Patient-controlled Admissions in Inpatient Mental Health Services

NCT03609515 | Completed

• 1 other identifier: 2011/790
• Study Type: interventional
• Target: 58
• Locations: 0 countries
• Sites: N/A

Brief Summary

Patient-controlled admissions are short self-referred inpatient admissions in mental health services without approval by clinicians. The intention is to reduce a high use of inpatient care. Patients are signing a contract for a specified period with stays limited to a maximum number of days and with a minimum number of weeks between stays. The few studies so far show tendencies to a possible effect, but additional studies are needed. The aims of the study are to describe the use and experiences of patient-controlled admissions, compare the use of inpatient admissions and inpatient days during the 24 months before and after baseline, and to identify subgroups who may benefit from the model. The study is a pre-post prospective intervention study where the use of inpatient admissions in the contract period is compared to a similar period before baseline so that the patients are their own controls. The study is done in inpatient wards in four community mental health centers of Akershus University Hospital, Norway. The study aims to recruit 120 patients. The eligible patients have a severe mental illness, high use of inpatient mental health care the last two years and are expected to benefit from patient-controlled admissions. The patients will be followed for 24 months from baseline. Data at baseline includes socio-demographics, diagnoses, type and severity of psychiatric problems, and use of alcohol and drugs. Data on admissions and experience of these are collected during the contract period, Data on patients' and relatives' experience of the model are collected at the end of the period. Data on total inpatient admissions/stays during the 24 months before and after baseline are extracted from the hospital patient records. Data analyses will include descriptive statistics on the sample and the use of inpatient care, testing of differences of inpatient care between 24 months before and after baseline, multiple regression of associations between baseline characteristics and the use of inpatient care, and analyses to identify subgroups who benefit from the model. The study protocol in Norwegian was approved by the Regional Committee on Medical and Health Research Ethics in Norway South East 29 April 2011 (reg.no. 2011/790). The inclusion period was 2011-2012. Data collection were done 2011-2014. Data extraction from the patient records was done 2015-2016. Quality control and organization of data was done 2017-2018. Data analysis will start in August 2018.

Conditions

Psychoses; Affective Disorder

Outcome Measures

Primary Outcomes (1)

• Number of inpatient days during the 24 months period with a contract for patient-controlled admissions compared to the previous 24 months

  Number of inpatient days during the 24 months period with a contract for patient-controlled admissions compared to the previous 24 months

  24 months

Secondary Outcomes (6)

• Number of inpatient admissions during the 24 months period with a contract about patient-controlled admissions compared to the previous 24 months

  24 months

• Number of involuntary inpatient admissions during the 24 months period with a contract about patient-controlled admissions compared to the previous 24 months

  24 months

• Number of inpatient days under coercion during the 24 months period with a contract about patient-controlled admissions compared to the previous 24 months

  24 months

• Patients' experience of patient-controlled admissions as reported at the end of the stay

  24 months

• Patients' experience of patient-controlled admissions as reported at the end of the period with contract about patient-controlled admissions

  24 months

Study Arms (1)

Patients with contract about patient-controlled admissions

EXPERIMENTAL

Patients have a contract about short self-referred inpatient admissions in mental health services without approval by clinicians, for a maximum of 5 days and with a minimum of three weeks between such stays

Other: Patient-controlled admission

Interventions

Patient-controlled admission OTHER

The patients with a contract for patient-controlled admissions may refer themselves to short inpatient stays when they feel the need, without needing an approval from a clinician. They will be accepted for admission if a patient-controlled bed is available in the ward. Patient-controlled admissions are limited to a length of 5 days and at least three weeks between such stays.

Patients with contract about patient-controlled admissions

Eligibility Criteria

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

You may qualify if:

• Patient with a severe mental illness
• Many and/or long inpatient stays in mental health services last two years
• Is expected to benefit from a contract about patient-controlled admissions
• Have signed a contract about patient-controlled admissions
• Give written consent to participate in the study

Sponsors & Collaborators

• University Hospital, Akershus: lead

Related Publications (10)

• Heskestad S, Tytlandsvik M. [Patient-guided crisis admissions for severe psychotic conditions]. Tidsskr Nor Laegeforen. 2008 Jan 3;128(1):32-5. Norwegian.

  PMID: 18183054 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

• Thomsen CT, Benros ME, Maltesen T, Hastrup LH, Andersen PK, Giacco D, Nordentoft M. Patient-controlled hospital admission for patients with severe mental disorders: a nationwide prospective multicentre study. Acta Psychiatr Scand. 2018 Apr;137(4):355-363. doi: 10.1111/acps.12868. Epub 2018 Mar 4.

  PMID: 29504127 BACKGROUND

• Wills CE, Holmes-Rovner M. Integrating Decision Making and Mental Health Interventions Research: Research Directions. Clin Psychol (New York). 2006;13(1):9-25. doi: 10.1111/j.1468-2850.2006.00002.x.

  PMID: 16724158 BACKGROUND

• Lloyd-Evans B, Slade M, Jagielska D, Johnson S. Residential alternatives to acute psychiatric hospital admission: systematic review. Br J Psychiatry. 2009 Aug;195(2):109-17. doi: 10.1192/bjp.bp.108.058347.

  PMID: 19648539 BACKGROUND

• Wing JK, Beevor AS, Curtis RH, Park SB, Hadden S, Burns A. Health of the Nation Outcome Scales (HoNOS). Research and development. Br J Psychiatry. 1998 Jan;172:11-8. doi: 10.1192/bjp.172.1.11.

  PMID: 9534825 BACKGROUND

• Mueser KT, Drake RE, Clark RE, McHugo GJ, Mercer-McFadden C, Ackerson TH. Toolkit for Evaluating Substance Abuse in Person with Severe Mental Illness. 1995.

  BACKGROUND

• Støvind H, Hanneborg EM, Ruud T. Bedre tid med brukerstyrte innleggelser? Sykepleien 2012, 100(14):62-64.

  BACKGROUND

• Nyttingnes O, Ruud T. When patients decide the admission - a four year pre-post study of changes in admissions and inpatient days following patient controlled admission contracts. BMC Health Serv Res. 2020 Mar 18;20(1):229. doi: 10.1186/s12913-020-05101-z.

  PMID: 32188451 RESULT

• Nyttingnes O, Saltyte Benth J, Ruud T. Patient-controlled admission contracts: a longitudinal study of patient evaluations. BMC Health Serv Res. 2021 Jan 7;21(1):36. doi: 10.1186/s12913-020-06033-4.

  PMID: 33413337 RESULT

MeSH Terms

Conditions

Psychotic Disorders; Mood Disorders

Condition Hierarchy (Ancestors)

Schizophrenia Spectrum and Other Psychotic Disorders; Mental Disorders

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Senior Researcher

Model Details: A prospective study of service use during a period by a cohort of patients compared to service use by the same cohort during av similar period before inclusion.

Study Record Dates

• First Submitted: July 28, 2018
• First Posted: August 1, 2018
• Study Start: April 1, 2011
• Primary Completion: December 31, 2012
• Study Completion: December 31, 2012
• Last Updated: January 15, 2021

Record last verified: 2021-01

Data Sharing

• IPD Sharing: Will not share