Antidepressants: relationship to the time to psychiatric readmission and probability of being in hospital in depressive patients

Comparison of the Effectiveness of Different Antidepressants in Preventing Psychiatric Rehospitalization

OBJECTIVE

Patients with major depressive disorder (MDD) often face poor health outcomes. Additionally, patients with multiple hospitalizations tend to have worse predicted disease prognosis. Antidepressant medications remain a first-line treatment option for MDD, but data evaluating the effects of different antidepressants on psychiatric readmission rates is lacking. The objective of this study was to assess readmission rates based on antidepressant selection upon discharge from an inpatient psychiatric hospitalization.

METHODS

This was a single-center, retrospective chart review evaluating psychiatric readmission rates of adults with MDD discharged on antidepressant therapy. The primary outcome was to compare 30-day psychiatric rehospitalization rates based on antidepressant treatment and secondary outcomes included six-month and one-year psychiatric rehospitalization based on antidepressant treatment. Odds ratios (OR), 95% confidence intervals (CI), and p-values were calculated to determine the odds of readmission in patients who were discharged on each antidepressant compared to patients who were discharged on an antidepressant other than that particular antidepressant.

RESULTS

Patients who were discharged on sertraline were four times less likely to be readmitted within 30 days compared to the combined readmission rate of other antidepressants or multiple antidepressants (OR: 0.228, 95%CI: 0.053-0.978, p<0.05). Meanwhile, patients discharged on any combination of multiple antidepressants were more likely to be readmitted than patients discharged on only one antidepressant (OR: 4.517, 95%CI: 1.581-12.908, p<0.05). The antidepressant medications included in the study were bupropion, duloxetine, escitalopram, fluoxetine, mirtazapine, paroxetine, sertraline, trazodone, and venlafaxine.

CONCLUSION

Careful consideration should be taken when choosing antidepressant therapy for inpatient psychiatric patients as this may impact relapse of symptoms and readmission rates. Further research is needed to evaluate other factors that may influence psychiatric readmissions for MDD.

Readmission rates and predictors of avoidable readmissions in older adults in a tertiary care centre

Context

Thirty-day readmissions are used to gauge health care accountability, which occurs as part of the natural course of the illness or due to avoidable fallacies during the index admission. The utility of this metric is unknown in older adults from developing countries.

Aim

To ascertain the unplanned 30-day readmission rate and enumerate predictors of avoidable hospital readmission among early (0-7 days) and late (8-30 days) readmissions.

Settings and Design

A retrospective chart audit of 140 older adults who were readmitted to a premier tertiary care teaching hospital under Geriatrics from the neighboring states of Tamil Nadu, Andhra Pradesh, and Kerala were undertaken.

Methods and Materials

Data from health records were collected from the hospital electronic database from May 2015 to May 2020. The data was reviewed to determine the 30-day readmission rate and to ascertain the predictors of avoidable readmissions among both early and late readmissions.

Results

Out of 2698 older adults admitted to the geriatric wards from the catchment areas, the calculated 30-day hospital readmission rate was 5.18%, and 41.4% of these readmissions were potentially avoidable. The median duration from discharge to the first readmission was ten days (Interquartile range: 5-18 days). Patients had to spend INR 44,000 (approximately 602 USD) towards avoidable readmission. The most common causes for readmission included an exacerbation, reactivation, or progression of a previously existing disease (55.7%), followed by the emergence of a new disease unrelated to index admission (43.2%). Fifty-eight patients (41.4%) were readmitted within seven days following discharge. Early readmissions were seen in patients with malignancies [8 (13.5%) vs. 4 (4.8%); P = 0.017], on insulin (P = 0.04) or on antidepressants (P = 0.01). Advanced age was found to be an independent predictor of avoidable early readmission (OR 2.99 95%CI 1.34-6.62, P = 0.007), and admission to a general ward (as compared to those admitted in a private ward) was an independent predictor of early readmissions (OR 2.99 95%CI 1.34-6.62, P = 0.007).

Conclusion

The 30-day readmission rate in a geriatric unit in a tertiary care hospital was 5.2%. Advanced age was considered to be an independent predictor of avoidable early readmission. Future prospective research on avoidable readmissions should be undertaken to delineate factors affecting 30-day avoidable hospital readmissions in developing nations.

Non-pharmacological treatments of inpatients with major depression - The case of Polish (Poznan) and German (Kiel) hospital

BACKGROUND AND PURPOSE

Although the treatment of depression should be comprehensive, there is insufficient information about non-pharmacological interventions used during hospitalization. Hence, the aim was to compare non-pharmacological interventions used in psychiatry clinics in Kiel (Germany) and Poznan (Poland).

METHODS AND MATERIALS

The retrospective study covered all patients hospitalized in 2016 (F32 or F33). Out of 545 patients hospitalized in 2016 in both centers, the analysis concerns 322 records from Kiel and 168 from Poznan.

RESULTS

Non-pharmacological treatments were used in both centers. However, in Kiel there were more therapeutic options. Contrary to Poznan, patients in Kiel used therapies like "Kneippen", Qigong, and light therapy.

CONCLUSIONS

Implementing Tai Chi in Kiel would be interesting to develop the scope of used interventions. Investment in non-pharmacological treatment should be a priority for healthcare decision-makers in Poland. The wide range of non-pharmacological interventions should be commonly accessible to provide the most comprehensive treatment.

