Hofstad Tore, Rugkåsa Jorun, Ose Solveig Osborg, Nyttingnes Olav, Kjus Solveig Helene Høymork, Husum Tonje Lossius
Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway.
Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway.
Front Psychiatry. 2021 Dec 9;12:737698. doi: 10.3389/fpsyt.2021.737698. eCollection 2021.
Compulsory hospitalisation in mental healthcare is contested. For ethical and legal reasons, it should only be used as a last resort. Geographical variation could indicate that some areas employ compulsory hospitalisation more frequently than is strictly necessary. Explaining variation in compulsory hospitalisation might contribute to reducing overuse, but research on associations with service characteristics remains patchy. We aimed to investigate the associations between the levels of compulsory hospitalisation and the characteristics of primary mental health services in Norway between 2015 and 2018 and the amount of variance explained by groups of explanatory variables. We applied random-effects within-between Poisson regression of 461 municipalities/city districts, nested within 72 community mental health centre catchment areas ( = 1,828 municipality-years). More general practitioners, mental health nurses, and the total labour-years in municipal mental health and addiction services per population are associated with lower levels of compulsory hospitalisations within the same areas, as measured by both persons (inpatients) and events (hospitalisations). Areas that, on average, have more general practitioners and public housing per population have lower levels of compulsory hospitalisation, while higher levels of compulsory hospitalisation are seen in areas with a longer history of supported employment and the systematic gathering of service users' experiences. In combination, all the variables, including the control variables, could account for 39-40% of the variation, with 5-6% related to municipal health services. Strengthening primary mental healthcare by increasing the number of general practitioners and mental health workers can reduce the use of compulsory hospitalisation and improve the quality of health services.
精神卫生保健中的强制住院治疗存在争议。出于伦理和法律原因，它应仅作为最后手段使用。地域差异可能表明，某些地区使用强制住院治疗的频率高于严格必要的程度。解释强制住院治疗的差异可能有助于减少过度使用，但关于与服务特征关联的研究仍然零散。我们旨在调查2015年至2018年挪威强制住院治疗水平与初级精神卫生服务特征之间的关联，以及解释变量组所解释的方差量。我们对461个市镇/市区进行了组内组间泊松随机效应回归，这些市镇/市区嵌套在72个社区精神卫生中心服务区域内（共1828个市镇年）。在同一地区，按住院人数（住院患者）和住院事件衡量，更多的全科医生、精神科护士以及人均市政精神卫生和成瘾服务的总劳动年数与较低的强制住院治疗水平相关。平均而言，人均全科医生和公共住房较多的地区强制住院治疗水平较低，而在有较长支持性就业历史和系统收集服务使用者体验的地区，强制住院治疗水平较高。综合来看，所有变量，包括控制变量，可解释39%至40%的变异，其中5%至6%与市政卫生服务相关。增加全科医生和精神卫生工作者的数量以加强初级精神卫生保健，可以减少强制住院治疗的使用并提高卫生服务质量。
