Over a period of 20 years (from 1968 to 1988) all inpatients (n = 839) who were admitted for the first time to the adolescent psychiatric unit in Copenhagen were registered, and 40 social and psychiatric variables were recorded, to investigate early predictors of later readmission. Overall, 44.8% of the patients were readmitted within a certain observation period (range, 1.5-21.5 years). Among a subsample of 488 patients (58%) who could be followed up for more than 10 years after their first admission 26% became heavy users of psychiatric services, defined as long-term inpatients or revolving-door patients. Severe early diagnoses (schizophrenia and affective psychoses) were strongly associated with rapid relapses and frequent readmissions. A statistical estimate of the risk of later heavy use based on 12 independent variables is presented.
The introduction of second-generation antipsychotic drugs during the 1990s is widely believed to have adversely affected mortality of patients with schizophrenia. Our aim was to establish the long-term contribution of antipsychotic drugs to mortality in such patients.
Nationwide registers in Finland were used to compare the cause-specific mortality in 66 881 patients versus the total population (5.2 million) between 1996, and 2006, and to link these data with the use of antipsychotic drugs. We measured the all-cause mortality of patients with schizophrenia in outpatient care during current and cumulative exposure to any antipsychotic drug versus no use of these drugs, and exposure to the six most frequently used antipsychotic drugs compared with perphenazine use.
Although the proportional use of second-generation antipsychotic drugs rose from 13% to 64% during follow-up, the gap in life expectancy between patients with schizophrenia and the general population did not widen between 1996 (25 years), and 2006 (22.5 years). Compared with current use of perphenazine, the highest risk for overall mortality was recorded for quetiapine (adjusted hazard ratio [HR] 1.41, 95% CI 1.09-1.82), and the lowest risk for clozapine (0.74, 0.60-0.91; p=0.0045 for the difference between clozapine vs perphenazine, and p
Comment In: Lancet. 2009 Nov 7;374(9701):1591; author reply 1592-319897117
Comment In: Lancet. 2009 Nov 7;374(9701):1591; author reply 1592-319897118
Comment In: Lancet. 2009 Aug 22;374(9690):590-219595448
Comment In: Lancet. 2009 Nov 7;374(9701):1592; author reply 1592-319897121
Comment In: Lancet. 2009 Nov 7;374(9701):1592; author reply 1592-319897120
A total of 546 children and adolescents, aged 5 to 15 years, who were admitted as in-patients to psychiatric hospitals throughout Denmark between 1970 and 1973, were followed up with regard to later readmissions and mortality. Approximately one-third of the sample had at least one readmission after the age of 18 years; there was no significant difference between male and female subjects. Probands with three selected diagnoses, namely childhood neurosis, conduct disorder and maladjustment reactions, did have a significantly greater general risk of readmission to psychiatric hospital in adulthood than the background population. In total, 24 probands (22 male, and 2 female subjects) died during the study period. Eight subjects had committed suicide. The standard mortality rate was significantly increased.
A comparison was undertaken between the frequencies of admission of medical patients over the age of 64 years and long-term/geriatric patients admitted to a large county hospital. The pattern of readmission is described in relation to the age groups and sex. The period of observation was nine months. In the investigation, the relationship between the distribution of men and women in the normal population was taken into consideration and a correction factor was calculated. A total of loll patients (CP) discharged from an acute medical department (AM) had 1954 readmissions (GI). In the long-term medical department (LMA) 158 CP had a total of 328-GI. The number of CP readmitted in each age group and sex reflects the representation of the group concerned in the background population, although a tendency was observed for slightly more admissions, the older the CP were. No difference in the pattern of readmission was observed concerning CP readmitted from AM and readmitted to all departments including AM. Similarly, despite some scatter, there was no difference in the GI pattern in CP discharged from LMA and readmitted to all departments including LMA. In addition, no significant difference in the GI pattern was observed as compared with the AM patient group and the LMA patient group. As patients referred to LMA have, quite naturally, poorer performance than the patients who were discharged directly from medical or surgical departments, it may be concluded that, after treatment in LMA, no difference between the patient groups was found if the GI frequency was taken as a yardstick. As GI, just as other measurements of turnover, only provides an expression of the status at a given moment, the author considers that it is of importance both for the departmental and the political planning that the GI frequency is followed as part of the current assessment.
