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Russolillo A, Carter M, Guan M, Singh P, Kealy D, Raudzus J. Adult psychiatric inpatient admissions and length of stay before and during the COVID-19 pandemic in a large urban hospital setting in Vancouver, British Columbia. FRONTIERS IN HEALTH SERVICES 2024; 4:1365785. [PMID: 38807747 PMCID: PMC11130439 DOI: 10.3389/frhs.2024.1365785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 05/01/2024] [Indexed: 05/30/2024]
Abstract
Introduction During the COVID-19 pandemic individuals with mental illnesses faced challenges accessing psychiatric care. Our study aimed to describe patient characteristics and compare admissions and length of stay (LOS) for psychiatric-related hospitalizations before and during the COVID-19 pandemic. Methods We conducted a retrospective analysis using health administrative data comparing individuals with an acute psychiatric admission between two time periods: 1st March 2019 to 31st December 2019 (pre-COVID) and 1st March 2020 to 31st December 2020 (during-COVID). Multivariable negative binomial regression was used to model the association between most responsible diagnosis type and the two-time periods to hospital LOS, reporting the Rate Ratio (RR) as the measure of effect. Results The cohort comprised 939 individuals who were predominately male (60.3%) with a severe mental illness (schizophrenia or mood-affective disorder) (72.7%) and a median age of 38 (IQR: 28.0, 52.0) years. In the multivariable analysis, anxiety disorders (RR: 0.63, CI: 0.4, 0.99) and personality disorders (RR: 0.52, CI: 0.32, 0.85) were significantly associated with a shorter LOS when compared to individuals without those disorders. Additionally, when compared to hospital admissions for non-substance related disorders the LOS for patients with substance-related disorders were significantly shorter during the COVID period (RR: 0.45, CI: 0.30, 0.67) and pre-COVID period (RR: 0.31, CI: 0.21, 0.46). Conclusions We observed a significant difference in the type and length of admissions for various psychiatric disorders during the COVID-19 period. These findings can support systems of care in adapting to utilization changes during pandemics or other global health events.
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Affiliation(s)
- Angela Russolillo
- Department of Psychiatry, Providence Health Care, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Michelle Carter
- Department of Psychiatry, Providence Health Care, Vancouver, BC, Canada
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Mejiao Guan
- Statistics and Health Economics, Centre for Advancing Health Outcomes, Vancouver, BC, Canada
| | - Pulkit Singh
- Department of Psychiatry, Providence Health Care, Vancouver, BC, Canada
| | - David Kealy
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Julia Raudzus
- Department of Psychiatry, Providence Health Care, Vancouver, BC, Canada
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Ismail H. Duration of hospital admission in severe mental illness: is longer better? BJPSYCH ADVANCES 2021. [DOI: 10.1192/bja.2021.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARYA Cochrane review has compared short-stay hospital admission with long-stay/standard admission of patients with severe mental illness for a number of outcomes in a total 2030 participants from 6 randomised trials. It reached the conclusion, supported by limited evidence, that short admissions in mental health units do not increase the risk of death, readmission or worsening of mental state, and pose less risk of delayed discharge and patient's unemployment. This commentary examines the available evidence from previous studies and discusses its relevance to current practice.
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Di Lorenzo R, Montardi G, Panza L, Del Giovane C, Saraceni S, Rovesti S, Ferri P. Retrospective Analysis of Factors Associated with Long-Stay Hospitalizations in an Acute Psychiatric Ward. Risk Manag Healthc Policy 2020; 13:433-442. [PMID: 32547274 PMCID: PMC7245472 DOI: 10.2147/rmhp.s238741] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 04/14/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the longest hospitalizations in an acute psychiatric ward [Service of Psychiatric Diagnosis and Treatment (SPDT)] and the related demographic, clinical and organizational variables to understand the factors that contribute to long-stay (LOS) phenomenon. The term “long stay” indicates clinical, social and organizational problems responsible for delayed discharges. In psychiatry, clinical severity, social dysfunction and/or health-care system organization appear relevant factors in prolonging stays. Patients and Methods We divided all the SPDT hospitalizations from 1 January 2010 to 31 December 2015 into two groups based on the 97.5th percentile of duration: ≤36 day (n=3254) and >36 day (n=81) stays, in order to compare the two groups for the selected variables. Comparisons were made using Pearson’s chi-square for categorical data and t-test for continuous variables, the correlation between the LOS, as a dependent variable, and the selected variables was analyzed in stepwise multiple linear regression and in multiple logistic regression models. Results The longest hospitalizations were significantly related to the diagnosis of “schizophrenia and other psychosis” (Pearson Chi2=17.24; p=0.045), the presence of moderate and severe aggressiveness (Pearson chi2=29; p=0.000), compulsory treatment (Pearson Chi2=8.05; p=0.005), parenteral or other route administration of psycho-pharmacotherapy (Pearson Chi2=12.91; p=0.007), poli-therapy (Pearson Chi2=6.40; p=0.041), complex psychiatric activities (Pearson Chi2=12.26; p=0.002) and rehabilitative programs (Pearson Chi2=37.05; p=0.000) during the hospitalization and at discharge (Pearson Chi2=29.89; p=0.000). Many demographic and clinical variables were statistically significantly correlated to the LOS at our multiple linear and logistic regression model. Conclusion In our sample, clinical illness severity and need for complex therapeutic and rehabilitative treatments were associated with prolonged psychiatric hospitalizations. Understanding this phenomenon can have not only economic but also clinical, ethical and social relevance.
