Patient-controlled hospital admission for patients with severe mental disorders: a nationwide prospective multicentre study

C. T. Thomsen, M. E. Benros, T. Maltesen, L. H. Hastrup, P. K. Andersen, D. Giacco, M. Nordentoft

Publikation: Bidrag til tidsskriftArtikelForskningpeer review

Abstrakt

Objective: To assess whether implementing patient-controlled admission (PCA) can reduce coercion and improve other clinical outcomes for psychiatric in-patients. Methods: During 2013–2016, 422 patients in the PCA group were propensity score matched 1:5 with a control group (n = 2110) that received treatment as usual (TAU). Patients were followed up for at least one year using the intention to treat principle utilising nationwide registers. In a paired design, the outcomes of PCA patients during the year after signing a contract were compared with the year before. Results: No reduction in coercion (risk difference = 0.001; 95% CI: −0.038; 0.040) or self-harming behaviour (risk difference = 0.005; 95% CI: −0.008; 0.018) was observed in the PCA group compared with the TAU group. The PCA group had more in-patient bed days (mean difference = 28.4; 95% CI: 21.3; 35.5) and more medication use (P < 0.0001) than the TAU group. Before and after analyses showed reduction in coercion (P = 0.0001) and in-patient bed days (P = 0.0003). Conclusion: Implementing PCA did not reduce coercion, service use or self-harm behaviour when compared with TAU. Beneficial effects of PCA were observed only in the before and after PCA comparisons. Further research should investigate whether PCA affects other outcomes to better establish its clinical value.

OriginalsprogEngelsk
Sider (fra-til)355-363
Antal sider9
TidsskriftActa Psychiatrica Scandinavica
Vol/bind137
Udgave nummer4
DOI
StatusUdgivet - apr. 2018

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