Trajectoires de soins de patients alcoolodépendants: une étude longitudinale en Suisse italophone

Abstract

Alcohol abuse predisposes to numerous public health problems leading to important direct and indirect costs. One out of four hospital beds in Switzerland is occupied by a patient presenting a diagnosis of alcohol consumption. The objectives of this retrospective study are firstly to have an overview of the therapeutic orientation of the patients in the existing alcohology network of the canton of Tessin and to analyse the treatment trajectories of the adult hospitalised patients, in the general psychiatric hospital, presenting a problematic alcohol consumption and in particular to evaluate the impact of socio-demographic and clinical factors on the eventual readmissions. The analysis of this longitudinal retrospective study (1995-2000) is based on the data collected from the computerised register of the socio-psychiatric cantonal organisation (OSC) and that of the Centre Ingrado, a centre specialised in alcohology. Two principal results are highlighted. Firstly, two groups of patients can be distinguished by their psychosocial aspects. Secondly, the two groups are distinguished by their post-hospitalisation trajectories. In the first group of patients subjects older than 50 years are overrepresented, those living in companionship as well as those having less antecedents of a specific healthcare. This group was preferentially sent to private practitioners and presented comparatively less rehospitalisations. The second group appears as socially less well integrated, has many antecedents of health care and had longer hospitalisations in 1995.The patients of this second group were addressed to specialised psychiatric health care structures and or those specialised in alcohology. The rehospitalisations were more frequent for patients of the second group. In the appreciation of the results of the study, its limits have to be taken into consideration. On the one hand, it is a retrospective study with the major limiting factor being a limited choice of predictive variables, the indicators of the trajectory of the patient, and on the other hand, the social class. It was not possible during the course of the study to take the social class into account as a predictive variable. Finally, we also lack the data on the eventual deaths, occurring in our cohort, outside the psychiatric hospital, during the observation period of the study. In conclusion, despite the fact that the alcohology network of the canton of Tessin needs in part to be systematised, we can nevertheless note that the existing practices and services are fully convenient. Future conceptualisations ideally need to rest on this experience in privileging mainly a perspective of treatment trajectory and to a lesser extent the option of a sequential episode of treatment.