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Comparative Effectiveness research on Psychiatric HOSpitalisation by record LINKage of large administrative data sets

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Less hospitalisation may help psychiatric patients

The aim of any hospitalisation is to promote a person’s health and wellbeing. Frequent rehospitalisations may indicate failure of the health system to achieve this goal.

Health

Over the last few decades, a process of deinstitutionalisation has reduced the use of hospital based care for psychiatric patients in many countries, favouring outpatient services in the community and if necessary, hospital stays within regular hospitals instead of in centralised ‘stand-alone’ psychiatric hospitals. Psychiatric rehospitalisation, also known as the ‘revolving door’ phenomenon is a multifaceted issue, determined by a whole host of factors including health service characteristics, the different clinical populations, as well as admission and service policy and practice. Rehospitalisation has been highlighted as a negative outcome by organisations such as the OECD, and an area in need of further attention. Repeated rehospitalisations are costly, creating significant disruptions to individuals and families alike. Against this backdrop, the CEPHOS-LINK (Comparative effectiveness research on psychiatric hospitalisation by record linkage of large administrative data sets) set about investigating psychiatric re-hospitalisation using health register data in six European countries (Austria, Finland, Italy, Norway, Romania, Slovenia). Of central importance was ensuring accurate comparability between the countries considering the different nature of their healthcare systems and health register data. Once comparability was achieved, data from a total of 225 600 patients was included in the study. Although differences were found between the six countries, it was found that about half of all patients returned to hospital care within one year, many of these rehospitalisations occurring within the first few weeks after hospital discharge, indicating the need for further preventative measures at this stage. Additionally, access to psychiatric outpatient services soon after discharge was found to reduce risk of rehospitalisation. Qualitative results from a set of focus groups held in all six countries highlighted areas needing special attention, namely that the first hospitalisation was generally found to be most traumatic for the patient, recognising the importance of the admission being on a voluntary basis, and the need for active outpatient follow-up including social and activity aspects. The project resulted in methodological tools intended to improve interoperability of national databases, policy briefs detailing recommendations for decision makers for each partner country, as well as a European policy brief, and one highlighting the need to including service users’ experiences in research.

Keywords

Psychiatric patients, rehospitalisation, mental health disorders, CEPHOS-LINK, healthcare, health register research

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