Health care professionals in several countries are searching for alternatives to acute hospitalization. In Hallingdal, Norway, selected acute patients are admitted to a community hospital. The aim of this study was to analyse whether acute admission to a community hospital as an alternative to a general hospital had any positive or negative health consequences for the patients.
Patients intended for acute admission to the local community hospital were asked to join a randomized controlled trial. One group of the enrolled patients was admitted as planned (group 1, n = 33), while another group was admitted to the general hospital (group 2, n = 27). Health outcomes were measured by the Nottingham Extended Activity of Daily Living Questionnaire and by collection of data concerning specialist and community health care services in a follow-up year.
After one year, no statistical significant differences in the level of daily function was found between group 1 (admissions to the community hospital) and group 2 (admissions to the general hospital). Group 1 had recorded fewer in-patient days at hospitals and nursing homes, as well as lower use of home nursing, than group 2. For outpatient referrals, the trend was the opposite. However, the differences between the two groups were not at a 5% level of statistical significance.
No statistical significant differences at a 5% level were found related to health consequences between the two randomized groups. The study however, indicates a consistent trend of health benefits rather than risk from acute admissions to a community hospital, as compared to the general hospital. Emergency admission and treatment at a lower-level facility than the hospital thus appears to be a feasible solution for a selected group of patients.
ClinicalTrials.gov NCT01069107 . Registered 2 April 2010.
The James iCAPTURE Centre for Cardiovascular and pulmonary Research, Heart and Lung Institute, St Paul's Hospital, Providence Healthcare, University of British Columbia, Vancouver, British Columbia, Canada.
Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is the leading reason for hospitalization in Canada and a significant financial burden on hospital resources. Identifying factors that influence the time a patient spends in the hospital and readmission rates will allow for better use of scarce hospital resources.
To determine the factors that influence length of stay (LOS) in the hospital and readmission for patients with AECOPD in an inner-city hospital.
Using the Providence Health Records, a retrospective review of patients admitted to St Paul's Hospital (Vancouver, British Columbia) during the winter of 2006 to 2007 (six months) with a diagnosis of AECOPD, was conducted. Exacerbations were classified according to Anthonisen criteria to determine the severity of exacerbation on admission. Severity of COPD was scored using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. For comparative analysis, severity of disease (GOLD criteria), age, sex and smoking history were matched.
Of 109 admissions reviewed, 66 were single admissions (61%) and 43 were readmissions (39%). The number of readmissions ranged from two to nine (mean of 3.3 readmissions). More than 85% of admissions had the severity of COPD equal to or greater than GOLD stage 3. The significant indicators for readmission were GOLD status (P
Cites: Am J Respir Crit Care Med. 1998 May;157(5 Pt 1):1418-229603117
Cites: Eur Respir J. 2005 Sep;26(3):414-916135721
Cites: Soc Work Health Care. 2006;43(4):1-1316966306
Postoperative admissions to hospital from a hospital-based day-surgery unit were analysed over a period of 19 months. A total of 2,411 patients were surveyed. The admission rate within 24 hours of the operation was 1.5% (35 patients). Surgery, anaesthesia, pain and social reasons accounted for 37, 29, 20 and 14% of the admissions respectively. One patient was re-operated on. 24 patients (1%) were hospitalized later than 24 hours but within 30 days after surgery (mean 7.5 days), and were called re-admissions. Surgery (75.6%), pain (12.6%) and anaesthetic reasons (8.4%) accounted for the re-admissions. 12 patients (50%) underwent surgery when re-admitted. The number of admissions (4.1%, p
U.S. and Canadian data demonstrate decreasing inpatient days, increasing nonurgent emergency department (ED) visits, and short supply of child psychiatrists. Our study aims to determine whether aftercare reduces ED visits and/or readmission in adolescents with first psychiatric hospitalization.
