The use of outpatient commitment in Norway: Who are the patients and what does it involve?

Rugkåsa, Jorun; Nyttingnes, Olav; Simonsen, Tone Breines; Benth, Jūratė Šaltytė; Lau, Bjørn; Riley, Henriette; Løvsletten, Maria; Christensen, Tore Buer; Austegard, Ann-Torunn Andersen; Høyer, Georg

doi:10.1016/j.ijlp.2018.11.001

Cited by 13 publications

(17 citation statements)

References 28 publications

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“… a Rural areas = municipalities with less than 20.000 inhabitants, Urban areas = municipalities with more than 20.000 inhabitants. We classified patients’ home municipality into rural and urban based on a combination of population density and proximity to regional centers and other towns/cities first calculated by Rugkåsa et al [42] and available on request…”

Section: Methodsmentioning

confidence: 99%

Dementia and patient safety in the community: a qualitative study of family carers’ protective practices and implications for services

Häikiö

Sagbakken

Rugkåsa

2019

BMC Health Serv Res

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Background Dementia is a cause of disability and dependency associated with high demands for health services and expected to have a significant impact on resources. Care policies worldwide increasingly rely on family caregivers to contribute to service delivery for older people, and the general direction of health care policy internationally is to provide care in the community, meaning most people will receive services there. Patient safety in primary care is therefore important for future care, but not yet investigated sufficiently when services are carried out in patients’ homes. In particular, we know little about how family carers experience patient safety of older people with dementia in the community. Methods This was an explorative study, with qualitative in-depth interviews of 23 family carers of older people with suspected or diagnosed dementia. Family carers participated after receiving information primarily through health professionals working in dementia care. A semi-structured topic guide was used in a flexible way to capture participants’ experiences. A four-step inductive analysis of the transcripts was informed by hermeneutic-phenomenological analysis. Results The ways our participants sought to address risk and safety issues can be understood to constitute protective practices that aimed to prevent or reduce the risk of harm and/or alleviate damage from harm that occurs. The protective practices relate to four areas: physical harm, economic harm, emotional harm, and relational harm. The protective practices are interlinked, and family carers sometimes prioritize one over another, and as they form part of family practice, they are not always visible to service providers. As a result, the practices may complicate interactions with health professionals and even inadvertently conceal symptoms or care needs. Conclusions When family caregivers prevent harm and meet needs, some needs may be concealed or invisible to health professionals. To recognize all needs and provide effective, safe and person-centered care, health professionals need to recognize these preventive practices and seek to build a solid partnership with family carers.

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Section: Methodsmentioning

confidence: 99%

Dementia and patient safety in the community: a qualitative study of family carers’ protective practices and implications for services

Häikiö

Sagbakken

Rugkåsa

2019

BMC Health Serv Res

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“…Patients were middle aged (30–50 years) with a slight male predominance (56.4%). 4,6,17 The percentage of all involuntary in-patients who received an out-patient commitment order at discharge varied between 9.2 and 11.9% over the study years, which is about the same level as reported from England, 14 but lower than other jurisdictions. 18 The percentages of involuntary in-patients discharged on out-patient commitment orders as well as incidence and prevalence rates differed significantly between sites in the present study.…”

Section: Discussionmentioning

confidence: 70%

“…The areas are described elsewhere. 6 The sites were the University Hospital of North Norway, Helse Bergen Trust, Sørlandet Hospital Trust, Innlandet Hospital Trust, Akershus University Hospital and Lovisenberg Hospital. The latter two are located in the Oslo area, the capital.…”

Section: Methodsmentioning

confidence: 99%

“…Further details about the Norwegian out-patient commitment population, the Norwegian out-patient commitment framework and what being on an out-patient commitment entailed for patients is described in our previous paper from the Norwegian Outpatient Commitment Study (NOCS). 6 Internationally, out-patient commitment has raised questions about the justification and effect of the order: does out-patient commitment reduce the overall use of coercion in the care of people with severe mental disorders, or does it increase coercion by adding coercive care in the community to in-patient coercion? 7,8 Another frequently raised question concerns the impact of out-patient commitment on the use of mental health services, especially inpatient care.…”

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confidence: 99%

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Out-patient commitment order use in Norway: incidence and prevalence rates, duration and use of mental health services from the Norwegian Outpatient Commitment Study

et al. 2019

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Background Norway authorised out-patient commitment in 1961, but there is a lack of representative and complete data on the use of out-patient commitment orders. Aims To establish the incidence and prevalence rates on the use of out-patient commitment in Norway, and how these vary across service areas. Further, to study variations in out-patient commitment across service areas, and use of in-patient services before and after implementation of out-patient commitment orders. Finally, to identify determinants for the duration of out-patient commitment orders and time to readmission. Method Retrospective case register study based on medical files of all patients with an out-patient commitment order in 2008–2012 in six catchment areas in Norway, covering one-third of the Norwegian population aged 18 years or more. For a subsample of patients, we recorded use of in-patient care 3 years before and after their first-ever out-patient commitment. Results Annual incidence varied between 20.7 and 28.4, and prevalence between 36.5 and 48.9, per 100 000 population aged 18 years or above. Rates differed significantly between catchment areas. Mean out-patient commitment duration was 727 days (s.d. = 889). Use of in-patient care decreased significantly in the 3 years after out-patient commitment compared with the 3 years before. Use of antipsychotic medication through the whole out-patient commitment period and fewer in-patient episodes in the 3 years before out-patient commitment predicted longer time to readmission. Conclusions Mechanisms behind the pronounced variations in use of out-patient commitment between sites call for further studies. Use of in-patient care was significantly reduced in the 3 years after a first-ever out-patient commitment order was made. Declaration of interest None.

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Community treatment orders in Western Switzerland: A retrospective epidemiological study

Silva

Golay

Boubaker

et al. 2019

International Journal of Law and Psychiatry

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The use of outpatient commitment in Norway: Who are the patients and what does it involve?

Cited by 13 publications

References 28 publications

Dementia and patient safety in the community: a qualitative study of family carers’ protective practices and implications for services

Dementia and patient safety in the community: a qualitative study of family carers’ protective practices and implications for services

Out-patient commitment order use in Norway: incidence and prevalence rates, duration and use of mental health services from the Norwegian Outpatient Commitment Study

Community treatment orders in Western Switzerland: A retrospective epidemiological study

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