Coralie Gandré1, Jeanne Gervaix1, Julien Thillard1, Jean-Marc Macé1, Jean-Luc Roelandt1, Karine Chevreul1. 1. Ms. Gandré, Ms. Gervaix, Mr. Thillard, Dr. Roelandt, and Pr. Chevreul are with the Épidémiologie Clinique et Évaluation Économique Appliquées aux Populations Vulnérables team, Unité Mixte de Recherche, Université Paris Diderot, Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale, Paris. With the exception of Dr. Roelandt, they are also with the Parisian Health Economics and Health Services Research Unit, URC Eco, AP-HP, Paris. Dr. Roelandt is also with the World Health Organization Collaborative Centre, Lille, France. Pr. Macé is with the Laboratoire Interdisciplinaire de Recherches en Sciences de l'Action, National Conservatory of Arts and Crafts, Paris.
Abstract
OBJECTIVE: The development of alternatives to full-time hospitalization in psychiatry is limited because consensus about the benefits of such alternatives is lacking. This study assessed whether the development of such alternatives in French psychiatric sectors was associated with a reduction in involuntary inpatient care, taking into account other factors that are potentially associated with involuntary admission. METHODS: Data on whether a patient had at least one involuntary full-time admission in 2012 were extracted from the French national discharge database for psychiatric care. The development of alternatives to full-time hospitalization was estimated as the percentage of human resources allocated to these alternatives out of all human resources allocated to psychiatry, measured at the level of the hospital hosting each sector. Other factors potentially associated with involuntary admission (characteristics of patients, health care providers, and the environment) were extracted from administrative databases, and a multilevel logistic model was carried out to account for the nested structure of the data. RESULTS: Significant variations were observed between psychiatric sectors in rates of involuntary inpatient admissions. A large portion of the variation was explained by characteristics of the sectors. A significant negative association was found between involuntary admissions and the development of alternatives to full-time hospitalization, after adjustment for other factors associated with involuntary admissions. CONCLUSIONS: Findings suggest that the development of alternatives to full-time hospitalization is beneficial for quality of care, given that it is negatively associated with involuntary full-time admissions. The reduction of such admissions aligns with international recommendations for psychiatric care.
OBJECTIVE: The development of alternatives to full-time hospitalization in psychiatry is limited because consensus about the benefits of such alternatives is lacking. This study assessed whether the development of such alternatives in French psychiatric sectors was associated with a reduction in involuntary inpatient care, taking into account other factors that are potentially associated with involuntary admission. METHODS: Data on whether a patient had at least one involuntary full-time admission in 2012 were extracted from the French national discharge database for psychiatric care. The development of alternatives to full-time hospitalization was estimated as the percentage of human resources allocated to these alternatives out of all human resources allocated to psychiatry, measured at the level of the hospital hosting each sector. Other factors potentially associated with involuntary admission (characteristics of patients, health care providers, and the environment) were extracted from administrative databases, and a multilevel logistic model was carried out to account for the nested structure of the data. RESULTS: Significant variations were observed between psychiatric sectors in rates of involuntary inpatient admissions. A large portion of the variation was explained by characteristics of the sectors. A significant negative association was found between involuntary admissions and the development of alternatives to full-time hospitalization, after adjustment for other factors associated with involuntary admissions. CONCLUSIONS: Findings suggest that the development of alternatives to full-time hospitalization is beneficial for quality of care, given that it is negatively associated with involuntary full-time admissions. The reduction of such admissions aligns with international recommendations for psychiatric care.
Entities:
Keywords:
Deinstitutionalization; alternatives to full-time hospitalization; involuntary admissions; psychiatry