We conducted a population-based cohort analysis using linked health administrative databases with accrual from April 1, 2002, to March 1, 2004. The study cohort included all 15- to 19-year-old adolescents with first psychiatric admission. Adolescents with and without aftercare in the month post-discharge were matched on their propensity to receive aftercare. Our primary outcome was time to first psychiatric ED visit or readmission. Secondary outcomes were time to first psychiatric ED visit and readmission, separately.
We identified 4,472 adolescents with first-time psychiatric admission. Of these, 57% had aftercare in the month post-discharge. Propensity-score-based matching, which accounted for each individual's propensity for aftercare, produced a cohort of 3,004 adolescents. In matched analyses, relative to those with no aftercare in the month post-discharge, those with aftercare had increased likelihood of combined outcome (hazard ratio [HR] = 1.22, 95% confidence interval [CI] = 1.05-1.42), and readmission (HR = 1.38, 95% CI = 1.14-1.66), but not ED visits (HR = 1.14, 95% CI = 0.95-1.37).
Our results are provocative: we found that aftercare in the month post-discharge increased the likelihood of readmission but not ED visit. Over and above confounding by severity and Canadian/U.S. systems differences, our results may indicate a relative lack of psychiatric services for youth. Our results point to the need for improved data capture of pediatric mental health service use.
To determine sex and age variations in hospital readmissions for chronic obstructive pulmonary disease (COPD) associated with overall and cardiac comorbid conditions.
A one-year follow-up study was conducted for 108 726 COPD in-patients aged >or=40 years who were discharged alive after their first admission in the 1999-2000 fiscal year.
Within a year, 38 955 of the patients were readmitted to hospital for COPD. The incidence rate of COPD readmission was 49.1% per year. It was higher for men than women aged >or=70 years, but was almost the same for patients aged
In this paper, I describe dividing practices in making up a specific medical-legal category-the revolving door patient-to identify, label, and direct the actions of particular people living with mental illness. The revolving door patient was a category that had been spoken of for some time, but became a formal legal subject with the introduction of the Alberta Mental Health Act 2010 and Community Treatment Orders (CTOs). I demonstrate how a rationale of control over unpredictable and dangerous individuals was primary in creating this new category, and that the characterization of the revolving door patient required a disciplinary technology to reduce danger. I argue that the CTO is a medical-legal technology that solves the problem of governing a subject in order to produce a patient that manages mental illness. I conclude by reflecting on how the narrative of the revolving door patient, and of mental illness more broadly, has implications for personal identity and tensions between care and control. Dans cet article, je décris comment des 'pratiques divisées' ont créé une catégorie spécifique médico-légale - le « revolving door patient » - afin d'identifier, d'étiqueter et de contrôler les comportements de certains individus vivants avec une maladie mentale. Le «revolving door patient», une catégorie dont on avait parlé depuis un certain temps, est devenu un sujet juridique formel par l'introduction de la loi de la santé mentale de l'Alberta 2010 et de l'Ordre de Traitement Communautaire (OCT). Je démontre comment une logique de contrôle sur les individus imprévisibles et dangereux eu un rôle prépondérant lors de la création de cette catégorie et que la caractérisation du «revolving door patient», entant que telle, a nécessité une technologie disciplinaire pour réduire le danger social. Je soutiens que le OTC est une technologie médico-légale qui résout le problème de contrôle d'un sujet en produisant un patient qui gère une maladie mentale. Je conclus en démontrant de quelle façon le «revolving door patient», et la maladie mentale en général, a des répercussions sur l'identité personnelle et produisent des tensions entre les soins et le contrôle.