Division of Mental Health Services, Akershus University Hospital, PB 1000, 1478, Lørenskog, Norway.
Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway.
BMC Health Serv Res. 2021 Jan 7;21(1):36. doi: 10.1186/s12913-020-06033-4.
Mental health professionals usually decide patients' access to inpatient care to ensure care based on need and potential benefit. The purpose of the current study is to investigate how patients evaluate admissions under a contract of Patient-Controlled Admissions (PCA), where the patient could initiate 5 day stays at a community mental health center at their own discretion.
Patients with a PCA contract in 2011 and 2012 were invited to participate in the study. Staff first recorded clinical baseline values for patients. Towards the end of each PCA stay, staff conducted a structured discharge interview of the admission with the patient. A structured follow-up interview evaluating the PCA arrangement 2 years after inclusion was also performed. We report frequencies from data on PCA requests, PCA admissions and the 2 year evaluation interview, and we used multiple regression models to explore predictors of perceived helpfulness and improvement from the PCA admissions.
The included patients (n = 74) made 628 requests for PCAs during the 2 years after inclusion, and 507 PCAs took place. The five-day limit could not be upheld in 7.5% of PCAs. Patients rated PCAs as helping considerably (33.1%), a good deal (30.4%) or somewhat (21.1%), and reported feeling considerably (15.2%), a good deal (26.2%) or somewhat (36.3%) better during the admission. Significant predictors of helpfulness and feeling better were socializing more during the stay and reporting higher motivation to get away from a difficult situation or getting to the ward safety and calmness. A diagnosis of schizophrenia spectrum or bipolar disorder and more services from mental health specialist care also predicted feeling better during the PCA. In the two-year follow-up interview, 90% rated themselves as very or quite satisfied, and more than 90% would recommend PCAs to others.
The PCA arrangement was feasible and was frequently utilized by patients. Patients were satisfied with PCAs and the PCA arrangement. These short stays seemed particularly helpful for patients with a more severe diagnosis. Strong patient satisfaction gives reasons for testing and implementing increased patient influence on the mental health admission procedures in the form of PCAs.
心理健康专业人员通常会根据需要和潜在收益来决定患者是否接受住院治疗。本研究的目的是调查患者如何评估在患者自控入院（PCA）合同下的入院情况，根据该合同，患者可以自行决定在社区心理健康中心进行为期 5 天的住院治疗。
邀请了 2011 年和 2012 年签订 PCA 合同的患者参加研究。工作人员首先记录患者的临床基线值。在每次 PCA 住院结束时，工作人员都会对患者的入院情况进行结构化的出院访谈。还对纳入后 2 年的 PCA 安排进行了结构化的随访访谈。我们报告了 PCA 请求、PCA 入院和 2 年评估访谈的数据频率，并使用多元回归模型来探讨 PCA 入院的有益性和改善程度的预测因素。
在纳入后的 2 年内，纳入的患者（n=74）共提出了 628 次 PCA 请求，其中 507 次 PCA 得以实施。在 7.5%的 PCA 中，无法遵守五天的限制。患者将 PCA 评定为非常有帮助（33.1%）、有很大帮助（30.4%）或有些帮助（21.1%），并报告在住院期间感觉非常好（15.2%）、有很大帮助（26.2%）或有些帮助（36.3%）。有益性和感觉良好的显著预测因素是住院期间社交活动增多，以及报告更高的摆脱困境或获得病房安全和平静的动机。精神科专家护理的诊断为精神分裂症谱系或双相情感障碍，以及更多的服务也预测 PCA 期间感觉更好。在两年的随访访谈中，90%的患者自我评定为非常满意或相当满意，超过 90%的患者会向他人推荐 PCA。
PCA 安排是可行的，并且经常被患者使用。患者对 PCA 和 PCA 安排感到满意。这些短期住院治疗对诊断更为严重的患者尤其有帮助。强烈的患者满意度为通过 PCA 的形式，测试和实施增加患者对心理健康入院程序的影响提供了理由。
