Prinsloo Riaan G, Swanepoel Andre, Lippi Gian
Department of Psychiatry, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa.
Department of Statistics, Faculty of Natural and Agricultural Science, University of Pretoria, South Africa.
S Afr J Psychiatr. 2017 Dec 4;23:1083. doi: 10.4102/sajpsychiatry.v23i0.1083. eCollection 2017.
Designated psychiatric facilities are responsible for the care, treatment and reintegration of State patients. The necessary long-term care places a considerable strain on health-care resources. Resource use should be optimised while managing the risks that patients pose to themselves and the community. Identifying unique factors associated with earlier discharge may decrease the length of stay. Factors associated with protracted inpatient care without discharge could identify patients who require early and urgent intervention.
We identify socio-economic, demographic, psychiatric and charge-related factors associated with the discharge of male State patients.
We reviewed the files of discharged and admitted forensic State patients at Weskoppies Psychiatric Hospital. Data were captured in an electronic recording sheet. The association between factors and the outcome measure (discharged vs. admitted) was determined using chi-squared tests and Fischer's exact tests.
Discharged State patients were associated with being a primary caregiver ( = 0.031) having good insight into illness ( = 0.025) or offence ( = 0.005) and having had multiple successful leaves of absences. A lack of substance abuse during admission ( = 0.027), an absence of a diagnosis of substance use disorder ( = 0.013) and the absence of verbal and physical aggression ( = 0.002 and = 0.016) were associated with being discharged. Prolonged total length of stay (9-12 years, = 0.031) and prolonged length of stay in open wards (6-9 years, = 0.000) were associated with being discharged. A history of previous offences ( = 0.022), a diagnosis of substance use disorder ( = 0.023), recent substance abuse ( = 0.018) and a history of physical aggression since admission ( = 0.017) were associated with continued admission.
Discharge of State patients is associated with an absence of substance abuse, lack of aggression, multiple successful leave of absences and length of stay in hospital.
指定的精神病治疗机构负责国家患者的护理、治疗和重新融入社会。必要的长期护理给医疗资源带来了相当大的压力。在管理患者对自身和社区构成的风险时，应优化资源利用。识别与提前出院相关的独特因素可能会缩短住院时间。与长期住院未出院相关的因素可以识别出需要早期和紧急干预的患者。
我们识别与男性国家患者出院相关的社会经济、人口统计学、精神病学和费用相关因素。
我们查阅了韦斯科皮斯精神病医院已出院和新入院的法医鉴定国家患者的档案。数据记录在电子记录表中。使用卡方检验和费舍尔精确检验确定因素与结局指标（出院与入院）之间的关联。
已出院的国家患者与作为主要照顾者（P = 0.031）、对疾病有良好洞察力（P = 0.025）或对犯罪有良好洞察力（P = 0.005）以及有多次成功请假经历有关。入院期间无药物滥用（P = 0.027）、无物质使用障碍诊断（P = 0.013）以及无言语和身体攻击行为（P = 0.002和P = 0.016）与出院有关。总住院时间延长（9 - 12年，P = 0.031）和在开放病房的住院时间延长（6 - 9年，P = 0.000）与出院有关。既往犯罪史（P = 0.022）、物质使用障碍诊断（P = 0.023）、近期药物滥用（P = 0.018）以及入院后有身体攻击史（P = 0.017）与继续住院有关。
国家患者的出院与无药物滥用、无攻击行为、多次成功请假以及住院时间有关。