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Affiliation(s)
- Rosaria Di Lorenzo
- Psychiatric Intensive Treatment Facility, Department of Mental Health and Drug Abuse, Az-USL Modena, Modena 41122, Italy
| | - Giulia Montardi
- School of Specialization in Psychiatry, University of Modena and Reggio Emilia, Modena 41124, Italy
| | - Leda Panza
- School of Nursing, University of Modena and Reggio Emilia, Modena 41124, Italy
| | - Cinzia Del Giovane
- Head of Statistics and Methodology, Institute of Primary Health Care (BIHAM), Bern, Switzerland
| | - Serena Saraceni
- School of Specialization in Psychiatry, University of Modena and Reggio Emilia, Modena 41124, Italy
| | - Sergio Rovesti
- General and Applied Hygiene, Department of Biomedical, Metabolic and Neural Sciences, Modena 41125, Italy
| | - Paola Ferri
- Nursing, Department of Biomedical, Metabolic and Neural Sciences, Modena 41125, Italy
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Babalola O, Gormez V, Alwan NA, Johnstone P, Sampson S. Length of hospitalisation for people with severe mental illness. Cochrane Database Syst Rev 2014:CD000384. [PMID: 24477710 PMCID: PMC10105316 DOI: 10.1002/14651858.cd000384.pub3] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND In high-income countries, over the last three decades, the length of hospital stays for people with serious mental illness has reduced drastically although considerable variation remains. In lower-income countries this variation may be greater. Some argue that reduction in hospital stay leads to 'revolving door admissions' and worsening mental health outcomes despite apparent cost savings, whilst others suggest longer stays may be more harmful by institutionalising people to hospital care. OBJECTIVES To evaluate the effect of short stay/brief admission hospital care with long stay/standard in-patient care in people with serious mental illness. SEARCH METHODS We searched the Cochrane Schizophrenia Group's register of trials, July 2007 and updated this search in May 2012. SELECTION CRITERIA We included all randomised controlled trials comparing planned short/brief with long/standard hospital stays for people with serious mental illnesses. DATA COLLECTION AND ANALYSIS We extracted data independently. For dichotomous data we calculated risk ratios (RR) and their 95% confidence intervals (CI) on an intention-to-treat basis based using a fixed-effect model. For continuous data, had we identified such data, we planned to calculate fixed-effect mean differences (MD). We assessed risk of bias for included studies and rated quality of evidence using GRADE. MAIN RESULTS We included six relevant trials undertaken between 1969 and 1980. We found no significant difference in death (n = 175, 1 RCT, RR in the longer term 0.42, CI 0.10 to 1.83, very low quality evidence). In the long term, there was no difference in improvement of mental state (n = 61, 1 RCT, RR 3.39, CI 0.76 to 15.02, very low quality evidence). There was no difference in readmission to hospital (n = 651, 4 RCTs, RR by the long term 1.26, CI 1.00 to 1.57, low quality evidence). Data for leaving the study prematurely by the longer term showed no difference (n = 229, 2 RCTs, (RR 0.77, CI 0.34 to 1.77, low quality evidence). There was a significant difference favouring short stay (P = 0.01) in numbers of participants with delayed discharge from hospital exceeding the time planned in study (n = 404, 3 RCTs, RR in the longer term 0.54, CI 0.33 to 0.88, low quality evidence). There was no difference in numbers of participants lost to follow-up (n = 404, 3 RCTs, RR by the longer term 1.07, CI 0.70 to 1.62, low quality evidence). Finally, there was a significant difference favouring short-stay hospitalisation for social functioning, including unemployment, unable to housekeep, or unknown employment status (n = 330, 2 RCTs, RR by longer term 0.61, CI 0.50 to 0.76, very low quality evidence). AUTHORS' CONCLUSIONS The effects of hospital care and the length of stay is important for mental health policy. We found limited low and very low quality data which were all over 30 years old. Outcomes from these studies do suggest that a planned short-stay policy does not encourage a 'revolving door' pattern of admission and disjointed care for people with serious mental illness. More large, well-designed and reported trials are justified especially where a short-stay policy is not routine care.
