Pierre Smith1, Pablo Nicaise2, Domenico Giacco3, Victoria Jane Bird3, Michael Bauer4, Mirella Ruggeri5, Marta Welbel6, Andrea Pfennig4, Antonio Lasalvia7, Jacek Moskalewicz6, Stefan Priebe3, Vincent Lorant2. 1. Institute of Health and Society IRSS, Université catholique de Louvain, Brussels, Belgium. Electronic address: pierre.smith@uclouvain.be. 2. Institute of Health and Society IRSS, Université catholique de Louvain, Brussels, Belgium. 3. Unit for Social and Community Psychiatry (World Health Organisation Collaborating Centre for Mental Health Services Development), Queen Mary University of London, London, UK. 4. Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany. 5. Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona, Verona, Italy. 6. Institute of Psychiatry and Neurology, Warsaw, Poland. 7. UOC di Psichiatria, Azienda Ospedaliera Universitaria Intergrata (AOUI) di Verona, Verona, Italy.
Abstract
BACKGROUND: In Europe, at discharge from a psychiatric hospital, patients with severe mental illness may be exposed to one of two main care approaches: personal continuity, where one clinician is responsible for in- and outpatient care, and specialisation, where various clinicians are. Such exposure is decided through patient-clinician agreement or at the organisational level, depending on the country's health system. Since personal continuity would be more suitable for patients with complex psychosocial needs, the aim of this study was to identify predictors of patients' exposure to care approaches in different European countries. METHODS: Data were collected on 7302 psychiatric hospitalised patients in 2015 in Germany, Poland, and Belgium (patient-level exposure); and in the UK and Italy (organisational-level exposure). At discharge, patients were exposed to one of the care approaches according to usual practice. Putative predictors of exposure at patients' discharge were assessed in both groups of countries. RESULTS: Socially disadvantaged patients were significantly more exposed to personal continuity. In all countries, the main predictor of exposure was the admission hospital, except in Germany, where having a diagnosis of psychosis and a higher education status were predictors of exposure to personal continuity. In the UK, hospitals practising personal continuity had a more socially disadvantaged patient population. CONCLUSION: Even in countries where exposure is decided through patient-clinician agreement, it was the admission hospital, not patient characteristics, that predicted exposure to care approaches. Nevertheless, organisational decisions in hospitals tend to expose socially disadvantaged patients to personal continuity.
BACKGROUND: In Europe, at discharge from a psychiatric hospital, patients with severe mental illness may be exposed to one of two main care approaches: personal continuity, where one clinician is responsible for in- and outpatient care, and specialisation, where various clinicians are. Such exposure is decided through patient-clinician agreement or at the organisational level, depending on the country's health system. Since personal continuity would be more suitable for patients with complex psychosocial needs, the aim of this study was to identify predictors of patients' exposure to care approaches in different European countries. METHODS: Data were collected on 7302 psychiatric hospitalised patients in 2015 in Germany, Poland, and Belgium (patient-level exposure); and in the UK and Italy (organisational-level exposure). At discharge, patients were exposed to one of the care approaches according to usual practice. Putative predictors of exposure at patients' discharge were assessed in both groups of countries. RESULTS: Socially disadvantaged patients were significantly more exposed to personal continuity. In all countries, the main predictor of exposure was the admission hospital, except in Germany, where having a diagnosis of psychosis and a higher education status were predictors of exposure to personal continuity. In the UK, hospitals practising personal continuity had a more socially disadvantaged patient population. CONCLUSION: Even in countries where exposure is decided through patient-clinician agreement, it was the admission hospital, not patient characteristics, that predicted exposure to care approaches. Nevertheless, organisational decisions in hospitals tend to expose socially disadvantaged patients to personal continuity.
Authors: Michael Deuschle; Stefan Scheydt; Dusan Hirjak; Doris Borgwedel; Katrin Erk; Oliver Hennig; Marco Heser; Martina Pfister; Markus F Leweke; Andreas Meyer-Lindenberg Journal: Nervenarzt Date: 2020-01 Impact factor: 1.214