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Use of psychiatric inpatient services by heavy users: Findings from a national survey in Italy

Published online by Cambridge University Press:  16 April 2020

M. Morlino ,
A. Calento ,
V. Schiavone ,
G. Santone ,
A. Picardi ,
G. de Girolamo  and
for the PROGRES-Acute group
M. Morlino
Affiliation:
Department of Neuroscience and Behavioral Science, Section of Psychiatry, University Medical School Federico II, via Pansini 5, 80131Naples, Italy
A. Calento
Affiliation:
Department of Neuroscience and Behavioral Science, Section of Psychiatry, University Medical School Federico II, via Pansini 5, 80131Naples, Italy
V. Schiavone
Affiliation:
Department of Neuroscience and Behavioral Science, Section of Psychiatry, University Medical School Federico II, via Pansini 5, 80131Naples, Italy
G. Santone
Affiliation:
Psychiatric Unit, United Hospitals of Ancona, Polytechnic University of Marche, via Conca, 60020Ancona, Italy
A. Picardi
Affiliation:
Mental Health Unit, Center of Epidemiology, Health Surveillance and Promotion, Italian National Institute of Health, 299, Viale Regina Elena, 00161Rome, Italy
G. de Girolamo*
Affiliation:
IRCCS Centro San Giovanni di Dio–Fatebenefratelli, via Pilastroni, 4, 25125Brescia, Italy
*
* Corresponding author. Tel.: +39 0303 501 590; fax: +39 0303 533 511. E-mail address: gdegirolamo@fatebenefratelli.it (G. de Girolamo).
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Abstract

Purpose

To analyze factors associated with a patient's probability of being a Heavy User (HU) of inpatient psychiatric services and to compare the HU inpatient population with Non-Heavy Users (NHUs).

Patients and methods

The survey was conducted among inpatients enrolled in the PROGRES-Acute-project, an Italian nationwide survey of public and private inpatient facilities. Patients with three or more admissions over the last 12 months were considered HUs, and patients who had undergone one or two admissions during the same period made up the NHU group.

Results

Four hundred and thirty-five (40.5%) were HUs, and 640 (59.5%) NHUs. HUs were younger, more frequently unmarried, unemployed, receiving a disability-pension, and either homeless or living in a residential facility. HUs were more likely to have experienced conflicts with their partners or family members during the week prior to admission. A logistic regression analysis revealed that age, age at first admission, number of life-time admissions, and having been the victim of violence were the most important predictive factors for the HU phenomenon.

Conclusion

Our study suggests that specific attention should be given to patients’ family context, due to its crucial role in daily informal care and in the triggering of events leading to rehospitalization.

Keywords

EpidemiologyHeavy usersPatterns of careResidential facilitiesRe-hospitalization
Type
Original article
Information
European Psychiatry , Volume 26 , Issue 4 , May 2011 , pp. 252 - 259
Copyright
Copyright © Elsevier Masson SAS 2011

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Footnotes

1

The PROGRES-Acute group includes: National and Regional Coordinators, and scientific consultants: F. Amaddeo, A. Barbato, G. Borgherini, G. Borsetti, R. Bracco, R. Canosa, M. Casacchia, I. Casula, P. Ciliberti, A. Colotto, A. D’Aloise, G. de Girolamo, G. Dell’Acqua, M. De Palma, W. Di Munzio, A. Gaddini, G. Grassi, N. Longhin, M. Miceli, R. Miglio, P. Morosini, M. Nicotera, M. Percudani, B. Norcio, A. Picardi, R. Potzolu, E. Rossi, P. Rucci, G. Santone, S. Schiaffino, F. Scotti, R. Tomasi, G. Turrini, E. Zanalda. Researchers: G. Agostani, F. Basile, F. Basilico, N. Battino, L. Bavero, G. Bazzacco, L. Biscaglia, R. Borio, S. Buttacavoli, B. Caporali, F. Cappelletti, L. Caserta, L. Cifarelli, P. Congia, M. Dazzi, L. Elia, E. Fantini, A. Galli, R. Gangi, P. Ghirardo, L. Giordano, S. Goldoni, A. Guidoni, S. Marchegiani, G. Morelli, M. Nassisi, E. Paltrinieri, K. Pesaresi, A. Pettolino, L. Pinciaroli, G. Pitzalis¸ M. Severini, C. Sighinolfi, G. Spinetti, A. Trequattrini, U. Unterfrauner, K. Wolf, L. Zecca.