Costs of inpatient care of depression in 2014 in Polish (Poznan) and German (Kiel) hospital

Objectives: Depression is highly prevalent worldwide and generates significant economic burden. Despite this, there is still insufficient information on hospitalisation costs related to depression. Therefore, this paper presents a comparison of costs of inpatient care of depression among patients hospitalised in 2014 in Kiel (Germany) and in Poznan (Poland).Methods: The retrospective study was conducted from October 2015 to May 2017 in Kiel and in Poznan and concerned all patients (n = 548 and eventually included n = 444; 334 in Kiel and 110 in Poznan) hospitalised in these centres.Results: The annual cost of inpatient care of patients hospitalised due to depression in 2014 was EUR [Formula: see text] = EUR 9397.21 (total EUR 313,8667.2) in Kiel and EUR [Formula: see text] = EUR 2962.90 (total EUR 325,919.38) in Poznan. In Kiel, the most frequently prescribed medicine was mirtazapine while in Poznan it was venlafaxine.Conclusions: The 3-fold difference in average costs of hospitalisation might result from differences in funding of mental health care which in Poland needs urgent amendment. Besides, mental health care was underfunded in Poznan. In general, treatment was comprehensive in both centres. Non-pharmacological treatment, however, was more comprehensive in Kiel.KEY POINTSThe cost of inpatient care of depression was very high both in Kiel and Poznan.Inpatient care of depression is long-lasting, but a reduction in the length of hospital stay seems to be possible.Hospital stay is the main part of costs of inpatient care of depression.Treatment of depression should be comprehensive, but differences e.g. in pharmacotherapy used are possible between hospitals and/or countries.

The economic burden of inpatient care of depression in Poznan (Poland) and Kiel (Germany) in 2016

Depression is a global health problem associated with a significant public health burden and costs. Although studies on costs of diseases are being considered as an increasingly important factor for health policies, information concerning costs of inpatient care of depression is still insufficient. Thus, the main aim of this study was to evaluate costs of hospitalization of patients treated in 2016 in psychiatric clinics in Poznan (Poland) and in Kiel (Germany) and to analyze treatment used in these centers. The study was conducted from September 2017 to February 2018. 545 hospital records were considered (187 in Poznan and 358 in Kiel). Eventually, 490 hospital records were included, 168 in Poland and 322 in Germany. In general, the costs were calculated based on the patients’ sex and diagnosis (F32 and F33) separately and, subsequently, the outcomes were added and multiplied by the length of hospital stay, giving the cost of hospitalization. The annual cost of inpatient care of depression in 2016 was EUR 491,067.19 (x¯=EUR2923.02) in Poznan and EUR 2,847,991.00 x¯=EUR8844.69 in Kiel. In Poznan, hospitalization was underfunded reaching EUR 183,042.55 (37.27% of total costs in Poznan). In Poznan, the most frequently prescribed medicine was quetiapine, followed by olanzapine and venlafaxine, whereas in Kiel it was venlafaxine, followed by mirtazapine and promethazine. Although non-pharmacological therapies were commonly used in both centers, in Kiel this type of treatment was better structured. The study confirms the degree of the economic burden of inpatient care of depression. The underfunding of mental health revealed, emphasizes the need for urgent amendment of organization and funding of mental health care in Poland. Patients in Poznan were hospitalized on average 10 days longer than in Kiel, thus a reduction of length of hospitalization in Poznan seems possible. Although pharmacotherapy seemed to be comprehensive in both centers, there were some differences between Poznan and Kiel. Access to non-pharmacological therapies during outpatient care was limited in Poznan, however, compared to Kiel.

FAM-FACE-SG: a score for risk stratification of frequent hospital admitters

Background

An accurate risk stratification tool is critical in identifying patients who are at high risk of frequent hospital readmissions. While 30-day hospital readmissions have been widely studied, there is increasing interest in identifying potential high-cost users or frequent hospital admitters. In this study, we aimed to derive and validate a risk stratification tool to predict frequent hospital admitters.

Methods

We conducted a retrospective cohort study using the readily available clinical and administrative data from the electronic health records of a tertiary hospital in Singapore. The primary outcome was chosen as three or more inpatient readmissions within 12 months of index discharge. We used univariable and multivariable logistic regression models to build a frequent hospital admission risk score (FAM-FACE-SG) by incorporating demographics, indicators of socioeconomic status, prior healthcare utilization, markers of acute illness burden and markers of chronic illness burden. We further validated the risk score on a separate dataset and compared its performance with the LACE index using the receiver operating characteristic analysis.

Results

Our study included 25,244 patients, with 70% randomly selected patients for risk score derivation and the remaining 30% for validation. Overall, 4,322 patients (17.1%) met the outcome. The final FAM-FACE-SG score consisted of nine components: Furosemide (Intravenous 40 mg and above during index admission); Admissions in past one year; Medifund (Required financial assistance); Frequent emergency department (ED) use (≥3 ED visits in 6 month before index admission); Anti-depressants in past one year; Charlson comorbidity index; End Stage Renal Failure on Dialysis; Subsidized ward stay; and Geriatric patient or not. In the experiments, the FAM-FACE-SG score had good discriminative ability with an area under the curve (AUC) of 0.839 (95% confidence interval [CI]: 0.825–0.853) for risk prediction of frequent hospital admission. In comparison, the LACE index only achieved an AUC of 0.761 (0.745–0.777).

Conclusions

The FAM-FACE-SG score shows strong potential for implementation to provide near real-time prediction of frequent admissions. It may serve as the first step to identify high risk patients to receive resource intensive interventions.