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Patient-controlled hospital admission for patients with severe mental disorders : a nationwide prospective multicentre study
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Thomsen, C. T., Benros, M. E., Maltesen, T., Hastrup, L. H., Andersen, P. K., Giacco, Domenico and Nordentoft, M. (2018) Patient-controlled hospital admission for patients with severe mental disorders : a nationwide prospective multicentre study. Acta Psychiatrica Scandinavica, 137 (4). pp. 355-363. doi:10.1111/acps.12868 ISSN 0001-690X.
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Official URL: http://dx.doi.org/10.1111/acps.12868
Abstract
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.
| Item Type: | Journal Article | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Mental Health and Wellbeing Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Journal or Publication Title: | Acta Psychiatrica Scandinavica | ||||||||
| Publisher: | Wiley | ||||||||
| ISSN: | 0001-690X | ||||||||
| Official Date: | April 2018 | ||||||||
| Dates: |
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| Volume: | 137 | ||||||||
| Number: | 4 | ||||||||
| Page Range: | pp. 355-363 | ||||||||
| DOI: | 10.1111/acps.12868 | ||||||||
| Status: | Peer Reviewed | ||||||||
| Publication Status: | Published | ||||||||
| Access rights to Published version: | Restricted or Subscription Access |
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