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Effectiveness and costs of acute day hospital treatment compared with conventional in-patient care
- Authors:
- PRIEBE Stefan, et al
- Journal article citation:
- British Journal of Psychiatry, 188, March 2006, pp.243-249.
- Publisher:
- Cambridge University Press
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. 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. 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.
Dual diagnosis patients in community or hospital care: One-year outcomes and health care utilization and costs
- Authors:
- TIMKO Christine, et al
- Journal article citation:
- Journal of Mental Health, 15(2), April 2006, pp.163-177.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
This American study evaluated the effectiveness and cost-effectiveness of community- and hospital-based acute residential treatment for dually disordered patients, and whether moderately-ill patients benefited more from community care, and severely-ill patients from hospital care. Two hundred and thirty patients with dual substance use and psychiatric disorders were randomly assigned to community or hospital acute care programs that had the same level of service-intensity. They were followed for 1 year (80%) using the Addiction Severity Index. Patients' health care utilization was assessed from charts, VA databases, and health care diaries; costs were assigned using methods established by the VA Health Economics Resource Center. Patients had better substance use outcomes when they were initially assigned to community rather than to hospital acute care. Patients assigned to hospital care had shorter index stays, but these index stays were more costly than were the longer index stays of patients assigned to community care. Patients assigned to hospital care also had more mental health follow-up outpatient visits, and more costly mental health follow-up stays, over the study year. The authors concluded that cost savings may be achieved without loss of benefit to all but the most decompensated dually disordered patients by shifting the locus of acute treatment from hospital to community care.
Twelve years on: service use and costs for people with mental health problems who left psychiatric hospital
- Authors:
- BEECHAM Jennifer, et al
- Journal article citation:
- Journal of Mental Health, 13(4), August 2004, pp.363-377.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
Few studies have estimated the full costs of moving people from long-stay psychiatric hospitals to community residence. Fewer still have examined the long-term implications of this important component of mental health policy. The aim was to assess the full service and cost implications of community care for people who moved from long-stay psychiatric hospitals 12 years ago. To explore the associations between costs and people's characteristics, needs and outcomes. Data were collected from 128 people in seven English localities that were part of the 1983 Care in the Community Initiative. For a sub-sample of 75 people, changes in resource use between 1 and 12 years after leaving hospital were assessed. Most people live in staffed accommodation supported by a range of community-based services. Mean community care costs (£555 per week) are lower than long-stay hospital residence or community costs 1 year later. High support homes, in-patient beds, and day care services are costly but important care components. The low utilization rate of general practitioners is concerning given residents' increasing age. There was no evidence to suggest the reduction in costs was a response to reductions in user needs.
Variations in the costs of child and adolescent psychiatric in-patient units
- Authors:
- BEECHAM Jennifer, et al
- Journal article citation:
- British Journal of Psychiatry, 18(9), September 2003, pp.220-225.
- Publisher:
- Cambridge University Press
Child and adolescent in-patient care is a highly specialised service, ideally requiring planning at a national level, but there are no routine data collections specifically for these services. The aim was to estimate unit costs for child and adolescent psychiatric in-patient units and to analyse the variations in costs between units. Data collection alongside a national survey with cost estimations guided byprinciples drawn from economic theory. Bivariate and multivariate analyses are employed to identify cost influences. Fifty-eight units could provide sufficient data to allow calculation of the cost per in-patient day; mean=£197 (s.d.=71.6; 1999–2000 prices). The management sector, type of provision, number of rooms, capacity and location explained nearly half of the cost variation. Child and adolescent psychiatric in-patient units are an expensive resource, with personnel absorbing two-thirds of the total costs. Costs per in-patient day vary fourfold and the exploration of cost variations can inform commissioning strategies.
Costs and outcomes for people with special psychiatric needs
- Author:
- HALLAM Angela
- Journal article citation:
- Mental Health Research Review, 3,, April 1996, pp.10-13.
- Publisher:
- Personal Social Services Research Unit
As the psychiatric hospital closure programme gathers momentum, an increasingly disabled population of 'new' long-stay patients accumulates in the remaining wards. These people were identified twenty years ago as the most difficult to support outside hospital and they are characterised by severe symptoms of mental illness and a range of additional behavioural and social problems. If the policy aim to relocate all long-stay hospital care is to be accomplished, the nature of the challenges presented by the special needs of this group of patients must be acknowledged and addressed.