The purpose of this study was to evaluate effects associated with moving patients from hospital to community-based settings, to compare persons who left the hospital with those who remained in the hospital, and to address the question of whether discharge reverses institutionalism in a sample of elderly long-stay psychiatric inpatients.
The hypotheses were that, compared with the control group of patients who stayed in the hospital, those who left would have significantly better mental states, social functioning, and social networks at follow-up; that community settings would provide a significantly better quality of environment than the hospital; and that discharged patients would express a preference for community care after discharge from the hospital. The study was a prospective nonrandomized controlled trial at Cane Hill, Friern, and Claybury Hospitals in England. Sixty long-term patients with schizophrenia who were discharged to community care were compared over time with matched controls (N=131).
No overall differences were detected in the pattern or severity of symptoms between patients who were discharged from the hospital and those who were not, and no significant changes over time were noted. Significant improvements in social networks, patients' preference for community settings, and quality of clinical environment were noted.
These results give qualified support for moving long-stay psychiatric patients from hospital to community settings.
"Furthermore, long-term hospitalization increased cases of re-hospitalization over short-term hospitalization. The financial loss that results from an inappropriate extended hospitalization period and the rise in the problem of institutionalization clearly show the importance of short-term hospitalization and effective management within a regional community after discharge (25). "
[Show abstract][Hide abstract] ABSTRACT: Alcoholism is becoming one of the most serious issues in Korea. The purpose of this review article was to understand the present status of the treatment system for alcoholism in Korea compared to the United States and to suggest its developmental direction in Korea. Current modalities of alcoholism treatment in Korea including withdrawal treatment, pharmacotherapy, and psychosocial treatment are available according to Korean evidence-based treatment guidelines. Benzodiazepines and supportive care including vitamin and nutritional support are mainly used to treat alcohol withdrawal in Korea. Naltrexone and acamprosate are the drugs of first choice to treat chronic alcoholism. Psychosocial treatment methods such as individual psychotherapy, group psychotherapy, family therapy, cognitive behavior therapy, cue exposure therapy, 12-step facilitation therapy, self-help group therapy, and community-based treatment have been carried out to treat chronic alcoholism in Korea. However, current alcohol treatment system in Korea is not integrative compared to that in the United States. To establish the treatment system, it is important to set up an independent governmental administration on alcohol abuse, to secure experts on alcoholism, and to conduct outpatient alcoholism treatment programs and facilities in an open system including some form of continuing care.
Journal of Korean medical science 02/2013; 28(2):181-9. DOI:10.3346/jkms.2013.28.2.181 · 1.27 Impact Factor
"According to this approach, the hospitalization period is intended for treatment of the acute phase of the mental illness and not for a prolonged stay. After the acute phase, efforts should be made to enable the disabled person to return as soon as possible to a normal and routine course of life and be integrated in the society [4-6]. All studies point to the fact that the wider the range of rehabilitation services provided to people with mental disabilities, the sooner and greater the improvement in their functioning [1,7,8]. "
[Show abstract][Hide abstract] ABSTRACT: In 2001, the Rehabilitation of the Mentally Disabled Law was implemented, defining a basket of rehabilitation services to which people with mental disabilities are entitled.
To describe change over time in the characteristics of applicants to rehabilitation committees, types of referral agencies, and the proportion of those referred who were admitted. To identify factors affecting implementation of decisions to admit people with mental disabilities into different rehabilitation services and predictors of the length of time they remain in the services.
The study population consisted of all applicants to rehabilitation committees during 2001-2008. Rehabilitation services included hostels, supported housing, and vocational services. Data were extracted from Ministry of Health rehabilitation and psychiatric hospitalization case registers. Findings were analyzed using descriptive statistics, Kaplan-Meier survival analyses, and Cox regressions.
There was a trend over time for more patients with shorter or no psychiatric hospitalization histories to be referred to rehabilitation services. Moreover, there was an increase in the proportion of referrals from the community, although the majority of referrals still came from psychiatric hospitals. Less than half of those recommended for a rehabilitation program were admitted and remained in a rehabilitation facility for one year or more. One factor predicting participants' longer stays in rehabilitation services after hospitalization was the proximity of the committees' decisions to the hospitalization. Another factor was the patient receiving vocational services while in residential care.
Although over time the new law has resulted in a broader spectrum of people with mental disabilities receiving rehabilitation services, additional efforts are needed to enable them to remain in the system for a sufficient amount of time. Programs addressing specific needs should be developed accordingly.
Israel Journal of Health Policy Research 06/2012; 1(1):24. DOI:10.1186/2045-4015-1-24
"Almost half of the patients in our study were reportedly frequent users of at least two categories of professionals: psychiatrists and case managers. Patients with SMD, especially with schizophrenia and recently hospitalised, usually need specialised care and close professional follow-up for their bio-psycho-social problems . Generally, psychiatrists also recommend that case managers follow patients with major needs . "
[Show abstract][Hide abstract] ABSTRACT: Generally, patients with serious mental disorders (SMD) are frequent users of services who generate high care-related costs. Current reforms aim to increase service integration and primary care for improved patient care and health-care efficiency. This article identifies and compares variables associated with the use by patients with SMD of services offered by psychiatrists, case managers, and general practitioners (GPs). It also compares frequent and infrequent service use.
One hundred forty patients with SMD from five regions in Quebec, Canada, were interviewed on their use of services in the previous year. Patients were also required to complete a questionnaire on needs-assessment. In addition, data were collected from clinical records. Descriptive, bivariate, and multivariate analyses were conducted.
Most patients used services from psychiatrists and case managers, but no more than half consulted GPs. Most patients were followed at least by two professionals, chiefly psychiatrists and case managers. Care access, continuity of care, and total help received were the most important variables associated with the different types of professional consultation. These variables were also associated with frequent use of professional service, as compared with infrequent service use. In all, enabling factors rather than need factors were the core predictors of frequency of service utilisation by patients with SMD.
This study reveals that health care system organisation and professional practice--rather than patient need profiles--are the core predictors of professional consultation by patients with SMD. The homogeneity of our study population, i.e. mainly users with schizophrenia, recently discharged from hospital, may partly account for these results. Our findings also underscored the limited involvement of GPs in this patient population's care. As comorbidity is often associated with serious mental disorders, closer follow-up by GPs is needed. Globally, more effort should be directed at increasing shared-care initiatives, which would enhance coordination among psychiatrists, GPs, and psychosocial teams (including case managers). Finally, there is a need to increase awareness among health care providers, especially GPs, of the level of care required by patients with disabling and serious mental disorders.
BMC Health Services Research 05/2010; 10(1):141. DOI:10.1186/1472-6963-10-141 · 1.71 Impact Factor
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