Abstract
To improve engagement with care and prevent psychiatric readmission, a transitional case management intervention has been established to link with primary and secondary care. The intervention begins during hospitalization and ends 1 month after discharge. The goal of this study was to assess the effectiveness of this short intervention in terms of the level of engagement with outpatient care and the rate of readmissions during 1 year after discharge. Individuals hospitalized with common mental disorders were randomly assigned to be discharged to routine follow-up by private psychiatrists or general practitioners with (n = 51) or without (n = 51) the addition of a transitional case management intervention. Main outcome measures were number of contacts with outpatient care and rate of readmission during 12 months after discharge. Transitional case management patients reported more contacts with care service in the period between 1 and 3 months after discharge (p = 0.004). Later after discharge (3-12 months), no significant differences of number of contacts remained. The transitional case management intervention had no statistically significant beneficial impact on the rate of readmission (hazard ratio = 0.585, p = 0.114). The focus on follow-up after discharge during hospitalization leads to an increased short-term rate of engagement with ambulatory care despite no differences between the two groups after 3 months of follow-up. This short transitional intervention did, however, not significantly reduce the rate of readmissions during the first year following discharge. ClinicalTrials.gov Identifier NCT02258737.
Highlights
The movement of deinstitutionalization transformed care provision in most Western Countries during last decades [1, 2]
The transitional case management team was not able to provide an intervention for 40 (23.12%) people: the admission time was too short for 24 patients, the case manager had no availability for 7 patients, and 9 did not live in a catchment area
One hundred two patients were randomly allocated to discharge with transitional case management intervention (n = 51) or with a treatment as usual (n = 51)
Summary
The movement of deinstitutionalization transformed care provision in most Western Countries during last decades [1, 2]. Mental health teams are faced with an increased number of discharges and have less time to prepare them. Among individuals who had been discharged from a hospital closest to their death by suicide, three-quarter died in the month following discharge, and the most consistent modifiable factor associated with death in the month following last contact was number of outpatient consultations following discharge [6]. In this context, linking with primary and secondary care after psychiatric hospitalization is a particular challenge
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