A Change of Paradigm in the Managementof Acute Psychiatric Episodes? A Retrospective Cohort Studyon Trajectoriesof Use of Clinical Resources After the Implementation of Intensive Home-Treatment.

Abstract

Intensive home treatment (IHT) has shown to be a feasible alternative to hospitalizationfor the management of acute psychiatric episodes, but there are no real-world studiesassessing if patients with a first IHT use it again for the management of theirrecurrences. The objectives of this retrospective cohort study were to map the use ofacute treatment resources after the implementation of IHT in our territory through theestablishment of trajectories of management, and to disentangle if there are profiles ofpatients who fit better each trajectory. We included the first 1000 episodes admitted toIHT, of which we selected those that corresponded to the first IHT of a patient (indexadmission). Trajectories after the index admission were: (T-A) absence of use of acuteresources, (T-B) only IHT, and (T-C) at least one hospitalization. Follow-up rangedfrom 6 months to 6 years. We calculated the frequency of each trajectory andperformed univariate analyses searching for associations between trajectory andclinical factors. Among those patients with psychiatric history (N=659), 66.2% followedT-A, 11.2% T-B, and 22.6% T-C. The probability of following T-C was higher forpatients with a psychotic disorder (pBonf=0.018) and with previous hospitalizations(pBonf<0.0001). Among those patients without psychiatric history (N=168), 82.7%followed T-A, 6.6% T-B, and 10.7% T-C. The probability of following T-B was higher forthose with a higher severity at the index admission (pBonf=0.028). This study showsthat some -or even all- recurrences of some subjects were successfully managed withIHT, providing real-world evidence for its use in acute psychiatric conditions.