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[Heavy users of inpatient services: a comparison of diagnostic subgroups]
Hans Rittmannsberger1, Anke Sulzbacher, Christian Foff
1Psychiatrie 1, LNK Wagner-Jauregg, Wagner-Jauregg-Weg 15, 4020, Linz, Österreich, hans.rittmannsberger@gespag.at.
Insights
Heavy users (HU) of psychiatric inpatient care often have severe mental illnesses and frequently require readmission. This study highlights the persistent nature of heavy use and the need for improved treatment strategies.
Area of Science:
- Psychiatry
- Healthcare Management
- Public Health
Background:
- Heavy users (HU) represent a significant challenge in psychiatric inpatient care.
- Understanding the characteristics and patterns of HU is crucial for developing effective interventions.
Purpose of the Study:
- To quantitatively and qualitatively assess heavy users (HU) of psychiatric inpatient treatment.
- To identify demographic, diagnostic, and treatment-related factors associated with heavy use.
Main Methods:
- Screened patients over 9 months for those with ≥3 admissions or ≥100 days of treatment in the prior year.
- Analyzed diagnostic groups, employment status, pension status, referral patterns, and community-based treatment participation.
Main Results:
- 10.8% of patients met HU criteria, predominantly with diagnoses in F2 (schizophrenia) and F1 (organic, including symptomatic, mental disorders).
- HU exhibited signs of more severe illness, lower employment rates, higher rates of involuntary treatment, and limited engagement in community care.
- Over 80% of HU were readmitted within a year, demonstrating a persistent pattern of heavy inpatient use, particularly for F1 and F2 diagnoses.
Conclusions:
- Heavy users of psychiatric inpatient services exhibit a persistent pattern of high treatment utilization.
- Current community-based support and referral systems appear insufficient for this population.
- Further strategies are needed to improve the management and outcomes for psychiatric heavy users.
Objective:
Quantitative and qualitative assessment of heavy users (HU) of psychiatric inpatient treatment.
Methods:
Screening over 9 months for patients with ≥ 3 admissions or ≥ 100 days of treatment during 1 year prior to index admission.
Results:
During the recruiting period 1217 persons were treated of whom 132 (10.8 %) fulfilled HU criteria. Patients belonged most often to the diagnostic group F2 (43 %), followed by F1 (21 %) and F3 (17 %). HU were most common within the diagnostic group F6 (33 %), next to F2 (21 %), F1 (9 %) and F3 (6 %). HU had signs of more severe illness compared to the other patients: only 8 % held a job and 73 % ware on a disablement pension, patients with a diagnosis of F2 faring worst. HU were treated more frequently involuntarily (50.5 vs 30.7 %). An office-based physician referred only 5 % of the patients and almost half attended the clinic without any referral. HU participated only to a modest degree in community-based treatments and 37 % attended no doctor in the month prior to admission. During the year following the index admission more than 80 % of HU were admitted again and were hospitalized almost as many days as before the index admission. Patients with a diagnosis of F1 and F2 showed the greatest persistence of heavy use behavior.
Conclusions:
This sample of HU show a persistent pattern of use of psychiatric inpatient treatment. Strategies to improve the situation are discussed.
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