La création du dossier informatisé de séjour avant l’admission est-elle un bon marqueur de programmation des réadmissions ? Étude dans un pôle médical d’activité de CHU

Abstract

Déterminer les facteurs associés aux réadmissions chez les patients hospitalisés en psychiatrie à Bingerville.Il s’agit d’une étude rétrospective menée à partir des dossiers de 436 patients hospitalisés pour la première fois en 2001 à l’hôpital psychiatrique de Bingerville. Nous avons appelé réadmission toutes les réhospitalisations survenues 15 jours après la sortie déclarée du patient au bureau des entrées. Les patients réadmis au moins une fois entre le 1er janvier 2001 et le 31 décembre 2006 ont été comparés aux sujets non réhospitalisés, selon leurs caractéristiques sociodémographiques et cliniques, en utilisant le test de Khi2.Quatre-vingt-dix-huit patients ont été réadmis au moins une fois. Plus de la moitié (69,4 %) des réadmissions ont eu lieu au cours des deux années suivant la fin de la première hospitalisation à Bingerville. La récurrence des symptômes psychiatriques en était la cause dans 94,9 % des cas. Les caractéristiques des patients qui ont été associées significativement à la survenue d’une réhospitalisation étaient : un âge inférieur à 21 ans (p = 9 × 10−4), avoir les deux parents vivants (p = 3 × 10−2), être le cadet de la fratrie utérine (p = 10−3), un diagnostic de troubles de l’humeur (p = 0,046) et un suivi ambulatoire après la fin de la première hospitalisation excédant 26 semaines (p = 4 × 10−3).Lorsqu’elles sont rapprochées et multiples, les réadmissions sont responsables d’une mauvaise insertion sociale des patients. La connaissance des facteurs favorisant ces réhospitalisations est utile à la prévention de cette conséquence.To ascertain the factors related to patients’ psychiatric readmissions at Bingerville.It was a case-control study built on 436 files of patients who had been hospitalized for the first time in 2001 at Bingerville's psychiatric hospital. We called readmission all rehospitalization arisen 15 days after the end of the previous hospital stay. Sociodemographic and clinical characteristics of the patients who had been readmitted for at least a fold within 1st January 2001 and 31st December 2006 were compared to those who had not been readmitted during this period, by using the Chi-square test.Patients admitted for the first time at Bingerville psychiatric hospital were in majority less than 44 years old (87.8%) with mean age at 31.1 ± 10.9 years. More than half of them, had male gender (61.9%), was single or widowed or separated (70.6%), without a kid (55.5%). Numerous of them were not educated above secondary school (95.4%). In these first admitted patients, 50.9% did not earn a wage, 68.8% lived in Abidjan. Those who had both their mother and father alive represented 53.9% of the study sample. About two-third of the patients were younger in their siblings, as well in father's children as in mother's. Regarding the clinical features, schizophrenia and other psychotic disorders (59.2%) were the most frequent diagnosis, followed by mood disorders (19.0%). These mental disorders started during the month before first psychiatric hospitalization at Bingerville (47.2%). The majority (74.5%) of these patients were hospitalized 30 days at most. They were discharged with medical advice (85.8%) and less than two drugs prescribed (66.3%). The aftercare treatment did not last more than 26 weeks for most of the patients (79.6%). Readmission occurred at least a fold in 22.5% of the subjects, in majority during the first 2 years after being discharged in 2001 (68.4%). Patients characteristics related to readmission during the 6 years of study period were: being less than 21 years old (p = 9 × 10−4), younger in the siblings of mother's children (p = 10−3), having both mother and father alive (p = 3 × 10−3), a mood disorder diagnosis (p = 0.046) and a length of aftercare treatment exceeding 26 weeks (p = 4 × 10−3).When they are repeated and closer, readmissions can worsen patients’ social reinsertion. The knowledge of factors related to these rehospitalizations is useful to prevent this consequence.