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Marshall M, Crowther R, Sledge WH, Rathbone J, Soares‐Weiser K. Day hospital versus admission for acute psychiatric disorders. Cochrane Database Syst Rev 2011; 2011:CD004026. [PMID: 22161384 PMCID: PMC4160006 DOI: 10.1002/14651858.cd004026.pub2] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Inpatient treatment is an expensive way of caring for people with acute psychiatric disorders. It has been proposed that many of those currently treated as inpatients could be cared for in acute psychiatric day hospitals. OBJECTIVES To assess the effects of day hospital versus inpatient care for people with acute psychiatric disorders. SEARCH METHODS We searched the Cochrane Schizophrenia Group Trials Register (June 2010) which is based on regular searches of MEDLINE, EMBASE, CINAHL and PsycINFO. We approached trialists to identify unpublished studies. SELECTION CRITERIA Randomised controlled trials of day hospital versus inpatient care, for people with acute psychiatric disorders. Studies were ineligible if a majority of participants were under 18 or over 65, or had a primary diagnosis of substance abuse or organic brain disorder. DATA COLLECTION AND ANALYSIS Two review authors independently extracted and cross-checked data. We calculated risk ratios (RR) and 95% confidence intervals (CI) for dichotomous data. We calculated weighted or standardised means for continuous data. Day hospital trials tend to present similar outcomes in slightly different formats, making it difficult to synthesise data. We therefore sought individual patient data so that we could re-analyse outcomes in a common format. MAIN RESULTS Ten trials (involving 2685 people) met the inclusion criteria. We obtained individual patient data for four trials (involving 646 people). We found no difference in the number lost to follow-up by one year between day hospital care and inpatient care (5 RCTs, n = 1694, RR 0.94 CI 0.82 to 1.08). There is moderate evidence that the duration of index admission is longer for patients in day hospital care than inpatient care (4 RCTs, n = 1582, WMD 27.47 CI 3.96 to 50.98). There is very low evidence that the duration of day patient care (adjusted days/month) is longer for patients in day hospital care than inpatient care (3 RCTs, n = 265, WMD 2.34 days/month CI 1.97 to 2.70). There is no difference between day hospital care and inpatient care for the being readmitted to in/day patient care after discharge (5 RCTs, n = 667, RR 0.91 CI 0.72 to 1.15). It is likely that there is no difference between day hospital care and inpatient care for being unemployed at the end of the study (1 RCT, n = 179, RR 0.88 CI 0.66 to 1.19), for quality of life (1 RCT, n = 1117, MD 0.01 CI -0.13 to 0.15) or for treatment satisfaction (1 RCT, n = 1117, MD 0.06 CI -0.18 to 0.30). AUTHORS' CONCLUSIONS Caring for people in acute day hospitals is as effective as inpatient care in treating acutely ill psychiatric patients. However, further data are still needed on the cost effectiveness of day hospitals.
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Affiliation(s)
- Max Marshall
- The Lantern CentreUniversity of ManchesterVicarage LaneOf Watling Street Road, FulwoodPreston.LancashireUK
| | - Ruth Crowther
- University of QueenslandSchool of Population HealthHerston RoadHerstonQueenslandAustralia4006
| | - William Hurt Sledge
- Yale UniversityYale New Haven Psychiatric Hospital131 Underhill RoadHamdenConnecticuttUSACT 06517
| | - John Rathbone
- The University of SheffieldHEDS, ScHARRRegent Court30 Regent StreetSheffieldUKS1 4DA
| | - Karla Soares‐Weiser
- Enhance Reviews LtdCentral Office, Cobweb BuildingsThe Lane, LyfordWantageUKOX12 0EE
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Abstract
Although multiple concepts of time can be found in psychiatric discourses and practices, the notion of time as an absolute category seems to predominate. In particular, the notion of "chronicity" implies the persistence of symptoms over the temporal course of a disease, thereby following a logic that conceptualizes time as an objective and universal measure. I argue that such a notion of time impedes the development of patients and the metrics by which to map change. This article, therefore, aims to present a different concept of time that should enable dealing with "chronic" mental illness in more flexible and creative ways. A case study of an everyday psychiatric routine is presented, followed by an in-depth analysis of its temporal implications. I conceptualize the notion of time as an extended field, being relationally and intersubjectively structured and linked to performed activities. Such a notion of time needs to be seen as a flexible and fluid matrix that possesses the character of an event-oriented and productive space. This conception favors an individualized temporality of change, suggesting concrete therapeutic procedures that can be implemented in clinical practice.
