Myklebust Lars Henrik, Sørgaard Knut, Bjorbekkmo Svein, Nymann Asle, Molvik Stian, Olstad Reidun
Psychiatric Research Centre of Northern Norway, UNN-Asgård, 9291, Tromsø, Norway.
Soc Psychiatry Psychiatr Epidemiol. 2009 Jul;44(7):550-7. doi: 10.1007/s00127-008-0470-6. Epub 2008 Dec 18.
The literature on the dynamics between community- and hospital services concerning utilization of psychiatric beds is inconclusive. The Norwegian VELO-project provides an opportunity to study this in a natural experiment. Two service-systems are compared. The "central-bed system" have mainly outpatient- and day-hospital services locally, with psychiatric beds at a central mental hospital. The "local-bed system" have only one outpatient clinic, with beds at three local inpatient units. Also utilization of sheltered homes was studied. Hypotheses were predicted from Goldberg and Huxley's' stage theory and the Thornicroft and Tansella's' hydraulic model.
The case-registries of 2005 were linked across service levels by patients' 11-digit Social Security Number. From 1,865 single treatment episodes, 1,348 continuous courses by 1,253 individual patients were extracted.
For overall utilization of psychiatric beds there was only a small difference, were the central-bed system utilized 10% less than the other. For utilization of emergency inpatient admissions and acute hospital beds, the rate was more than twice in the central-bed system compared to the other. For utilization of municipalities sheltered homes, the rate was three times higher in the local-bed system.
There may be bedrock of need for psychiatric beds regardless of system-organization. Distance may in general be a minor issue for utilization of psychiatric beds, and may primarily interact with patient- or contextual characteristics associated with acute situations. Activity of day-hospital services rather than outpatient consultations may affect utilization of sheltered homes. The main theoretical models are conceptually useful, although more research is needed to specify mechanisms.
关于社区服务与医院服务在精神科床位利用方面的动态关系的文献尚无定论。挪威的VELO项目提供了一个在自然实验中对此进行研究的机会。对两种服务系统进行了比较。“中央床位系统”在当地主要提供门诊和日间医院服务，精神科床位设在一家中央精神病院。“本地床位系统”只有一个门诊诊所，床位设在三个本地住院单元。还对庇护所的使用情况进行了研究。根据戈德堡和赫胥黎的阶段理论以及索恩克罗夫特和坦塞拉的水力模型提出了假设。
通过患者的11位社会保障号码将2005年的病例登记在不同服务层面进行关联。从1865个单次治疗事件中，提取了1253名个体患者的1348个连续疗程。
在精神科床位的总体利用方面，差异很小，中央床位系统的利用率比另一个系统低10%。在急诊住院收治和急性医院床位的利用方面，中央床位系统的使用率是另一个系统的两倍多。在市政庇护所的利用方面，本地床位系统的使用率高出三倍。
无论系统组织如何，对精神科床位可能都有基本需求。一般来说，距离可能不是精神科床位利用的主要问题，并且可能主要与与急性情况相关的患者或背景特征相互作用。日间医院服务的活动而非门诊咨询可能会影响庇护所的利用。主要的理论模型在概念上是有用的，尽管需要更多研究来明确机制。
