Myklebust Lars Henrik, Sørgaard Knut, Wynn Rolf
Psychiatric Research Centre of Northern Norway, Nordland Hospital Trust, Bodø, Norway.
Department of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway.
SAGE Open Med. 2017 Aug 3;5:2050312117724311. doi: 10.1177/2050312117724311. eCollection 2017.
Studies on the dynamics between service organization and acute admissions to psychiatric specialized care have given ambiguous results. We studied the effect of several variables, including service organization, coercion, and patient characteristics on the rate of acute admissions to psychiatric specialist services. In a natural experiment-like study in Norway, we compared a "deinstitutionalized" and a "locally institutionalized" model of mental health services. One had only community outpatient care and used beds at a large Central Mental Hospital; the other also had small bed-units at the local District Psychiatric Centre.
From the case registries, we identified a total of 5338 admissions, which represented all the admissions to the psychiatric specialist services from 2003 to 2006. The data were analyzed with chi-square tests and Z-tests. In order to control for possible confounders and interaction effects, a multivariate analysis was also performed, with a logistic regression model.
The use of coercion emerged as the strongest predictor of acute admissions to specialist care (odds ratio = 7.377, 95% confidence interval = 4.131-13.174) followed by service organization (odds ratio = 3.247, 95% confidence interval = 2.582-4.083). Diagnoses of patients predicted acute admissions to a lesser extent. We found that having psychiatric beds available at small local institutions rather than beds at a Central Mental Hospital appeared to decrease the rate of acute admissions.
While it is likely that the seriousness of the patients' condition is the most important factor in doctors' decisions to refer psychiatric patients acutely, other variables are likely to be important. This study suggests that the organization of mental health services is of importance to the rate of acute admissions to specialized psychiatric care. Systems with beds at local District Psychiatric Centers may reduce the rate of acute admissions to specialized care, compared to systems with local community outpatient services and beds at Central Mental Hospitals.
关于服务机构与精神科专科护理急性入院之间动态关系的研究结果并不明确。我们研究了包括服务机构、强制手段和患者特征在内的多个变量对精神科专科服务急性入院率的影响。在挪威一项类似自然实验的研究中，我们比较了精神卫生服务的“去机构化”模式和“地方机构化”模式。一种模式只有社区门诊护理，并使用一家大型中央精神病院的床位；另一种模式在当地地区精神病中心也设有小型床位单元。
从病例登记处，我们共识别出5338例入院病例，这些病例代表了2003年至2006年期间精神科专科服务的所有入院病例。数据采用卡方检验和Z检验进行分析。为了控制可能的混杂因素和交互作用，还进行了多变量分析，采用逻辑回归模型。
强制手段的使用成为专科护理急性入院的最强预测因素（优势比=7.377，95%置信区间=4.131-13.174），其次是服务机构（优势比=3.247，95%置信区间=2.582-4.083）。患者的诊断对急性入院的预测程度较低。我们发现，当地小型机构设有精神病床位而非中央精神病院设有床位，似乎会降低急性入院率。
虽然患者病情的严重程度可能是医生决定急性转诊精神科患者的最重要因素，但其他变量可能也很重要。本研究表明，精神卫生服务的组织对专科精神科护理的急性入院率很重要。与设有当地社区门诊服务和中央精神病院床位的系统相比，在当地地区精神病中心设有床位的系统可能会降低专科护理的急性入院率。
