Citation

Valdés-Stauber J, Kilian R. Ger. J. Psychiatry 2013; 16(1): 20-28.

Copyright

(Copyright © 2013, University of Goettingen)

DOI

unavailable

PMID

unavailable

Abstract

BACKGROUND: The number of psychiatric patients living in residential facilities in Germany continues to increase. Nevertheless, there is a lack of knowledge about the provision and adequacy of psychiatric care in residential facilities, so it is unclear whether the distance between residential and psychiatric service facilities has any effect on the psychiatric treatment of the residents.

OBJECTIVES: The main target of this study is the examination of the effects of the distance between psychiatric nursing homes and the psychiatric service facilities on the psychiatric treatment of the residents.

METHOD: The design of this investigation is cross-sectional and comparative. The sample was composed of the residents of two psychiatric nursing homes (n=76 resp. N=61). We investigated 20 variables by means of descriptive statistics, t-tests, chi-square-tests, and robust multivariate regression models. All analyses were conducted with STATA 12.

RESULTS: Residents of assessed psychiatric nursing homes, the majority suffering from schizophrenia and under legal guardianship, were notably impaired. Ninety per cent received psychopharmacological treatment, 45% attempted suicide, and 19% were hospitalised within a year. There were only a few differences between assessed homes. Suicide attempts in the past were positively associated with more and longer present hospitalisations, psychiatric care costs and number of psychoactive drugs. Age was negatively associated with intensity of outpatient care and psychopharmacological treatment, but positively associated with number of drugs to treat physical diseases. Psychopharmacological treatment patterns were appropriate for the diagnoses.

CONCLUSIONS: Distance of assessed psychiatric nursing homes to psychiatric services hardly explains differences of care variables. Risk of suicide in a patient's history may better predict need of present hospitalisation than diagnosis, level of functioning or psychiatric impairment. The negative shift in treatment intensity of older residents has to be taken into account in order to avoid an age-related institutionalism effect. Psychopharmacological patterns found point to a rational implementation of prescriptions according to diagnoses.

Language: en

Keywords

adult; human; age; Germany; schizophrenia; suicide attempt; nursing home; geography; article; major clinical study; controlled study; length of stay; health care access; mental health service; psychotropic agent; psychopharmacotherapy; health care cost; cross-sectional study; outpatient care; home mental health care; Ambulatory psychiatric care; Cumulative length of inpatient-stay; Hospitalisations in psychiatry; Psychiatric care costs; Psychiatric nursing homes