To what extent could acute general psychiatric day care reduce inpatient admissions?

Abstract

Background: Percentage reduction of inpatient admissions by acute general psychiatric day care in individual facilities (i.e. feasibility rate of acute day care) seems to be an important parameter for service planning. Previously reported feasibility rates showed significant variation, however, and were based on eligibility criteria defined for randomized controlled trials. This paper aims to perform an in-depth exploration of the calculation method of these feasibility rates, to propose different calculation methods expanding research definitions to the reality of service provision, and to analyze the association between the availability of residential services in regional mental health service systems and these rates. Methods: Data from the randomization process of the European Day Hospital Evaluation (EDEN) study in which a total of 1117 patients were included in five sites provided the basis to calculate site-specific and overall rates of patients for whom this mode of treatment might be adequate. Sensitivity analyses were carried out by varying the selection of patients’ eligibility criteria and thus calculating different feasibility estimates. Data on the regional mental health care systems were collected by use of the European Service Mapping Schedule. Results: The use of four different calculation methods showed that site-specific feasibility rates of acute day care for general psychiatric patients varied from 13.8% to 25.7% up to 44.1% to 79.0%. Overall rates varied from 17.3% up to 67.7%, respectively. The high values were calculated under a scenario where the current acute day care model of care is enhanced to manage more complicated patients than currently treated under existing acute day care models. In three out of the four calculation methods higher rates were calculated for sites which demonstrated higher figures of residential services, and thus were less advanced in their process of deinstitutionalization. Conclusions: In order to determine the capacity of day hospitals as an alternative to acute psychiatric hospital care, mental health care planning must clearly decide on the eligibility criteria of patients to be treated in these facilities. Guided by such definitions, treatment concepts and professional qualifications of the staff in these facilities need to be adapted. The finding that less de-institutionalized regions may benefit most from a transition to acute day care as a means for promoting the transition to a community model of care for otherwise institutionalized patients must be assessed in more detail. Comprehensive research exploring the impact of all regional mental health service configuration characteristics on the concept of acute day care is needed.