van der Post L F M, Beekman A T F, Peen J, Zoeteman J, Twisk J W R, Dekker J J M
*Dit onderzoek werd eerder gepubliceerd in International Journal of Mental Health (2016;45:105-17) met als titel 'Patterns of care consumption after compulsory admission: a five-year follow-up to the Amsterdam Study of Acute Psychiatry VIII'. Afgedrukt met toestemming.
Ned Tijdschr Geneeskd. 2017;161:D1205.
To explore the relationship between psychiatric care consumption after a compulsory admission and the probability of a repeat compulsory admission.
Prospective cohort study with a 5-year follow-up.
Mental health care consumption was registered for 460 patients admitted compulsorily under the Dutch Psychiatric Care (Compulsory Admissions) Act by the Amsterdam Emergency Psychiatry service between 15 September 2004 and 14 September 2006, with socio-demographic and clinical data as independent variables.
There was no repeat compulsory admission in 63% of the cohort. The odds ratio for repeat compulsory admission only decreased in the fourth year (odds ratio (OR) 0.64; 95% CI 0.45-0.92). Repeat compulsory admission was associated with high treatment continuity (χ2 p ≤ 0.001) and a high level of care consumption during the follow-up period (χ2 p ≤ 0.001). Compulsory admission was predicted on the basis of: high care consumption in the five years prior to inclusion (OR 2.61; 1.44-4.73), aged younger than 35 years at outset (OR 1.65; 1.08-2.52), living alone at the time of inclusion (OR 1.68; 1.22-2.33), and a history of compulsory admission (OR 1.56; 1.03-2.35).
Two-thirds of the patients were not re-admitted compulsorily. The probability of a repeat admission of this kind fell only after four years. Patients who underwent a repeat compulsory admission proved to be the ones who had been treated most intensively, yet this intense treatment did not prevent a higher probability of readmission. When not taking the quality and nature of care and social integration of patients into account, attempts to reduce treatment dropout on the one hand and more intense treatments on the other may not have an effect on reducing the probability of a repeat compulsory admission.
探讨强制入院后精神科护理消耗与再次强制入院概率之间的关系。
为期5年随访的前瞻性队列研究。
对2004年9月15日至2006年9月14日期间由阿姆斯特丹紧急精神病服务部门根据荷兰精神科护理（强制入院）法案强制入院的460名患者的精神卫生护理消耗进行登记，将社会人口统计学和临床数据作为自变量。
63%的队列患者未再次强制入院。再次强制入院的优势比仅在第四年有所下降（优势比（OR）0.64；95%置信区间0.45 - 0.92）。再次强制入院与高治疗连续性（χ2 p≤0.001）以及随访期间的高护理消耗水平（χ2 p≤0.001）相关。基于以下因素可预测强制入院：纳入前五年的高护理消耗（OR 2.61；1.44 - 4.73）、入院时年龄小于35岁（OR 1.65；1.08 - 2.52）、纳入时独居（OR 1.68；1.22 - 2.33）以及有强制入院史（OR 1.56；1.03 - 2.35）。
三分之二的患者未再次被强制入院。这种再次入院的概率仅在四年后下降。事实证明，再次被强制入院的患者是接受治疗最密集的患者，但这种强化治疗并未降低再次入院的较高概率。如果不考虑护理质量、性质以及患者的社会融合情况，一方面试图减少治疗中断，另一方面进行更强化的治疗，可能对降低再次强制入院的概率没有效果。
