuntary care decrease, suggesting that patients admit themselves more often, but require less fewer admissions of shorter duration, in line with the idea of using PCA to promote independence and increase help-seeking behaviours.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

“…These include the following: (1) 'I feel confident about receiving care when I need it', (2) 'I am able to actively participate in my care' and (3) 'I believe care is available when needed'. These are scored on a continuum ranging from 'I do not agree at all' (0) to 'totally agree' (10). Also, a fourth item concerns 'How would you rate your current health status?…”

Section: Hospitalisation Ratesmentioning

confidence: 99%

“…Also, a fourth item concerns 'How would you rate your current health status? ', which is rated between 'worst possible health' (0) and 'best possible health' (10).…”

Section: Hospitalisation Ratesmentioning

confidence: 99%

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What are the effects of implementing patient-controlled admissions in inpatient care? A study protocol of a large-scale implementation and naturalistic evaluation for adult and adolescent patients with severe psychiatric conditions throughout Region Stockholm

et al. 2022

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IntroductionPatient-controlled admissions (PCAs) represent a change in psychiatric inpatient care where patients are allowed to decide for themselves when hospitalisation might be required. Prior research has demonstrated that PCA increase the number of admissions, but decrease days in inpatient care, while both the admissions to and days in involuntary care decrease. However, investigations have been restricted to specific patient groups and have not examined other possible benefits, such as effects on symptoms, quality of life and autonomy.Methods and analysisThis study explores the implementation process and effects of PCA in Region Stockholm, who is currently introducing PCA for all patients with severe psychiatric conditions and extensive healthcare utilisation. In total, the study comprises approximately 45 inpatient wards, including child and adolescent psychiatry. In a naturalistic evaluation, patients assigned PCA will be followed up to 36 months, both with regard to hospitalisation rates and self-reported outcomes. In addition, qualitative studies will explore the experiences of patients, caregivers of adolescents and healthcare providers.Ethics and disseminationApproval has been granted by the Swedish Ethical Review Authority (Dnr: 2020-06498). The findings from this study will be disseminated via publications in international peer-reviewed journals, at scientific conferences, as part of two doctoral theses, and through the Swedish Partnership for Mental Health.Trial registration numberNCT04862897.

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Section: Discussionmentioning

confidence: 99%

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Section: Hospitalisation Ratesmentioning

confidence: 99%

“…Also, a fourth item concerns 'How would you rate your current health status? ', which is rated between 'worst possible health' (0) and 'best possible health' (10).…”

Section: Hospitalisation Ratesmentioning

confidence: 99%

See 2 more Smart Citations

What are the effects of implementing patient-controlled admissions in inpatient care? A study protocol of a large-scale implementation and naturalistic evaluation for adult and adolescent patients with severe psychiatric conditions throughout Region Stockholm

et al. 2022

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“…Available funding and health-economic aspects will need to be taken into consideration when offering BA to a selected group. As indicated in a Danish study on patient-controlled hospital admissions among adult patients with severe mental disorders [ 46 ], an intervention like this may lead to increased healthcare costs, at least in the short-term.…”

Section: Discussionmentioning

confidence: 99%

‘A Safe Place Where I Am Welcome to Unwind When I Choose to’—Experiences of Brief Admission by Self-Referral for Adolescents Who Self-Harm at Risk for Suicide: A Qualitative Study

Lindkvist

Westling

Eberhard

et al. 2021

IJERPH

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Evidence is lacking on how to manage imminent suicidality in adolescents with self-harm. Brief Admission by Self-referral (BA) is a crisis-management intervention, developed for adults with self-harm at risk for suicide. Structured, individualized and based on responsible autonomy, BA aims to provide a respite while minimizing negative effects of hospitalization. This qualitative interview study illuminates adolescents’ experiences of BA, adapted for this target group. Nineteen adolescents aged 14 to 19 years, described BA as helpful for timely rest and recovery to save themselves from impulses to self-harm. The individual contract, which is a prerequisite for access to BA, was perceived to give access to professional support in a safe environment, also among adolescents not using their contract. Being trusted with responsibility to self-admit was also hard work with struggles of self-doubt. Challenges included experiencing distrust from staff and fear of not being able to abstain from self-harm, which BA is conditioned upon. However, this condition was also perceived to induce self-motivation and growth. BA appeared well-adapted to the target group, fulfilling needs of predictability, autonomy, and opportunity for recovery to prevent self-harm. Suggestions for improvement included continually informing staff about important features of BA. To further evaluate benefits and challenges of BA, future research may evaluate clinical and health-economic outcomes and perspectives from parents and caregivers.

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Healthcare costs associated with opportunistically identifiable vertebral fractures

Skjødt

Nicolaes

Smith

et al. 2023

Bone

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The impact of patient-controlled hospital admissions among patients with severe mental disorders on health care cost: A nationwide register-based cohort study using quasi-experimental design

Cited by 5 publications

References 24 publications

What are the effects of implementing patient-controlled admissions in inpatient care? A study protocol of a large-scale implementation and naturalistic evaluation for adult and adolescent patients with severe psychiatric conditions throughout Region Stockholm

What are the effects of implementing patient-controlled admissions in inpatient care? A study protocol of a large-scale implementation and naturalistic evaluation for adult and adolescent patients with severe psychiatric conditions throughout Region Stockholm

‘A Safe Place Where I Am Welcome to Unwind When I Choose to’—Experiences of Brief Admission by Self-Referral for Adolescents Who Self-Harm at Risk for Suicide: A Qualitative Study

Healthcare costs associated with opportunistically identifiable vertebral fractures

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