Original Title: Alternativas a la hospitalización psiquiátrica de corta estancia. Programas de seguimiento intensivo ambulatorio

Authors' objectives: • Carry out a systematic review of the most widely used ambulatory facilities and their clinical and functional effectiveness. • Lower the number of admissions in patients seeking a specific, intensive ambulatory treatment. • Offer support for the Out of Hospital Mental Health network to deal with those patients who exceed the capacity of such networks or are complicated to manage, by favouring communications and collaboration with In and Out of Hospital Mental Health mechanisms. • Provide support for patients from the moment they are discharged until they are incorporated into the Out of Hospital network.

Authors' results and conclusions: In the systematic review of the literature, a total of 2,928 references compliant with the search criteria were obtained. After reviewing all the articles found in the search, a selection was made following the criteria indicated in the inclusion criteria section. 20 articles were selected. With regard to the programme initiated in our unit, there were a total of 164 patients with the following age distribution: In 2009, 89 patients were seen and in 2010, 75. It was observed that there were significant differences before and after the intervention, the average number of previous admissions being 0.47 and the number of later admissions 0.14 (p less-than 0.001) There was also an insignificant reduction in the average number of days of admission (6.56 vs. 3.06 days, p= 0.3 student «t» test for related samples). As might be expected, there was a significant reduction of CGI from beginning to end (4.05 vs 2.01, p less-than 0.001). With regard to the number of cases of care in the emergency service, a drop in the number of cases dealt with by the Emergency Services of 1.44 times to an average of 0.29 (p= 0.019) was obtained. CONCLUSIONS The efficiency results concerning the different ambulatory facilities are contradictory. The most significant finding is the improvement in the quality of life of patients and satisfaction with the treatment received. Although the drop in admissions and number of cases of emergency care following the application of our programme cannot be attributed to the treatment offered (as it was not a randomised clinical trial), the results are helpful in this sense.

Authors' methods: A systematic review was made of the literature with the aim of locating articles and documents concerning the national and international programmes, services and organisational models carried out as an alternative to short stay psychiatric hospitalisation units. To do this, a bibliographical search was made of the following databases: Medline, Embase and PsycInfo through the Ovid on line tool. Likewise, a search was made of the Cochrane Central Register of Controlled Trials (CRCT) and the systematic reviews and meta-analysis of the Cochrane Database of Systematic Reviews (CDSR) and its Spanish version (Cochrane Library Plus) were screened. The databases integrated within the CSIC were also reviewed, namely the Spanish Medical Index (IME) and the Social Sciences and Humanities Index (ISOC) and the databases of the Doctoral Thesis register of Spanish universities (TESEO). The search was carried out during the period between January 1, 2000 and October 1, 2011. Although the time limitation was arbitrary, the aim was to assess the clinical tests carried out with up-to-date resources. However, for obvious reasons, the classical studies carried out on different types of facilities cited in current reviews, have been included. On the other hand, an intensive programme designed specifically in accordance with their needs and those of its environment was offered. Patients were given the usual care received in hospital (clinical monitoring, intake of medication, psychoeducation, etc.), but admissions were avoided and with them the associated stigma. All those patients who showed signs of potential improvement within a reasonable period of time and for whom other resources were not more appropriate (hospitalisation, day centres, etc.), were included. All of this was done in close collaboration with the Out of Hospital Mental Health network. The number of cases of emergency care, the number of admissions and days per admission of patients following the treatment in a monitoring period of two years were used as the main variables of the study.

Project Status: Completed

Year Published: 2013

URL for published report: https://www.euskadi.eus/contenidos/informacion/2013_osteba_publicacion/es_def/adjuntos/D_13_04%20alternativas%20a%20la%20hospitalizacion.pdf

English language abstract: An English language summary is available

Publication Type: Other

Country: Spain

Organisation Name: Basque Office for Health Technology Assessment

Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz

Contact Name: Lorea Galnares-Cordero

Contact Email: lgalnares@bioef.eus

Copyright: <p>Osteba (Basque Office for Health Technology Assessment) Health Department of the Basque Government</p>