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Effectiveness and costs of acute day hospital treatment compared with conventional in-patient care: Randomised controlled trial

  • Stefan Priebe (a1), Gemma Jones (a1), Rosemarie McCabe (a2), Jane Briscoe (a1), Donna Wright (a1), Michelle Sleed (a3) and Jennifer Beecham (a2)...

Abstract

Background

Data on effectiveness of acute day hospital treatment for psychiatric illness are inconsistent.

Aims

To establish the effectiveness and costs of care in a day hospital providing acute treatment exclusively.

Method

In a randomised controlled trial, 206 voluntarily admitted patients were allocated to either day hospital treatment or conventional wards. Psychopathology, treatment satisfaction and subjective quality of life at discharge, 3 months and 12 months after discharge, readmissions to acute psychiatric treatment within 3 and 12 months, and costs in the index treatment period were taken as outcome criteria.

Results

Day hospital patients showed significantly more favourable changes in psychopathology at discharge but not at follow-up. They also reported higher treatment satisfaction at discharge and after 3 months, but not after 12 months. There were no significant differences in subjective quality of life or in readmissions during follow-up. Mean total support costs were higher for the day hospital group.

Conclusions

Day hospital treatment for voluntary psychiatric patients in an inner-city area appears more effective in terms of reducing psychopathology in the short term and generates greater patient satisfaction than conventional in-patient care, but may be more costly.

Copyright

Corresponding author

Professor Stefan Priebe, Unitfor Socialand Community Psychiatry, Newham Centre for Mental Health, London E13 8SP, UK. E-mail: s.priebe@qmul.ac.uk

Footnotes

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Declaration of interest

None. Funding det alled in Acknowledgements.

Footnotes

References

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Beecham, J. (1995) Collecting and estimating costs. In The Economic Evaluation of Mental Health Care (ed. Knapp, M.), pp. 83102. Aldershot: Arena.
Beecham, J. & Knapp, M. (2001) Costing psychiatric interventions. In Measuring Mental Health Needs (2nd edn) (ed. Thornicroft, G.), pp. 200224. London: Gaskell.
Briscoe, J., McCabe, R., Priebe, S., et al (2004) A national survey of psychiatric day hospitals. Psychiatric Bulletin, 28, 160163.
Creed, F., Black, D., Anthony, P., et al (1990) Randomised controlled trial of day hospital versus inpatient psychiatric treatment. British Medical Journal, 300, 10331037.
Creed, F., Mbaya, P., Lancashire, S., et al (1997) Cost effectiveness of day and inpatient psychiatric treatment. British Medical Journal, 314, 13811385.
Dick, P., Cameron, L., Cohen, D., et al (1985) Dayand full time psychiatric treatment: a controlled comparison. British Journal of Psychiatry, 147, 246249.
Horwitz-Lennon, M., Normand, S. L. T., Gaccione, P., et al (2001) Partial versus full hospitalisation for adults in psychiatric distress: a systematic review of the published literature. American Journal of Psychiatry, 158, 676685.
Marshall, M., Crowther, R., Almaraz-Serrano, A., et al (2001) Systematic reviews of the effectiveness of day care for people with severe mental disorders: (1) acute day hospital versus admission; (2) vocational rehabilitation; (3) day hospital versus outpatient care. Health Technology Assessment, 5, 175.
Netten, A. & Curtis, L. (eds) (2002) The Unit Costs of Health and Social Care. Canterbury: Personal Social Services Research Unit, University of Kent.
Priebe, S. (2002) Making crises day services happen in practice. Mental Health Times, 1, 1213.
Priebe, S. & Gruyters, T. (1994) Patients’ and caregivers’ initial assessments of day hospital treatment and course of symptoms. Comprehensive Psychiatry, 35, 234238.
Priebe, S., Gruyters, T., Heinze, M., et al (1995) Subjective criteria for evaluation of psychiatric care. Methods for assessment in research and routine care. Psychiatrische Praxis, 22, 140144.
Priebe, S., Huxley, P., Knight, S., et al (1999) Application and results of the Manchester short assessment of quality of life (MANSA). International Journal of Social Psychiatry, 45, 712.
Schene, A. H., van Wijngaarden, B., Poelijoe, N. W., et al (1993) The Utrecht comparative study on psychiatric day treatment and inpatient treatment. Acta Psychiatrica Scandinavica, 87, 427436.
Sledge, W. H., Tebes, J., Rakfeldt, J., et al (1996) Day hospital/crisis respite care versus inpatient care, Part I: Clinical outcomes. American Journal of Psychiatry, 153, 10651073.
Ventura, J., Green, M., Shaner, A., et al (1993) Training and quality assurance with the brief psychiatric rating scale: ‘The drift busters'. International Journal of Methods in Psychiatric Research, 3, 221226.
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Effectiveness and costs of acute day hospital treatment compared with conventional in-patient care: Randomised controlled trial

  • Stefan Priebe (a1), Gemma Jones (a1), Rosemarie McCabe (a2), Jane Briscoe (a1), Donna Wright (a1), Michelle Sleed (a3) and Jennifer Beecham (a2)...
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eLetters

Statistical significance and clinical significance

Mohammed J Abbas, Specialist registrar in psychiatry
21 June 2006

Priebe et al (2006) conclude that “day hospital treatment for voluntary psychiatric patients in an inner-city area appears more effective in terms of reducing psychopathology in the short term and generates greater patient satisfaction than conventional in-patient care”.This paper was presented in the journal club as part of the postgraduate teaching program of North Derbyshire Mental Health Services NHS Trust in Chesterfield. Among other points raised during our discussion, we would like to point out two. The conclusion about patient satisfaction was basedon a “significantly” higher mean CAT (Client’s Assessment of Treatment Scale) scores in the day hospital group at discharge (P=0.004) and 3 months after discharge (P=0.005). However, in both cases no confidence intervals of the mean differences were presented making it difficult to judge the generalisability of these findings.

When the confidence interval was presented for the other “statistically significant finding” (reduction in psychopathology at discharge using Brief Psychiatric Rating Scale as an outcome measure), it was very close to zero (lower limit=0.03) indicating a very small difference and limiting its generalisability. We think that this small size of difference should have been mentioned in the conclusions and limitations.

A statistically significant difference, especially when small, does not always indicate a clinical significance. We welcome the publication ofpapers which report negative or very small positive result on the assumption that the result and its size are reflected clearly in the conclusions.

References

Priebe, S., Jones, G., McCabe, R., Briscoe, J., Wright, D., Sleed, M., and Beecham, J. (2006) Effectiveness and costs of acute day hospital treatment compared with conventional in-patient care: Randomised controlled trial. British Journal of Psychiatry 188,243-249.
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Conflict of interest: None Declared

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