Patient-controlled Admissions to Inpatient Care
For patients and families
In plain language
An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.
- What is being studied
- The protocol lists: Patient-controlled admissions.
- Who it may be relevant to
- Registry conditions: Patient-controlled Admissions, Matched Control Group. Basic parameters: from 15 years · All.
- What needs checking
- Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
- Where it takes place
- Sweden
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
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Official title
Patient-controlled Admissions to Inpatient Care for Patients With Severe Psychiatric Conditions in Region Stockholm
Overview
Patient-controlled admissions refer to the possibility for patients with severe psychiatric conditions to admit themselves to inpatient care. Compared to having the healthcare providers make this decision, patient-controlled admissions are believed to decrease the need for involuntary care, decrease symptom levels, and increase quality of life and autonomy for the patient. The current research project aims to evaluate the implementation of patient-controlled admissions to all patients with severe psychiatric conditions within Region Stockholm, Sweden, including child and adolescent psychiatry (but excluding forensic psychiatry and addiction care).
Detailed description
Patients with severe psychiatric conditions represent a group who have extensive care needs and for whom few effective interventions exist. Diagnoses such as schizophrenia and borderline personality disorder usually have a poor prognostic outlook in terms of recovery, and patients often suffer from life-long disabilities. Meanwhile, their healthcare expenditures are typically high. In case of increased symptoms and novel sickness spells, healthcare providers make an assessment if admission to inpatient care is needed. This gatekeeper-model is typical of most western countries and infers that the decision to be admitted is always made by a third party. Since about a decade, attempts at transferring the responsibility of admissions to patients themselves is being implemented and tested in several countries and contexts, referred to as patient-controlled admissions. The idea is to increase patient involvement, enhance self-determination, and improve their ability to manage signs of illness. Patient-controlled admissions involve signing an agreement between inpatient care, outpatient care, and those patients that are deemed to have the highest care needs, whereby the patients can contact an inpatient ward and be admitted when required. Previous research has revealed that patient-controlled admissions decrease involuntary admissions and that both healthcare providers and patients are positive towards its use. These studies have however been small and used limited outcome measures. The current research project aims to study the results of implementing patient-controlled admissions to all patients with severe psychiatric conditions within Region Stockholm, Sweden, including child and adolescent psychiatry (but excluding forensic psychiatry and addiction care). Apart from determining the possible impact on both number of admissions and days in admission (voluntary and involuntary), other psychiatric or somatic healthcare consumption, sick-leave, and redeemed medical prescriptions, self-report measures will be used to assess the effects on symptom levels, quality of life, and autonomy. A matched control group (matched on account of age, gender, diagnosis, and history of psychiatric inpatient care, but who have not been granted access to patient-controlled admissions) will also be utilised to determine the effects of patient-controlled admissions on all primary outcomes measures, other psychiatric or somatic healthcare consumption, sick-leave, and redeemed medical prescriptions.
Interventions
- Other Patient-controlled admissions
Patients are allowed to admit themselves to inpatient care when needed (standard procedure, four days of inpatient care at a time, up to three times a month)
Primary outcome measures
- Admissions to inpatient care [Time frame: Change in number of admissions to inpatient care between baseline and at 12 months]
- Days in inpatient care [Time frame: Change in number of days in inpatient care between baseline and 12 months]
- Admissions to inpatient care [Time frame: Change in number of admissions to inpatient care between baseline and at 24 months]
- Days in inpatient care [Time frame: Change in number of days in inpatient care between baseline and 24 months]
- Admissions to inpatient care [Time frame: Change in number of admissions to inpatient care between baseline and at 36 months]
- Days in inpatient care [Time frame: Change in number of days in inpatient care between baseline and 36 months]
- Admissions to involuntary care [Time frame: Change in number of admissions to involuntary care between baseline and at 12 months]
- Days in involuntary care [Time frame: Change in number of days in involuntary care between baseline and at 12 months]
- Admissions to involuntary care [Time frame: Change in number of admissions to involuntary care between baseline and at 24 months]
- Days in involuntary care [Time frame: Change in number of days in involuntary care between baseline and at 24 months]
Secondary outcome measures (11)
- EQ5D-5L [Time frame: Change in self-rated quality of life (somatic) between baseline and at 12 months]
- World Health Organization Disability Assessment Schedule [Time frame: Change in self-rated quality of life (somatic) between baseline and at 12 months]
- Clinical Global Impression [Time frame: Change in clinician-rated functional level between baseline and at 12 months]
- Brunnsviken Brief Quality of life scale [Time frame: Change in self-rated quality of life (psychological) between baseline and at 12 months]
- General Self-Efficacy scale [Time frame: Change in self-rated self-efficacy between baseline and at 12 months]
- Generalized Anxiety Disorder - 7 items [Time frame: Change in self-rated anxiety between baseline and at 12 months]
- The Patient Health Questionnaire - 9 items [Time frame: Change in self-rated depression between baseline and at 12 months]
- Visual Analogue Scales [Time frame: Change in self-rated care needs and current health status between baseline and at 12 months]
- Other psychiatric or somatic healthcare consumption [Time frame: Change in number of other psychiatric or somatic healthcare consumption between baseline and 12 months]
- Sick-leave [Time frame: Change in number of days in sick-leave between baseline and 12 months]
- Redeemed medical prescriptions [Time frame: Change in number of redeemed medical prescriptions between baseline and 12 months]
Eligibility criteria
Inclusion criteria
- Have an on-going contact with outpatient care.
- Have an individual care plan and crisis plan.
- Have had at least one inpatient care period the previous year.
- Are expected to have the greatest need of inpatient care.
- Are interested in, and understand the concept of, patient-controlled admissions.
Exclusion criteria
- No informed consent to participate in the research project (concerns only self-reported outcomes).
Matched control group:
\- A matched control group consisting of seven times the number of of patients receiving patient-control admissions will be utilised for all primary outcome measures, other psychiatric or somatic healthcare consumption, sick-leave, and redeemed prescriptions (matched on account of age, gender, diagnosis, and history of psychiatric inpatient care, but who have not been granted access to patient-controlled admissions)
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Healthy volunteers: No
Study design
- Observational model
- Case-control
Study locations
Sweden · 1 center
- Centre for Psychiatry Research — Stockholm
Publications
- Smitmanis Lyle M, Allenius E, Salomonsson S, Bjorkdahl A, Strand M, Flyckt L, Hellner C, Lundgren T, Jayaram-Lindstrom N, Rozental A. What are the effects of implementing patient-controlled admissions in inpatient care? A study protocol of a large-scale implementation and naturalistic evaluation for adult and adolescent patients with severe psychiatric conditions throughout Region Stockholm. BMJ O PMID 35973700
Identifiers
NCT: NCT04862897 · 2020-06498