Böckmann Volker, Lay Barbara, Seifritz Erich, Kawohl Wolfram, Roser Patrik, Habermeyer Benedikt
Department of Addictive Disorders, Psychiatric Services Aargau, Brugg, Switzerland.
Department of Psychiatry and Psychotherapy, Psychiatric Services Aargau, Brugg, Switzerland.
Front Psychiatry. 2019 Nov 26;10:828. doi: 10.3389/fpsyt.2019.00828. eCollection 2019.
Repeated psychiatric readmissions are a particular challenge in the treatment of substance use disorders and are associated with substantial burden for patients and their associates and for healthcare providers. Factors affecting readmission rates are heterogeneous and need to be identified to better allocate resources. Within the Swiss healthcare system, such data on substance use disorder patients are largely missing. Understanding these factors might bear important implications for future healthcare planning. Thus here, we examine risk factors of inpatient readmission. We retrospectively analyzed all admissions to the hospital's department of addictive disorders in the year 2016. Patients included in the study were followed over a period of 1 year after discharge regarding readmissions to the clinic. Besides the demographic, social, and economic data, we extracted data concerning patient history, admission, and discharge as well as clinical data regarding type and number of substances abused and comorbid diagnoses. In order to describe severity of cases, we furthermore included the scores of the Health of the Nation Outcome Scale (HoNOS) at admission and at discharge as documented in the medical database. Of the 554 patients included in the study, 228 (41.2%) were readmitted within 12 months. Previous admissions, concomitant use of different substances, presence of psychosis or mania, and a higher severity score at discharge increased the likelihood of readmission. The odds for readmission were furthermore higher in patients not being married, living alone, and being unemployed. When all (bivariate) statistically significant factors are included into a logistic regression model, the previous number of admissions and the HoNOS clinical score at discharge significantly contributed to this model. Our findings stress that patients with higher symptom load at discharge are prone to be readmitted within 12 months. The same applies for patients with previous admissions. These findings suggest that the development of specific interventions to prevent premature discharge before satisfactory symptom remission, in particular in those patients with previous admissions in their patient history, might help to prevent readmissions.
反复精神科再入院是物质使用障碍治疗中的一项特殊挑战，给患者及其家属以及医疗服务提供者带来了沉重负担。影响再入院率的因素多种多样，需要加以识别，以便更好地分配资源。在瑞士医疗体系中，关于物质使用障碍患者的此类数据基本缺失。了解这些因素可能对未来的医疗规划具有重要意义。因此，在此我们研究住院再入院的风险因素。我们回顾性分析了2016年该医院成瘾疾病科的所有入院病例。研究纳入的患者在出院后1年内被跟踪观察是否再次入院。除了人口统计学、社会和经济数据外，我们还提取了有关患者病史、入院和出院情况的数据，以及关于滥用物质的类型和数量及共病诊断的临床数据。为了描述病例的严重程度，我们还纳入了医疗数据库中记录的入院时和出院时的国民健康结果量表（HoNOS）评分。在纳入研究的554例患者中，228例（41.2%）在12个月内再次入院。既往入院史、同时使用不同物质、存在精神病或躁狂症以及出院时较高的严重程度评分增加了再入院的可能性。此外，未婚、独居和失业的患者再入院的几率更高。当将所有（二元）具有统计学意义的因素纳入逻辑回归模型时，既往入院次数和出院时的HoNOS临床评分对该模型有显著贡献。我们的研究结果强调，出院时症状负荷较高的患者在12个月内容易再次入院。既往有入院史的患者也是如此。这些研究结果表明，制定具体干预措施以防止在症状未得到满意缓解之前过早出院，特别是针对那些有既往入院史的患者，可能有助于预防再入院。