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Niehaus DJH, Koen L, Galal U, Dhansay K, Oosthuizen PP, Emsley RA, Jordaan E. Crisis discharges and readmission risk in acute psychiatric male inpatients. BMC Psychiatry 2008; 8:44. [PMID: 18559078 PMCID: PMC2443127 DOI: 10.1186/1471-244x-8-44] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2007] [Accepted: 06/17/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Severe pressures on beds in psychiatric services have led to the implementation of an early ("crisis") discharge policy in the Western Cape, South Africa. The study examined the effect of this policy and length of hospital stay (LOS) on readmission rates in one psychiatric hospital in South Africa. METHODS Discharge summaries of adult male patients (n = 438) admitted to Stikland Psychiatric Hospital during 2004 were retrospectively examined. Each patient's clinical course was then analysed for the period between January 1st, 2004, and August 31st, 2006. RESULTS Although shorter LOS was associated with decreased readmission rates, the effect of crisis discharges was far more powerful. Patients discharged as usual had a far lower risk of readmission than those discharged due to bed pressures (i.e. crisis discharge). CONCLUSION Increased risks associated with the early discharge policy necessitate the urgent review of the current management of bed shortages in this inpatient facility. The strengthening of community initiatives, particularly assertive outreach could be a way forward.
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Affiliation(s)
- Dana JH Niehaus
- Department of Psychiatry, University of Stellenbosch, South Africa
| | - Liezl Koen
- Department of Psychiatry, University of Stellenbosch, South Africa
| | - Ushma Galal
- Biostatics Units of the Medical Research Council, Bellville, South Africa
| | - Khalid Dhansay
- Department of Psychiatry, University of Stellenbosch, South Africa
| | | | - Robin A Emsley
- Department of Psychiatry, University of Stellenbosch, South Africa
| | - Esme Jordaan
- Biostatics Units of the Medical Research Council, Bellville, South Africa
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Jakobsen KD, Hansen T, Werge T. Diagnostic stability among chronic patients with functional psychoses: an epidemiological and clinical study. BMC Psychiatry 2007; 7:41. [PMID: 17705843 PMCID: PMC1978203 DOI: 10.1186/1471-244x-7-41] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2006] [Accepted: 08/16/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diagnostic stability and illness course of chronic non-organic psychoses are complex phenomena and only few risk factors or predictors are known that can be used reliably. This study investigates the diagnostic stability during the entire course of illness in patients with non-organic psychoses and attempts to identify non-psychopathological risk factors or predictors. METHOD 100 patients with functional psychosis were initially characterised using the Operational Criteria Checklist for Psychotic Illness and Affective Illness (OPCRIT), medical records and health registers. To study the stability of diagnoses (i.e. shifts per time), we used registry data to define four measures of diagnostic variation that were subsequently examined in relation to four possible measures of time (i.e. observation periods or hospitalisation events). Afterwards, we identified putative co-variables and predictors of the best measures of diagnostic stability. RESULTS All four measures of diagnostic variation are very strongly associated with numbers-of-hospitalisations and less so with duration-of-illness, duration-of-hospitalisation and with year-of-first-admission. The four measures of diagnostic variation corrected for numbers-of-hospitalisations were therefore used to study the diagnostic stability. Conventional predictors of illness course - e.g. age-of-onset and premorbid-functioning - are not significantly associated with stability. Only somatic-comorbidity is significantly associated with two measures of stability, while family-history-of-psychiatric-illness and global-assessment-of-functioning (GAF) scale score show a trend. However, the traditional variables age-of-first-admission, civil-status, first-diagnosis-being-schizophrenia and somatic-comorbidity are able to explain two-fifth of the variation in numbers-of-hospitalisations. CONCLUSION Diagnostic stability is closely linked with the contact between patient and the healthcare system. This could very likely be due to fluctuation of disease manifestation over time or presence of co-morbid psychiatric illness in combination with rigid diagnostic criteria that are unable to capture the multiple psychopathologies of the functional psychoses that results in differential diagnoses and therefore diagnostic instability. Not surprisingly, somatic-comorbidity was found to be a predictor of diagnostic variation thereby being a non-psychiatric confounder.
