Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, 199 Aba Khushi Ave, Mt Carmel, Haifa, Israel.
Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, 199 Aba Khushi Ave, Mt Carmel, Haifa, Israel.
Isr J Health Policy Res. 2024 Apr 3;13(1):18. doi: 10.1186/s13584-024-00605-z.
The high rates of psychiatric re-hospitalizations (also termed "revolving door") presents a "wicked problem" which requires a systematic and holistic approach to its resolution. Israel's mental-health rehabilitation law provides a comprehensive set of services intended to support the ability of persons with severe mental illness to rely on community rather than in-patient facilities for their ongoing care needs. Guided by the Health Behavior Model, we examined the relationship between psychiatric re-hospitalizations and the three Health Behavior Model factors (predisposing factor: socio-demographic characteristics and health beliefs; enabling factor: personal and social/vocational relationships facilitated by rehabilitation interventions and services; and need factor: outcomes including symptoms, and mental health and functional status) among persons with severe mental illness receiving rehabilitation services.
Logistic regression models were used to measure the association between re-hospitalization within a year and variables comprising the three Health Behavior Model factors on the sample of consumers utilizing psychiatric services (n = 7,165). The area under the curve for the model was calculated for each factor separately and for all three factors combined.
A total of 846 (11.8%) consumers were hospitalized within a year after the study began. Although multivariable analyses showed significant associations between re-hospitalization and all three Health Behavior Model factors, the magnitude of the model's area under the curve differed: 0.61 (CI = 0.59-0.64), 0.56 (CI = 0.54-0.58), 0.78 (CI = 0.77-0.80) and 0.78 (CI = 0.76-0.80) for predisposing, enabling, need and the full three-factor Health Behavior Model, respectively.
Findings revealed that among the three Health Behavior Model factors, the need factor best predicted re-hospitalization. The enabling factor, comprised of personal relationships and social/vocational activities facilitated by interventions and services representing many of psychiatric rehabilitation's key goals, had the weakest association with reduced rates of re-hospitalization. Possible explanations may be inaccurate assessments of consumers' personal relationships and social/vocational activities by the mental healthcare professionals, problematic provider-consumer communication on the consumers' involvement in social/vocational activities, or ineffective methods of facilitating consumer participation in these activities. Clearly to reduce the wicked "revolving-door" phenomenon, there is a need for targeted interventions and a review of current psychiatric rehabilitation policies to promote the comprehensive integration of community rehabilitation services by decreasing the fragmentation of care, facilitating continuity of care with other healthcare services, and utilizing effective personal reported outcomes and experiences of consumers with severe mental illness.
精神科再住院率（也称为“ revolving door ”）很高，这是一个“棘手问题”，需要采取系统和整体的方法来解决。以色列的精神卫生康复法提供了一整套服务，旨在支持严重精神疾病患者依靠社区而不是住院设施来满足其持续的护理需求。本研究以健康行为模式为指导，研究了严重精神疾病患者的再住院率与健康行为模式的三个因素（易感性因素：社会人口特征和健康信念；促成因素：康复干预和服务促进的个人和社会/职业关系；需要因素：包括症状、心理健康和功能状态在内的结果）之间的关系。
使用逻辑回归模型来衡量在一年内在利用精神科服务的消费者样本中再住院与健康行为模式三个因素组成变量之间的关联（n=7165）。为每个因素和所有三个因素的组合分别计算模型的曲线下面积。
共有 846 名（11.8%）消费者在研究开始后一年内住院。尽管多变量分析显示再住院与健康行为模式的三个因素均存在显著关联，但模型曲线下面积的大小有所不同：易感性因素为 0.61（CI=0.59-0.64）、促成因素为 0.56（CI=0.54-0.58）、需要因素为 0.78（CI=0.77-0.80），以及完整的健康行为模式三因素为 0.78（CI=0.76-0.80）。
研究结果表明，在健康行为模式的三个因素中，需求因素是再住院的最佳预测因素。促成因素由干预措施和服务所促进的个人关系和社会/职业活动组成，这些活动代表了精神康复的许多关键目标，与降低再住院率的关联最弱。可能的解释是精神卫生保健专业人员对消费者个人关系和社会/职业活动的评估不准确、提供者与消费者之间在消费者参与社会/职业活动方面的沟通存在问题，或者促进消费者参与这些活动的方法无效。显然，为了减少这种“棘手的”“ revolving door ”现象，需要有针对性的干预措施和对当前精神康复政策的审查，通过减少护理的碎片化、促进与其他医疗保健服务的护理连续性以及利用严重精神疾病患者的个人报告结果和经验，来促进社区康复服务的全面整合。
