Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
Can J Psychiatry. 2012 Nov;57(11):666-76. doi: 10.1177/070674371205701104.
Timely aftercare can be viewed as a patient safety imperative. In the context of decreasing inpatient length of stay (LOS) and known child psychiatry human resource challenges, we investigated time to aftercare for adolescents following psychiatric hospitalization.
We conducted a population-based cohort study of adolescents aged 15 to 19 years with psychiatric discharge between April 1, 2002, and March 1, 2004, in Ontario, using encrypted identifiers across health administrative databases to determine time to first psychiatric aftercare with a primary care physician (PCP) or a psychiatrist within 395 days of discharge.
Among the 7111 adolescents discharged in the study period, 24% had aftercare with a PCP or a psychiatrist within 7 days and 49% within 30 days. High socioeconomic status (adjusted hazard ratio [AHR] 1.31; 95% CI 1.21 to 1.43, P < 0.001) and psychotic disorders (AHR 1.24; 95% CI 1.12 to 1.36, P < 0.001) were associated with greater likelihood of aftercare. Youth in the northern part of the province (AHR 0.48; 95% CI 0.32 to 0.71, P < 0.001), rural areas (AHR 0.82; 95% CI 0.76 to 0.89, P < 0.001), and with self-harm or suicide attempts (AHR 0.58; 95% CI 0.53 to 0.64, P < 0.001) and substance use disorders (AHR 0.50; 95% CI 0.44 to 0.56, P < 0.001) were less likely to receive aftercare.
Hospitalization is our most intensive, intrusive, and expensive psychiatric treatment setting, yet in our cohort of formerly hospitalized adolescents fewer than 50% received psychiatry-related aftercare in the month postdischarge. Innovations are necessary to address geographic inequities and improve timely access to mental health aftercare for all youth.
及时的后续护理可以被视为患者安全的必要条件。在住院时间（LOS）减少和已知儿童精神病学人力资源挑战的背景下，我们调查了青少年精神病住院后接受后续护理的时间。
我们对 2002 年 4 月 1 日至 2004 年 3 月 1 日期间在安大略省接受精神科出院的 15 至 19 岁青少年进行了一项基于人群的队列研究，使用健康行政数据库中的加密标识符确定出院后 395 天内首次与初级保健医生（PCP）或精神科医生进行精神科后续护理的时间。
在研究期间出院的 7111 名青少年中，有 24%在 7 天内，49%在 30 天内接受了 PCP 或精神科医生的后续护理。高社会经济地位（调整后的危险比[AHR]1.31；95%置信区间[CI]1.21 至 1.43，P<0.001）和精神病性障碍（AHR 1.24；95%CI 1.12 至 1.36，P<0.001）与更高的后续护理可能性相关。该省北部地区（AHR 0.48；95%CI 0.32 至 0.71，P<0.001）、农村地区（AHR 0.82；95%CI 0.76 至 0.89，P<0.001）以及有自伤或自杀企图（AHR 0.58；95%CI 0.53 至 0.64，P<0.001）和物质使用障碍（AHR 0.50；95%CI 0.44 至 0.56，P<0.001）的青少年不太可能接受后续护理。
住院治疗是我们最密集、最具侵入性和最昂贵的精神科治疗方式，但在我们的前住院青少年队列中，不到 50%的人在出院后一个月内接受了与精神科相关的后续护理。需要创新以解决地理不平等问题，并改善所有青少年及时获得心理健康后续护理的机会。
