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Ådnanes M, Cresswell-Smith J, Melby L, Westerlund H, Šprah L, Sfetcu R, Straßmayr C, Donisi V. Discharge planning, self-management, and community support: Strategies to avoid psychiatric rehospitalisation from a service user perspective. Patient Educ Couns 2020; 103:1033-1040. [PMID: 31836249 DOI: 10.1016/j.pec.2019.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 12/02/2019] [Accepted: 12/03/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Psychiatric rehospitalisation is often seen as a negative outcome in terms of healthcare quality and cost, as well as potentially hindering the process of recovery. The purpose of our study was to explore psychiatric rehospitalisation from a service-user perspective, paying attention to how rehospitalisation can be avoided. METHOD Eight focus groups, including a total of 55 mental health service users, were conducted in six European countries (Austria, Finland, Italy, Norway, Romania, and Slovenia). The results were analysed using systematic text condensation. RESULTS All participants had been in touch with mental health services for at least one year, and had experienced more than one psychiatric hospitalisation. Participants emphasised the importance of discharge planning and psychoeducation both during and after the hospital stay, as well as the benefits of structured plans, coping strategies, self-monitoring techniques, and close contact with local community services.Social contacts and meaningful activities were also considered to be critical, as was support from peers and family members. CONCLUSION Efforts to avoid psychiatric rehospitalisation should include actions that support a functional day-to-day life, improve coping strategies, and build on cross-sectoral collaboration. PRACTICE IMPLICATIONS The study emphasises the need for psychoeducational and psychosocial interventions, starting already during the inpatient stay.
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Affiliation(s)
- M Ådnanes
- SINTEF Digital, Dept of Health Research, PO Box 4760 Torgarden, 7465 Trondheim, Norway.
| | - J Cresswell-Smith
- National Institute for Health and Welfare (THL), Mental Health Unit, Helsinki, Finland.
| | - L Melby
- SINTEF Digital, Dept of Health Research, Trondheim, Norway.
| | - H Westerlund
- Competence Centre for Experiential Knowledge and Service Development, Trondheim, Norway.
| | - L Šprah
- Research Centre of the Slovenian Academy of Sciences and Arts, Sociomedical Institute, Ljubljana, Slovenia.
| | - R Sfetcu
- National School of Public Health, Management and Professional Development, Bucharest; 2. Faculty of Psychology and Educational Sciences, Bucharest, Romania.
| | - C Straßmayr
- IMEHPS. Research - Forschungsinstitut für Sozialpsychiatrie, Vienna, Austria.
| | - V Donisi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
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Tedeschi F, Donisi V, Salazzari D, Cresswell-Smith J, Wahlbeck K, Amaddeo F. Clinical and organizational factors predicting readmission for mental health patients across Italy. Soc Psychiatry Psychiatr Epidemiol 2020; 55:187-196. [PMID: 31463615 DOI: 10.1007/s00127-019-01766-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 08/20/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The aims of our study are: to explore rehospitalization in mental health services across Italian regions, Local Health Districts (LHDs), and hospitals; to examine the predictive power of different clinical and organizational factors. METHODS The data set included adult patients resident in Italy discharged from a general hospital episode with a main psychiatric diagnosis in 2012. Independent variables at the individual, hospital, LHD, and region levels were used. Outcome variables were individual-level readmission and LHD-level readmission rate to any hospital at 1-year follow-up. The association with readmission of each variable was assessed through both single- and multi-level logistic regression; descriptive statistics were provided to assess geographical variation. Relevance of contextual effects was investigated through a series of random-effects regressions without covariates. RESULTS The national 1-year readmission rate was 43.0%, with a cross-regional coefficient of variation of 6.28%. Predictors of readmission were: admission in the same LHD as residence, psychotic disorder, higher length of stay (LoS), higher rate of public beds in the LHD; protective factors were: young age, involuntary admission, and intermediate number of public healthcare staff at the LHD level. Contextual factors turned out to affect readmission only to a limited degree. CONCLUSIONS Homogeneity of readmission rates across regions, LHDs, hospitals, and groups of patients may be considered as a positive feature in terms of equity of the mental healthcare system. Our results highlight that readmission is mainly determined by individual-level factors. Future research is needed to better explore the relationship between readmission and LoS, discharge decision, and resource availability.
