Utilization of psychiatric inpatient care. A study of changes related to the introduction of a sectorized care organization.

Utilization of inpatient care in a catchment area was studied by means of a 4-year comparison before and after a sectorization of the care organization. There was almost no reduction in the number of patients hospitalized, but the number of admissions was reduced by 20% and the total number of days in hospital by 40%. An initial rise in the hospitalization of nonpsychotic patients was found in the new organization, probably because of the increased accessibility and availability of psychiatric care in the catchment area. The rate of hospitalization decreased for schizophrenic patients and remained unchanged for other psychotic patients. There was a significant reduction in rates of readmission, and mean length of stay in hospital was reduced for all groups of patients except patients with a diagnosis of neurosis or personality disorder. A reduction in rates of compulsory care, primarily for patients with alcohol diagnosis, was found. The sectorized care organization has fulfilled the objective of reducing inpatient care. However, great attention must be paid to evaluating new patient categories reached by the development of outpatient facilities, especially in areas where accessibility to and availability of the care organization were formerly low.