Heavy users of inpatient services: a comparison of diagnostic subgroups

Abstract

Quantitative and qualitative assessment of heavy users (HU) of psychiatric inpatient treatment. Screening over 9 months for patients with ≥ 3 admissions or ≥ 100 days of treatment during 1 year prior to index admission. During the recruiting period 1217 persons were treated of whom 132 (10.8 %) fulfilled HU criteria. Patients belonged most often to the diagnostic group F2 (43 %), followed by F1 (21 %) and F3 (17 %). HU were most common within the diagnostic group F6 (33 %), next to F2 (21 %), F1 (9 %) and F3 (6 %). HU had signs of more severe illness compared to the other patients: only 8 % held a job and 73 % ware on a disablement pension, patients with a diagnosis of F2 faring worst. HU were treated more frequently involuntarily (50.5 vs 30.7 %). An office-based physician referred only 5 % of the patients and almost half attended the clinic without any referral. HU participated only to a modest degree in community-based treatments and 37 % attended no doctor in the month prior to admission. During the year following the index admission more than 80 % of HU were admitted again and were hospitalized almost as many days as before the index admission. Patients with a diagnosis of F1 and F2 showed the greatest persistence of heavy use behavior. This sample of HU show a persistent pattern of use of psychiatric inpatient treatment. Strategies to improve the situation are discussed.