Maria Skott1,2, Natalie Durbeej1,3, Maria Smitmanis-Lyle1,2, Clara Hellner1,2, Emelie Allenius1,2, Sigrid Salomonsson1,2, Tobias Lundgren1,2, Nitya Jayaram-Lindström1,2, Alexander Rozental4,5,6. 1. Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, 117 63, Stockholm, Sweden. 2. Stockholm County Council, Stockholm Health Care Services, Stockholm, Sweden. 3. Child Health and Parenting, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden. 4. Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, 117 63, Stockholm, Sweden. alexander.rozental@ki.se. 5. Stockholm County Council, Stockholm Health Care Services, Stockholm, Sweden. alexander.rozental@ki.se. 6. Great Ormond Street Hospital Institute of Child Health, University College London, London, UK. alexander.rozental@ki.se.
Abstract
BACKGROUND: Patients with schizophrenia spectrum diagnoses have a poor prognostic outlook and rates of recovery. Inpatient care is common, but the decision to initiate such care is not solely up to the patient but also influenced by the healthcare providers. Recent ideas about shared decision-making however challenges this idea. Patient-Controlled Admissions (PCA) refers to a care model where a patient signs a contract that allows the decision for admission into inpatient care to be transferred onto the patient. METHODS: In Region Stockholm's public healthcare PCA was introduced to patients with schizophrenia spectrum diagnoses deemed to have the greatest care needs. Outcomes of a 12-month naturalistic within-group follow-up was analyzed using Wilcoxon signed-rank test. RESULTS: In total, 56 patients fulfilled the study's inclusion criteria, with between 20 to 42 patients having complete data and being able to analyze statistically, depending on the variable. Number of admissions, inpatient days, number of involuntary admissions, and involuntary admission days decreased, but only significantly so for inpatient days, p < .01 (a mean reduction of 11.5 days). Neither self-rated well-being, as assessed using the EQ5D-3L, or a clinician-administered rating of overall health status, the Clinical Global Impression Scale, demonstrated a significant change. CONCLUSIONS: The use of PCA points towards a trend in decreased hospitalization for patients with schizophrenia spectrum diagnoses, although this needs to be explored further in larger samples and over a longer follow-up.
BACKGROUND:Patients with schizophrenia spectrum diagnoses have a poor prognostic outlook and rates of recovery. Inpatient care is common, but the decision to initiate such care is not solely up to the patient but also influenced by the healthcare providers. Recent ideas about shared decision-making however challenges this idea. Patient-Controlled Admissions (PCA) refers to a care model where a patient signs a contract that allows the decision for admission into inpatient care to be transferred onto the patient. METHODS: In Region Stockholm's public healthcare PCA was introduced to patients with schizophrenia spectrum diagnoses deemed to have the greatest care needs. Outcomes of a 12-month naturalistic within-group follow-up was analyzed using Wilcoxon signed-rank test. RESULTS: In total, 56 patients fulfilled the study's inclusion criteria, with between 20 to 42 patients having complete data and being able to analyze statistically, depending on the variable. Number of admissions, inpatient days, number of involuntary admissions, and involuntary admission days decreased, but only significantly so for inpatient days, p < .01 (a mean reduction of 11.5 days). Neither self-rated well-being, as assessed using the EQ5D-3L, or a clinician-administered rating of overall health status, the Clinical Global Impression Scale, demonstrated a significant change. CONCLUSIONS: The use of PCA points towards a trend in decreased hospitalization for patients with schizophrenia spectrum diagnoses, although this needs to be explored further in larger samples and over a longer follow-up.
Authors: Maria Smitmanis Lyle; Emelie Allenius; Sigrid Salomonsson; Anna Björkdahl; Mattias Strand; Lena Flyckt; Clara Hellner; Tobias Lundgren; Nitya Jayaram-Lindström; Alexander Rozental Journal: BMJ Open Date: 2022-08-16 Impact factor: 3.006