References

Casper, ES, Romo, JM, Fasnacht, RCReadmission patterns of frequent users of inpatient psychiatric services. Hosp Community Psychiatry 1991;42(11):1166–1167.Google ScholarPubMed
Conley, RR, Love, RC, Kelly, DL, Bartko, JJRehospitalization rates of patients recently discharged on a regimen of risperidone or clozapine. Am J Psychiatry 1999;156(6):863–868.CrossRefGoogle ScholarPubMed
de Girolamo, G, Barbato, A, Bracco, R, Gaddini, A, Miglio, R, Morosini, P, et al.The characteristics and activities of acute psychiatric inpatient facilities: a national survey in Italy. Br J Psychiatry 2007; 191: 170–177.CrossRefGoogle Scholar
de Girolamo, G, Bassi, M, Neri, G, Ruggeri, M, Santone, G, Picardi, AThe current state of mental health care in Italy Circa 2006: problems, perspectives and lessons to learn. Eur Arch Psychiatry Clin Neurosci 2007; 257: 83–91.CrossRefGoogle Scholar
de Girolamo, G, Bellini, M, Bocchia, S, Ruggeri, MBrief Psychiatric Rating Scale versione 4.0 “ampliata” (BPRS 4.0). Epidemiol Psichiatr Soc 1995; 4: 69–85.CrossRefGoogle Scholar
de Girolamo, G, Picardi, A, Micciolo, R, Falloon, I, Fioritti, A, Morosini, PResidential care in Italy. National survey of non-hospital facilities. Br J Psychiatry 2002; 181: 220–225.CrossRefGoogle ScholarPubMed
de Girolamo, G, Picardi, A, Santone, G, Falloon, I, Morosini, P, Fioritti, A, et al.The severely mentally ill in residential facilities: a national survey in Italy. Psychol Med 2005;35(3):421–431.CrossRefGoogle ScholarPubMed
Fisher, S, Stevens, RFSubgroups of frequent users of an inpatient mental health program at a community hospital in Canada. Psychiatr Serv 1999;50(2):244–247.CrossRefGoogle Scholar
Gaddini, A, Biscaglia, L, Bracco, R, de Girolamo, G, Miglio, R, Norcio, B, et al.A 1-day census of acute psychiatric inpatient facilities in Italy: findings from the PROGRES-acute project. Psychiatr Serv 2008; 59: 722–724.CrossRefGoogle Scholar
Gaddini, A, Franco, F, Di Lallo, D, Biscaglia, LHospitalisation for schizophrenia in acute psychiatric wards of the Lazio region: a 4-year follow-up study. Epidemiol Psichiatr Soc 2005;14(4):227–234.CrossRefGoogle ScholarPubMed
Gastal, FL, Andreoli, SB, Quintana, MI, Almeida Gameiro, M, Leite, SO, McGrath, JPredicting the revolving door phenomenon among patients with schizophrenic, affective disorders and non-organic psychoses. Rev Saude Publica 2000;34(3):280–285.CrossRefGoogle ScholarPubMed
Gaston, A, Aceti, F, Gaston, CM, Marioni, P, Giacchetti, N, Di Giuseppe, PFollow-up multicentrico su pazienti al primo ricovero in SPDC per identificare e valutare le caratteristiche cliniche ed extra-cliniche associate al fenomeno “revolving-door”. Progetto Nazionale Salute Mentale. Rapporto Conclusivo 2001 Istituto Superiore di Sanità Romap. 155–7Google Scholar
Goodpastor, WA, Hare, BKFactors associated with multiple readmissions to an urban public psychiatric hospital. Hosp Community Psychiatry 1991;42(1):85–87.Google Scholar
Green, JHFrequent rehospitalisation and non compliance with treatment. Am J Psychiatry 1998; 29: 963–966.Google Scholar
Harrison, J, Barrow, S, Creed, FSocial deprivation and psychiatric admission rates among different diagnostic groups. Br J Psychiatry 1995;167(4):456–462.CrossRefGoogle ScholarPubMed
Harrison-Read, P, Lucas, B, Tyrer, P, Ray, J, Shipley, K, Simmonds, S, et al.Heavy users of acute psychiatric beds: randomized controlled trial of enhanced community management in an outer London borough. Psychol Med 2002;32(3):403–416.CrossRefGoogle Scholar
Havassy, BE, Hopkin, JTFactors predicting utilization of acute psychiatric inpatient services by frequently hospitalized patients. Hosp Community Psychiatry 1989;40(8):820–823.Google ScholarPubMed
Haywood, TW, Kravitz, HM, Grossman, LS, Cavanaugh, JL Jr., Davis, JM, Lewis, DAPredicting the “revolving door” phenomenon among patients with schizophrenic, schizoaffective, and affective disorders. Am J Psychiatry 1995;152(6):856–861.Google ScholarPubMed
Junghan, UM, Brenner, HDHeavy use of acute in-patient psychiatric services: the challenge to translate a utilization pattern into service provision. Acta Psychiatr Scand Suppl 2006; 429: 24–32.CrossRefGoogle Scholar
