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Needs-oriented discharge planning for high utilisers of psychiatric services: multicentre randomised controlled trial

Published online by Cambridge University Press:  18 March 2011

B. Puschner ,
S. Steffen ,
K. A. Völker ,
C. Spitzer ,
W. Gaebel ,
B. Janssen ,
H. E. Klein ,
H. Spiessl ,
T. Steinert  and
J. Grempler
...Show all authors
B. Puschner*
Affiliation:
Department of Psychiatry II, Ulm University, Günzburg, Germany
S. Steffen
Affiliation:
Department of Psychiatry II, Ulm University, Günzburg, Germany
K. A. Völker
Affiliation:
Department of Psychiatry and Psychotherapy, Greifswald, Germany
C. Spitzer
Affiliation:
Department of Psychiatry and Psychotherapy, Greifswald, Germany Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Klinik Hamburg-Eilbek, Germany
W. Gaebel
Affiliation:
Department of Psychiatry and Psychotherapy, Düsseldorf University, Germany
B. Janssen
Affiliation:
Department of Psychiatry and Psychotherapy, Düsseldorf University, Germany
H. E. Klein
Affiliation:
Department of Psychiatry and Psychotherapy, Regensburg University, Germany
H. Spiessl
Affiliation:
Department of Psychiatry and Psychotherapy, Regensburg University, Germany District Hospital Landshut, Germany
T. Steinert
Affiliation:
Department of Psychiatry I, Ulm University, Ravensburg, Germany
J. Grempler
Affiliation:
Department of Psychiatry I, Ulm University, Ravensburg, Germany
R. Muche
Affiliation:
Institute for Biometrics, Ulm University, Germany
T. Becker
Affiliation:
Department of Psychiatry II, Ulm University, Günzburg, Germany
*
*Address for correspondence: Dr Bernd Puschner, Department of Psychiatry II, Ulm University, Ludwig-Heilmeyer-Str. 2, 89312 Günzburg, Germany. (Email: bernd.puschner@bkh-guenzburg.de)
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Abstract

Aims.

Attempts to reduce high utilisation of mental health inpatient care by targeting the critical time of hospital discharge are rare. In this study, we test the effect of a needs-oriented discharge planning intervention on number and duration of psychiatric inpatient treatment episodes (primary), as well as on outpatient service use, needs, psychopathology, depression and quality of life (secondary).

Methods.

Four hundred and ninety-one adults with a defined high utilisation of mental health care gave informed consent to participate in a multicentre RCT carried out at five psychiatric hospitals in Germany (Düsseldorf, Greifswald, Regensburg, Ravensburg and Günzburg). Subjects allocated to the intervention group were offered a manualised needs-led discharge planning and monitoring intervention with two intertwined sessions administered at hospital discharge and 3 months thereafter. Outcomes were assessed at four measurement points during a period of 18 months following discharge.

Results.

Intention-to-treat analyses showed no effect of the intervention on primary or secondary outcomes.

Conclusions.

Process evaluation pending, the intervention cannot be recommended for implementation in routine care. Other approaches, e.g. team-based community care, might be more beneficial for people with persistent and severe mental illness.

Keywords

Discharge planninghigh utilizationmental health servicesmulticentre randomised controlled trial
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 20 , Issue 2 , June 2011 , pp. 181 - 192
Copyright
Copyright © Cambridge University Press 2011

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