R&D Department, Division of Mental Health Services, Akershus University Hospital, PB 1000, 1478, Lørenskog, Norway.
Health Services Research Unit, Akershus University Hospital, Akershus, Norway.
BMC Health Serv Res. 2020 Mar 18;20(1):229. doi: 10.1186/s12913-020-05101-z.
Mental health professionals usually decide patients' access to inpatient care to ensure the rational and fair distribution of care based on need and prognosis. The purpose of the current study is to investigate the effects of increasing patients' influence on admission by enabling patients to initiate brief inpatient stays of up to five days at a community mental health center. Patients can initiate admission according to their own discretion, outside the existing referral and gatekeeping system.
Patient-controlled admission (PCA) contracts were offered to eligible patients for inpatient stays in four community mental health centers in one health trust in Norway. Data on included patients' inpatient stays at any of the hospitals' mental health or addiction wards were collected by hospital electronic journal data extraction specialists for the two years before PCA contracts were introduced and the first two years after PCA contracts were introduced for the included patients.
The included patients (n = 57) had 406 PCAs in the two years following signing PCA contracts. When comparing the periods before and after the introduction of the contracts, the total number of admissions increased from 203 to 498 (p < .001), while the number of inpatient days decreased from 7172 to 3178 (p < .001). No significant change in involuntary care was observed. A comparison of box plots of inpatient day use in the eight half-year periods of the study indicates a gradual increase in median inpatient days up to the signing of a PCA contract for the sample, and an abrupt reduction to a stable median level of inpatient days after signing a contract.
The included patients' use of inpatient days changed profoundly after signing PCA contracts, similar to what previous studies of PCAs have indicated. In spite of the marked reductions in inpatient days, the pre-post design makes it impossible to rule out that the reductions were caused by regression toward the mean. No study of PCAs has reported negative effects, indicating that giving patients control over very short admissions is a feasible and potentially positive scheme in mental health care wards.
精神卫生专业人员通常根据需要和预后来决定患者是否获得住院治疗，以确保医疗资源的合理和公平分配。本研究旨在调查通过使患者能够在社区心理健康中心发起为期五天的短暂住院治疗，从而增加患者对住院治疗的影响，以达到为患者提供服务的目的。患者可以根据自己的判断在现有转诊和把关系统之外发起住院治疗。
在挪威的一个医疗信托机构的四个社区心理健康中心向符合条件的患者提供患者控制入院（PCA）合同，医院电子期刊数据提取专家收集了在 PCA 合同引入之前的两年和包含患者的两年内，他们在任何一家医院的心理健康或成瘾病房的住院情况的数据。
在签署 PCA 合同后的两年内，包含的患者（n=57）进行了 406 次 PCA。与合同引入前后相比，总入院人数从 203 人增加到 498 人（p<0.001），而住院天数从 7172 天减少到 3178 天（p<0.001）。非自愿护理没有明显变化。对研究中八个半年期间的住院天数箱线图的比较表明，在签署 PCA 合同之前，住院天数中位数逐渐增加，在签署合同后，住院天数中位数急剧减少到稳定水平。
签署 PCA 合同后，包含的患者的住院天数发生了深刻变化，与之前 PCA 研究的结果相似。尽管住院天数明显减少，但前后设计使得不能排除减少是由于向均值回归引起的。没有研究报告 PCA 产生负面影响，这表明让患者控制非常短暂的住院治疗是精神卫生保健病房中一种可行且潜在积极的方案。