Kastrup, MThe use of a psychiatric register in predicting the outcome “revolving door patient”. A nation-wide cohort of first time admitted psychiatric patients. Acta Psychiatr Scand 1987;76(5):552–560.CrossRefGoogle ScholarPubMed
Kent, S, Yellowlees, PPsychiatric and social reasons for frequent rehospitalization. Hosp Community Psychiatry 1994;45(4):347–350.Google ScholarPubMed
Kessler, RC, Amminger, GP, Aguilar-Gaxiola, S, Alonso, J, Lee, S, Ustün, TBAge of onset of mental disorders: a review of recent literature. Curr Opin Psychiatry 2007;20(4):359–364.CrossRefGoogle ScholarPubMed
Kumar, S, Robinson, E, Kumar Sinha, VWhat leads to frequent rehospitalisation when community care is not well developed? Soc Psychiatry Psychiatr Epidemiol 2002;37(9):435–440.CrossRefGoogle Scholar
Magliano, L, Fiorillo, A, Malangone, C, De Rosa, C, Favata, G, Sasso, A, et al.Family psychoeducational interventions for schizophrenia in routine settings: impact on patients’ clinical status and social functioning and on relatives’ burden and resources. Epidemiol Psichiatr Soc 2006;15(3):219–227.CrossRefGoogle ScholarPubMed
McGrew, JH, Bond, GR, Dietzen, L, McKasson, M, Miller, LDA multisite study of client outcomes in assertive community treatment. Psychiatr Serv 1995;46(7):696–701.Google ScholarPubMed
Morlino, M, Avvisati, A, Schiavone, VAdmissions to five general hospital psychiatric wards in Naples, Italy. Epidemiol Psichiatr Soc 2006;15(1):77–83.CrossRefGoogle ScholarPubMed
Morosini, PL, Magliano, L, Brambilla, L, Ugolini, S, Pioli, RDevelopment, reliability and acceptability of a new version of the DSM-IV Social and Occupational Functioning Assessment Scale (SOFAS) to assess routine social functioning. Acta Psychiatr Scand 2000;101(4):323–329.Google ScholarPubMed
Ostman, M, Wallsten, T, Kjellin, LFamily burden and relatives’ participation in psychiatric care: are the patient's diagnosis and the relation to the patient of importance? Int J Soc Psychiatry 2005;51(4):291–301.CrossRefGoogle ScholarPubMed
Peen, J, Dekker, JSocial deprivation and psychiatric service use for different diagnostic groups. Soc Sci Med 2001;53(1):1–8.CrossRefGoogle ScholarPubMed
Rabinowitz, J, Mark, M, Popper, M, Slyuzberg, M, Munitz, HPredicting revolving-door patients in a 9-year national sample. Soc psychiatry Psychiatr Epidemiol 1995;30(2):65–72.CrossRefGoogle Scholar
Roick, C, Heider, D, Angermeyer, MCDevelopment of a screening instrument for heavy users of psychiatric inpatient services. Fortschr Neurol Psychiatr 2003;71(7):378–386.Google ScholarPubMed
Roick, C, Heider, D, Kilian, R, Angermeyer, MCHeavy users of inpatient psychiatric services. Psychiatr Prax 2002;29(7):343–349.CrossRefGoogle ScholarPubMed
Roick, C, Heider, D, Kilian, R, Matschinger, H, Toumi, M, Angermeyer, MCFactors contributing to frequent use of psychiatric inpatient services by schizophrenia patients. Soc Psychiatry Psychiatr Epidemiol 2004;39(9):744–751.CrossRefGoogle ScholarPubMed
Santone, G, de Girolamo, G, Falloon, I, Fioritti, A, Micciolo, R, Picardi, A, et al.The process of care in residential facilities – a national survey in Italy. Soc Psychiatry Psychiatr Epidemiol 2005;40(7):540–550.CrossRefGoogle ScholarPubMed
Soni, SD, Gaskell, K, Reed, PFactors affecting rehospitalisation rates of chronic schizophrenic patients living in the community. Schizophr Res 1994;12(2):169–177.CrossRefGoogle ScholarPubMed
Spiessl, H, Huebner-Liebermann, B, Binder, H, Cording, CHeavy users in a psychiatric hospital – a cohort study on 1811 patients over 5 years. Psychiatr Prax 2002;29(7):350–354.Google Scholar
Suzuki, Y, Yasumura, S, Fukao, A, Otani, KAssociated factors of rehospitalization among schizophrenic patients. Psychiatry Clin Neurosci 2003;57(6):555–561.CrossRefGoogle ScholarPubMed
Swigar, ME, Astrachan, B, Levine, MA, Mayfield, V, Radovich, CSingle and repeated admissions to a mental health center: demographic, clinical and use of service characteristics. Int J Soc Psychiatry 1991;37(4):259–266.CrossRefGoogle ScholarPubMed
Tibaldi, G, Munizza, C, Pasian, S, Johnson, S, Salvador-Carulla, L, Zucchi, S, et al.Indicators predicting use of mental health services in Piedmont, Italy. J Ment Health Policy Econ 2005;8(2):95–106.Google ScholarPubMed
Woogh, CMA cohort through the revolving door. Can J Psychiatry 1986;31(3):214–221.CrossRefGoogle ScholarPubMed
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