Aagaard Jørgen, Aagaard Andreas, Buus Niels
Centre for Psychiatric Research, Aarhus University Hospital, DK-8240 Risskov, Denmark; Unit for Psychiatric Research, Aarhus University Hospital, DK-9000 Aalborg, Denmark.
Centre for Psychiatric Research, Aarhus University Hospital, DK-8240 Risskov, Denmark.
Int J Nurs Stud. 2014 Jul;51(7):1003-13. doi: 10.1016/j.ijnurstu.2013.11.002. Epub 2013 Nov 15.
The role of the psychiatric emergency services has undergone extensive changes following a significant downsizing of the number of psychiatric hospital beds during the past decades. A relatively small number of "frequent visitors" accounts for a disproportionately large amount of visits to psychiatric emergency services.
To identify predictors of frequent use of a psychiatric emergency room at a Danish University Psychiatric Hospital through a 12-year period (1995-2007) and to speculate on how changes in the mental healthcare services affect predictors of frequent use through time.
A large-scale register based logistic regression analysis combined with a small-scale explorative, interpretative interview study. Register data were drawn from the Danish Central Psychiatric Research Register. Four-year cohorts (1995, 1998, 2001 and 2004) of patients with at least one visit to the psychiatric emergency room were followed for 3 years to identify general trends of predictors throughout the period. A purposeful sample of 15 frequent visitors were interviewed about their personal motives for visiting the psychiatric emergency room, their pathways to care, and their social network and social support.
The study identified two overall trends of predictors of frequent use of the psychiatric emergency room. High use of psychiatric services: ≥5 visits to the psychiatric emergency room, ≥3 admissions or ≥60 bed days during the year, was and continued to be predictive of high use of the psychiatric emergency room throughout the whole period. Furthermore, the emergence and continual presence of the predictors: severe mental illness (1999-onwards), substance abuse (2002-onwards) and sheltered housing (2002-2003-2005-onwards) indicated changes in the general profile of frequent visitors to the psychiatric emergency room, where predictors related to illness behaviour were supplemented by predictors related to disease.
The changing profile of the conditions predicting frequent visits at the psychiatric emergency room was most probably related to the adverse effects of the continuous deinstitutionalising of the Danish mental health services and a radical health care reform. A basic multiplicative model was designed for the early detection of individual frequent visitors.
在过去几十年中，随着精神病院病床数量大幅减少，精神科急诊服务的作用发生了广泛变化。相对少数的“常客”占了精神科急诊服务就诊量中不成比例的很大一部分。
通过12年期间（1995 - 2007年）确定丹麦一所大学精神病院精神科急诊室频繁使用的预测因素，并推测精神卫生服务的变化如何随时间影响频繁使用的预测因素。
一项基于大规模登记的逻辑回归分析，结合一项小规模的探索性、解释性访谈研究。登记数据取自丹麦中央精神病学研究登记册。对至少去过一次精神科急诊室的患者的四年队列（1995年、1998年、2001年和2004年）进行了3年的随访，以确定整个时期预测因素的总体趋势。对15名常客进行了有目的抽样访谈，了解他们前往精神科急诊室的个人动机、就医途径以及他们的社会网络和社会支持情况。
该研究确定了精神科急诊室频繁使用预测因素的两个总体趋势。精神科服务的高使用量：一年中≥5次前往精神科急诊室、≥3次住院或≥60个住院日，在整个时期一直是精神科急诊室高使用量的预测因素。此外，预测因素的出现和持续存在：严重精神疾病（1999年起）、药物滥用（2002年起）和庇护性住房（2002 - 2003 - 2005年起）表明精神科急诊室常客的总体特征发生了变化，与疾病行为相关的预测因素被与疾病相关的预测因素所补充。
预测精神科急诊室频繁就诊情况的条件变化很可能与丹麦精神卫生服务持续去机构化的不利影响以及激进的医疗改革有关。设计了一个基本的乘法模型用于早期发现个体常客。
