O Saarento

The Nordic Comparative Study on Sectorized Psychiatry: continuity of care related to characteristics of the psychiatric services and the patients

Abstract The problem addressed in this paper is how continuity of care is related to characteristics of psychiatric services, previous events in a patients pattern of care and patient characteristics. The present paper is a part of a Nordic Comparative Study on Sectorized Psychiatry in seven catchment areas in four Nordic countries. One-year-treated-incidence cohorts were used. Each patient was followed for 1 year after the first contact with the psychiatric service. Continuity of care was measured by the time from discharge from hospital to the first subsequent day-patient or outpatient contact. Notable findings were large differences in the continuity of care in the seven services, high proportions of discharges without any aftercare contacts and long time lags between discharges and aftercare contacts in most of the catchment areas. A Cox regression analysis revealed that aftercare following hospitalisation seems to be more probable if the outpatient services are located geographically close to the patients, if the hospitalisation lasted between 2 and 4 weeks, if there was a community care contact shortly before the hospital admission and if the patient is not retired and not divorced. Staff resources were not related to continuity of care.

The Nordic comparative study on sectorized psychiatry: rates of compulsory care and use of compulsory admissions during a 1-year follow-up

AbstractBackground: As part of a Nordic comparative study on contact rates of new patients and use of services in seven catchment areas, rates of compulsory care and use of compulsory admissions were explored and analyzed. The total cohort comprised 2834 patients. Results: A total of 219 patients, 7.7%, were subject to compulsory care during the follow-up. The proportion of compulsorily admitted patients of all admitted patients ranged from 6% to 58% in the seven psychiatric services, and the rate of compulsory care per 1,000 inhabitants, from 0.14 to 0.99. The diagnostic subgroup most commonly committed to inpatient care was functional psychosis, comprising around 50% of all compulsory admissions. The strongest predictor of being compulsorily admitted was the specific psychiatric service the patient was in contact with, followed by having a psychosis diagnosis. High consumption of care was also associated with compulsory care, while social variables played only a minor role in predicting compulsory care. Conclusions: There was a great variation in rates of compulsory care. No consistent rural-urban pattern in rates of commitment was found. It is discussed whether a formal referral procedure to the psychiatric service is associated with higher rates of compulsory care.

Repeated use of psychiatric emergency out-patient services among new patients: a 3-year follow-up study

The aim of this study was to examine repeated use of psychiatric emergency out‐patient services during the second and third years after the first contact. A 1‐year treated incidence cohort of 537 new patients was studied in the Department of Psychiatry in Oulu, Finland. Repeat users were defined as patients belonging to the upper 10th percentile of the emergency out‐patient contacts. The median of emergency out‐patient contacts among repeaters was 4. The repeaters constituted 8% of the cohort and they used 65% of the cohorts emergency contacts. They were more likely to be male and living alone, and they tended to have more serious diagnoses than non‐repeaters. Having hospital admissions, planned out‐patient contacts and repeated emergency out‐patient contacts also during the first year of follow‐up was associated with an increased probability of repeatedly using emergency services during the second and third years. Living alone and having hospital admissions during the follow‐up period were associated with being a continuous repeat visitor during the whole follow‐up period. It is concluded that the extended repeated use of emergency services is associated with inadequate social support and serious psychiatric problems.

The Nordic Comparative Study on Sectorized Psychiatry–length of in‐patient stay

øiesvold T, Saarento O, Sytema S, Christiansen L, Göstas G, Lönnerberg O, Muus S, Sandlund M, Hansson L. The Nordic Comparative Study on Sectorized Psychiatry — length of in‐patient stay. Acta Psychiatr Scand 1999: 100: 220–228.

Socio-demographic and clinical predictors of occupational status in schizophrenic psychoses—follow-up within the Northern Finland 1966 Birth Cohort

We studied occupational status of persons with schizophrenic psychoses by age 34 in a longitudinal population-based cohort and predicted which demographic and illness-related factors could support the patients to maintain their occupational capacity. Subjects of the Northern Finland 1966 Birth Cohort with the diagnosis of DSM-III-R schizophrenic psychoses (n=113) by the year 1997 were followed until the end of year 2000. Various illness and socio-demographic factors at the time of onset of illness were used as predictors. At the end of the follow-up time 50 (44%) of patients were not pensioned and 22 (20%) were also working at least half of the time during year 2000. After adjusting for gender, being unemployed at onset, educational level and proportion of time spent in psychiatric hospitals, those who were married or cohabiting at the time of onset of illness were less often on pension than those who were single (OR 6.51; 95% CI 1.83-23.12). Thus, nearly half of the patients with schizophrenic psychoses were not pensioned after an average 10 years follow-up. Based on our findings, those who were single at time of their onset of illness probably need most support to retain their contacts to work life.