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Affiliation(s)
- Federico Tedeschi
- Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, Ospedale Policlinico "G.B. Rossi", University of Verona, P.le L.A. Scuro, 10, 37134, Verona, Italy.
| | - V Donisi
- Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, Ospedale Policlinico "G.B. Rossi", University of Verona, P.le L.A. Scuro, 10, 37134, Verona, Italy
| | - D Salazzari
- Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, Ospedale Policlinico "G.B. Rossi", University of Verona, P.le L.A. Scuro, 10, 37134, Verona, Italy
| | - J Cresswell-Smith
- Mental Health Unit, National Institute for Health and Welfare (THL), P.O. Box 30, 00271, Helsinki, Finland
| | - K Wahlbeck
- Mental Health Unit, National Institute for Health and Welfare (THL), P.O. Box 30, 00271, Helsinki, Finland
| | - F Amaddeo
- Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, Ospedale Policlinico "G.B. Rossi", University of Verona, P.le L.A. Scuro, 10, 37134, Verona, Italy
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Ådnanes M, Melby L, Cresswell-Smith J, Westerlund H, Rabbi L, Dernovšek MZ, Šprah L, Sfetcu R, Straßmayr C, Donisi V. Mental health service users' experiences of psychiatric re-hospitalisation - an explorative focus group study in six European countries. BMC Health Serv Res 2018; 18:516. [PMID: 29970098 PMCID: PMC6029175 DOI: 10.1186/s12913-018-3317-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 06/21/2018] [Indexed: 12/04/2022] Open
Abstract
Background Psychiatric re-hospitalisation is considered costly and disruptive to individuals. The perspective of the mental health service user is largely unexplored in literature. The purpose of our study was to explore service users’ experiences of psychiatric re-hospitalisation across six countries in Europe. Method Eight focus groups were conducted in Romania, Slovenia, Finland, Italy, Austria and Norway. Results A total of 55 service users participated in the study. All participants had been in receipt of mental health services for at least 1 year, and had experienced more than one psychiatric hospitalisation. The experience of re-hospitalisation was considered: (1) less traumatising than the first hospitalisation, (2) to be necessary, and a relief, (3) occurring by default and without progress, (4) part of the recovery process. Conclusions Psychiatric re-hospitalisation was considered inevitable by the study participants, in both positive and negative terms. Striking similarities in service user experiences were found across all of the six countries, the first experience of psychiatric hospitalisation emerging as especially significant. Findings indicate the need for further action in order to develop more recovery and person-centred approaches within hospital care. For psychiatric inpatient care to be a positive part of the recovery process, further knowledge on what therapeutic action during the hospital stay would be beneficial, such as therapy, activities and integration with other services. Electronic supplementary material The online version of this article (10.1186/s12913-018-3317-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M Ådnanes
- Department of Health Research, SINTEF Technology and Society, PO Box 4760, 7465, Trondheim, Norway.
| | - L Melby
- Department of Health Research, SINTEF Technology and Society, PO Box 4760, 7465, Trondheim, Norway
| | - J Cresswell-Smith
- Mental Health Unit, National Institute for Health and Welfare (THL), PL 30, 00271, Helsinki, Finland
| | - H Westerlund
- KBT Foundation (Competence center for experiential knowledge and service development), PO Box 934, 7409, Trondheim, Norway
| | - L Rabbi
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, P.le L.A. Scuro, 10, 37134, Verona, Italy
| | - M Z Dernovšek
- Institute Karakter, Ježa 90, 1000, Ljubljana, Slovenia
| | - L Šprah
- Research Centre of the Slovenian Academy of Sciences and Arts, Sociomedical Institute, Novi trg 2, 1001, Ljubljana, Slovenia
| | - R Sfetcu
- National School of Public Health, Management and Professional Development, Bucharest (NSPHMPD), Faculty of Psychology and Educational Sciences, SHU Bucharest, Vaselor Street, No 31 Sector 2, 02125, Bucharest, Romania
| | - C Straßmayr
- IMEHPS.research - Forschungsinstitut für Sozialpsychiatrie, Glasergasse 24/23, A-1090, Vienna, Austria
| | - V Donisi
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, P.le L.A. Scuro, 10, 37134, Verona, Italy
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Haaramo P, Kalseth J, Marola N, Cresswell-Smith J, Wahlbeck K. System level factors as predictors of psychiatric rehospitalisation: A pilot study with Finnish data. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw170.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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