Abeldt Brittany M, Brown Kathryn H, Wei Julia, Ramalingam Nirmala D, Hirschtritt Matthew E
Department of Psychiatry, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA.
Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
Perm J. 2024 Sep 16;28(3):76-83. doi: 10.7812/TPP/24.019. Epub 2024 Jul 9.
Intensive outpatient programs (IOPs) have been shown to reduce posttraumatic stress disorder (PTSD) symptoms in veteran populations. The aim of this study was to examine the association between IOP participation and inpatient psychiatric and mental health-related emergency department (ED) encounters among patients with PTSD.
This is a retrospective cohort study among 258 adults with PTSD who participated in the IOP at Kaiser Permanente Oakland Medical Center between January 1, 2017, and December 31, 2018. The authors compared changes in inpatient psychiatric hospitalizations and mental health-related ED encounters from the year before vs after the first IOP engagement. Bivariate analyses comparing ED and inpatient utilization pre- and post-IOP engagement, stratified by sociodemographic variables were conducted using paired -tests and McNemar's test. Conditional multivariable logistic regression was performed to assess the odds of psychiatric utilization.
Participants were more likely to have ≥ 1 inpatient psychiatric encounter (28.7% vs 15.9%; p < 0.01) and ≥ 1 mental health-related ED encounter (24.8% vs 18.2%; p = 0.04) pre-IOP vs post-IOP. The authors' multivariable analysis demonstrated that patients experienced a 56% reduction in the odds of inpatient psychiatric encounters (adjusted odds ratio = 0.42, 95% confidence interval: 0.26-0.68, p < 0.01) and a 35% reduction in mental health-related ED encounters (adjusted odds ratio = 0.63, 95% confidence interval: 0.40-1.00, p = 0.05) post-IOP vs pre-IOP.
This study demonstrated a significant reduction in inpatient psychiatric hospitalizations and mental health-related ED visits among patients with PTSD in the year following participation in an IOP.
These findings support the use of IOPs for patients with PTSD to reduce the likelihood of intensive service use.
强化门诊项目（IOPs）已被证明可减轻退伍军人创伤后应激障碍（PTSD）的症状。本研究旨在探讨参与IOP与PTSD患者住院精神科及心理健康相关急诊科（ED）就诊之间的关联。
这是一项回顾性队列研究，研究对象为2017年1月1日至2018年12月31日期间在奥克兰凯撒永久医疗中心参与IOP的258名成年PTSD患者。作者比较了首次参与IOP之前和之后一年住院精神科住院次数及心理健康相关ED就诊次数的变化。采用配对t检验和McNemar检验对按社会人口统计学变量分层的IOP参与前后的ED和住院利用率进行双变量分析。进行条件多变量逻辑回归以评估精神科利用的几率。
与参与IOP后相比，参与者在参与IOP前更有可能有≥1次住院精神科就诊（28.7%对15.9%；p<0.01）以及≥1次心理健康相关ED就诊（24.8%对18.2%；p = 0.04）。作者的多变量分析表明，与参与IOP前相比，患者住院精神科就诊几率降低了56%（调整后的优势比 = 0.42，95%置信区间：[0.26, 0.68]，p<0.01），心理健康相关ED就诊次数降低了35%（调整后的优势比 = 0.63，95%置信区间：[0.40, 1.00]，p = 0.05）。
本研究表明，参与IOP后的一年中，PTSD患者的住院精神科住院次数及心理健康相关ED就诊次数显著减少。
这些发现支持将IOP用于PTSD患者，以降低强化服务使用的可能性。