The Nordic Comparative Study on Sectorized Psychiatry

As part of a Nordic Comparative Study on Sectorized Psychiatry, accessibility of psychiatric services and degree of urbanization in seven catchment areas were related to treated incidence. One-year treated incidence cohorts were used. Accessibility was assessed according to referral practice, existence of a round the clock emergency service and geographical location of the services. Accessiblity was, surprisingly, weakly associated with treated incidence. Easy access to the psychiatric services was not related to a high treated incidence of less severe psychiatric problems at the expense of patients suffering from severe illness. Geographical distance to the services did not predict the demand for services. A positive correlation was found between the degree of urbanization and treated incidence of psychoses but not of other diagnostic groups.

Utilization of psychiatric in-patient care among new patients in a comprehensive community-care system: a 3-year follow-up study

Utilization of psychiatric in‐patient care among 537 new patients was studied in the Department of Psychiatry in Oulu, Finland, during a 3‐year follow‐up period. Hospitalization during the second and third years of the follow‐up was predicted by hospitalization and number of emergency out‐patient contacts during the first year of the study, diagnosis of functional psychosis or personality disorder, and previous in‐patient care. In total, 5% of the cohort fulfilled our criteria for ‘revolving‐door’ patients. The ‘revolving‐door’ phenomenon was associated with in‐patient care at the first contact with the psychiatric services and diagnosis of psychosis or personality disorder. In total, 2% of the cohort became long‐stay hospital patients, and this was predicted by psychosis diagnosis. The clinical implications of these findings are that increased attention should be paid to the first assessment of new patients and to the interaction between psychiatric services and patients during the first year of care.

The Nordic comparative study on sectorized psychiatry. I. Treated point prevalence and characteristics of the psychiatric services.

Comparative studies relating characteristics of psychiatric services to rates of treated prevalence are scarce. As part of a Nordic comparative study on sectorized psychiatry, a point‐prevalence study was performed in 5 sectorized psychiatric services with comprehensive service facilities for a defined population under responsibility. The rates of treated prevalence on a census day were related to a number of characteristics of the respective services and to accessibility of care. The results showed a great variation in one‐day point prevalence in the 5 services, with almost fourfold differences. There were also marked differences in the diagnostic distribution of the cohorts. A positive correlation was found between number of beds and point prevalence, measured both as total point prevalence and impatient prevalence. The rates of beds and psychiatrists were most strongly related to the prevalence of patients with organic disorders and functional psychoses. A closed referral system was associated with a lower level of treated prevalence.

The nordic comparative study on sectorized psychiatry II. Resources of the psychiatric services and treated incidence

As a part of a Nordic comparative study on sectorized psychiatry, treated incidence was related to the resources and dynamic qualities of psychiatric services in 7 catchment areas. One‐year treated incidence cohorts were used. Data was collected concerning number of beds and staff, number of long‐term patients and turnover rate of patients in the services and availability of specialized services. A positive correlation was found between rates of outpatient staff and treated incidence. No statistically significant correlation was found between the dynamic qualities of the services and treated incidence. Treated incidence of dependence was the highest in a center that had a special service unit for abusers. Special services for young and old people were not clearly reflected in treated incidence in respective patient groups.

Early presence of thought disorder as a prospective sign of mental disorder

The purpose of this study was to assess whether premorbid signs, such as thought disorder, could predict the subsequent manifestation of psychiatric disorders. A group of 75 adoptees at high genetic risk for schizophrenia and 96 low-risk adoptees without any psychiatric disorder at the initial assessment were assessed blindly with the Thought Disorder Index (TDI). Their psychiatric status was re-assessed according to DSM-III-R criteria in a re-interview 11 years later and based on available registers 16 years later. High scores on several TDI variables at the initial assessment predicted a psychiatric disorder of all adoptees at follow-up. Prediction was statistically unsuccessful among the high-risk adoptees because of the small number of cases, but high scores at the 0.50 severity level did predict mental disorders among the low-risk adoptees.