Self-admission: A New Treatment Approach for Patients With Severe Eating Disorders

NCT02937259 | Completed

• 1 other identifier: Self-Admission
• Study Type: interventional
• Target: 34
• Locations: 1 country
• Sites: 1

Brief Summary

Self-admission is a novel treatment tool whereby patients who are well-known to a service who have high previous utilization of health care are offered the possibility of self-admission to the inpatient ward for up to seven days without having their motive for admission questioned. Patients are free to admit themselves because of deteriorating mental health, acute stress, lack of structure in their everyday life, loneliness, boredom, or any other reason. The patients decide when they want to admit themselves and can discharge themselves at any time. The purpose behind the self-admission model is to increase the availability of inpatient care for severely ill patients, to avoid stressful and possibly destructive visits to the emergency service, and to decrease total inpatient care utilization. Patients offered a contract for self-admission usually have a history of repeated and prolonged hospitalizations. By encouraging them to monitor their own mental health status and allowing them to seek help swiftly when they are feeling poorly, the delay from first signs of deterioration to admission can be minimized and full-blown relapse can be avoided, ultimately reducing the total time spent in hospital. Until now, projects of self-admission have mainly targeted patients with long-standing psychotic disorders, such as schizophrenia, or bipolar disorder. Starting in August 2014, a four-year clinical project at the Stockholm Centre for Eating Disorders began offering self-admission to patients with severe and enduring eating disorders. The purpose of this study is to determine whether this model is viable in a specialized eating disorders treatment setting, if it does lead to increased patient participation and agency and a reduction of the total time spent hospitalized for this particular patient group, and if it is cost-effective.

Conditions

Eating Disorders; Anorexia Nervosa; Bulimia Nervosa

Outcome Measures

Primary Outcomes (1)

• Change in days spent in inpatient treatment

  The number of days the participants spend in inpatient treatment at a) a specialized eating disorders clinic, b) a psychiatric hospital, and c) a somatic hospital during the time they have a contract for self-admission will be compared with the number of days during the same time period before receiving their contracts.

  1 year

Secondary Outcomes (27)

• Change in days spent in inpatient treatment

  3 years

• Change in days spent in involuntary inpatient treatment

  1 year

• Change in days spent in involuntary inpatient treatment

  3 years

• Change in number of outpatient or day-patient visits

  1 year

• Change in number of outpatient or day-patient visits

  3 years

Study Arms (1)

Self-admission

EXPERIMENTAL

Participants are given a contract whereby they are offered the possibility to admit themselves at will to the inpatient ward at the Stockholm Centre for Eating Disorders for a maximum of seven consecutive days at a time. They are also free to discharge themselves at any time. The participants may use this opportunity as often as they want to for a period of one year, or longer if the contract is renewed after one year.

Other: Patient self-admission to inpatient treatment

Interventions

Patient self-admission to inpatient treatment OTHER

Participants are given a contract whereby they are offered the possibility to admit themselves at will to the inpatient ward at the Stockholm Centre for Eating Disorders for a maximum of seven consecutive days at a time. They are also free to discharge themselves at any time. The participants may use this opportunity as often as they want to for a period of one year, or longer if the contract is renewed after one year.

Also known as: Patient-controlled hospital admission

Self-admission

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Having been admitted to the inpatient treatment ward for adults at the Stockholm Centre for Eating Disorders at least once before.
• Being able to follow the routines and rules and partake in the treatment at the inpatient ward.

You may not qualify if:

• Active and untreated substance use disorder.
• Active suicidal ideation.
• No BMI criteria will be applied.

Sponsors & Collaborators

• Karolinska Institutet: lead

Study Sites (1)

Stockholm Centre for Eating Disorders

Stockholm, 11850, Sweden

Location

Related Publications (4)

• Strand M, von Hausswolff-Juhlin Y. Patient-controlled hospital admission in psychiatry: A systematic review. Nord J Psychiatry. 2015;69(8):574-86. doi: 10.3109/08039488.2015.1025835. Epub 2015 Apr 2.

  PMID: 25832757 BACKGROUND

• Strand M, Gustafsson SA, Bulik CM, von Hausswolff-Juhlin Y. Patient-controlled hospital admission: A novel concept in the treatment of severe eating disorders. Int J Eat Disord. 2015 Nov;48(7):842-4. doi: 10.1002/eat.22445. Epub 2015 Aug 28. No abstract available.

  PMID: 26316388 BACKGROUND

• Strand M, Bulik CM, Gustafsson SA, Welch E. Self-admission in the treatment of eating disorders: an analysis of healthcare resource reallocation. BMC Health Serv Res. 2021 May 17;21(1):465. doi: 10.1186/s12913-021-06478-1.

  PMID: 34001113 DERIVED

• Strand M, Gustafsson SA, Bulik CM, von Hausswolff-Juhlin Y. Self-admission to inpatient treatment in psychiatry: lessons on implementation. BMC Psychiatry. 2017 Oct 10;17(1):343. doi: 10.1186/s12888-017-1505-x.

  PMID: 29017471 DERIVED

MeSH Terms

Conditions

Feeding and Eating Disorders; Anorexia Nervosa; Bulimia Nervosa

Condition Hierarchy (Ancestors)

Signs and Symptoms, Digestive; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Mental Disorders

Study Officials

• Yvonne von Hausswolff-Juhlin, M.D, Ph.D.

  Karolinska Institutet

  STUDY DIRECTOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate professor

Study Record Dates

• First Submitted: October 14, 2016
• First Posted: October 18, 2016
• Study Start: August 1, 2014
• Primary Completion: September 1, 2020
• Study Completion: September 1, 2020
• Last Updated: December 16, 2020

Record last verified: 2020-12

Data Sharing

• IPD Sharing: Will not share

Locations

SE (1)