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Affiliation(s)
- Klaus D Jakobsen
- Research Institute of Biological Psychiatry, Sct. Hans Hospital, DK-4000 Roskilde, Denmark
- University Department of Psychiatry, Psychiatric Centre Hvidovre, DK-2605 Broendby, Denmark
- Center for Pharmacogenomics, University of Copenhagen, 2200 Copenhagen N, Denmark
| | - Thomas Hansen
- Research Institute of Biological Psychiatry, Sct. Hans Hospital, DK-4000 Roskilde, Denmark
- Center for Pharmacogenomics, University of Copenhagen, 2200 Copenhagen N, Denmark
| | - Thomas Werge
- Research Institute of Biological Psychiatry, Sct. Hans Hospital, DK-4000 Roskilde, Denmark
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Marshall M, Crowther R, Almaraz-Serrano AM, Tyrer P. Day hospital versus out-patient care for psychiatric disorders. Cochrane Database Syst Rev 2001:CD003240. [PMID: 11687059 DOI: 10.1002/14651858.cd003240] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND This review considers the use of day hospitals as an alternative to out-patient care. Three types of day hospital are covered by the review: 'day treatment programmes', 'day care centres' and 'transitional' day hospitals. Day treatment programmes offer more intense treatment for patients who have failed to respond to out-patient care (usually patients with affective or personality disorders). Day care centres offer structured support to patients with long-term severe mental disorders (mainly schizophrenia), who would otherwise be treated in the out-patient clinic. Transitional day hospitals offer time-limited care to patients who have just been discharged from in-patient care. OBJECTIVES The review had three objectives. First, to assess the effectiveness of day treatment programmes versus out-patient care for people with treatment-refractory disorders. Second, to assess the effectiveness of day care centres versus out-patient care for people with severe long term disorders. Third, to assess the effectiveness of transitional day hospital care for people who had just been discharged from hospital. SEARCH STRATEGY We searched the Cochrane Controlled Trials Register (Cochrane Library, issue 4, 2000), MEDLINE (January 1966 to December 2000), EMBASE (1980 to December 2000), CINAHL (1982 to December 2000), Psyc LIT (1966 to December 2000), and the reference lists of articles. Researchers were approached to identify unpublished studies. SELECTION CRITERIA Randomised controlled trials comparing day hospital care (including day treatment programme, day care centre, and transitional day hospital) against out-patient care. Studies were ineligible if a majority of participants were under 18 or over 65, or who had a primary diagnosis of substance abuse or organic brain disorder. DATA COLLECTION AND ANALYSIS Data were extracted independently by two reviewers and cross-checked. Relative risks and 95% confidence intervals (CI) were calculated for dichotomous data. Weighted or standardised means were calculated for continuous data. MAIN RESULTS There was evidence from one trial suggesting that day treatment programmes were superior to continuing out-patient care in terms of improving psychiatric symptoms. There was no evidence that day treatment programmes were better or worse than out-patient care on any other clinical or social outcome variable, or on costs. There was no evidence that day care centres were better or worse than out-patient care on any clinical or social outcome variable. There were some inconclusive data on costs suggesting that day care centres might be more expensive than out-patient care. There was evidence from one trial suggesting that transitional day hospital care was superior to out-patient care in keeping patients engaged in treatment, however there was insufficient evidence to judge whether it was better or worse on any other clinical or social outcome variable, or on costs. REVIEWER'S CONCLUSIONS There is only limited evidence to justify the provision of day treatment programmes and transitional day hospital care, and no evidence to support the provision of day care centres.
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Affiliation(s)
- M Marshall
- School of Psychiatry and Behavioural Sciences, University of Manchester, Academic Unit, Royal Preston Hospital, Sharoe Green Lane, Fulwood, Preston., Lancashire, UK, PR2 4HT.
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Williams RJ, Chang SY. A comprehensive and comparative review of adolescent substance abuse treatment outcome. ACTA ACUST UNITED AC 2000. [DOI: 10.1093/clipsy.7.2.138] [Citation(s) in RCA: 196] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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