How mental health service systems are organized may affect the rate of acute admissions to specialized care: Report from a natural experiment involving 5338 admissions

摘要

Objectives: Studies on the dynamics between service organization and acute admissions to psychiatric specialized carehave given ambiguous results. We studied the effect of several variables, including service organization, coercion, andpatient characteristics on the rate of acute admissions to psychiatric specialist services. In a natural experiment-like study inNorway, we compared a “deinstitutionalized” and a “locally institutionalized” model of mental health services. One had onlycommunity outpatient care and used beds at a large Central Mental Hospital; the other also had small bed-units at the localDistrict Psychiatric Centre.Methods: From the case registries, we identified a total of 5338 admissions, which represented all the admissions to thepsychiatric specialist services from 2003 to 2006. The data were analyzed with chi-square tests and Z-tests. In order tocontrol for possible confounders and interaction effects, a multivariate analysis was also performed, with a logistic regressionmodel.Results: The use of coercion emerged as the strongest predictor of acute admissions to specialist care (odds ratio = 7.377,95% confidence interval = 4.131–13.174) followed by service organization (odds ratio = 3.247, 95% confidence interval = 2.582–4.083). Diagnoses of patients predicted acute admissions to a lesser extent. We found that having psychiatric beds availableat small local institutions rather than beds at a Central Mental Hospital appeared to decrease the rate of acute admissions.Conclusion: While it is likely that the seriousness of the patients’ condition is the most important factor in doctors’ decisionsto refer psychiatric patients acutely, other variables are likely to be important. This study suggests that the organization ofmental health services is of importance to the rate of acute admissions to specialized psychiatric care. Systems with beds atlocal District Psychiatric Centers may reduce the rate of acute admissions to specialized care, compared to systems withlocal community outpatient services and beds at Central Mental Hospitals.