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Patient‐controlled hospital admission for patients with severe mental disorders: a nationwide prospective multicentre study
Author(s) -
Thomsen C. T.,
Benros M. E.,
Maltesen T.,
Hastrup L. H.,
Andersen P. K.,
Giacco D.,
Nordentoft M.
Publication year - 2018
Publication title -
acta psychiatrica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.849
H-Index - 146
eISSN - 1600-0447
pISSN - 0001-690X
DOI - 10.1111/acps.12868
Subject(s) - coercion (linguistics) , medicine , psychiatry , philosophy , linguistics
Objective To assess whether implementing patient‐controlled admission ( PCA ) can reduce coercion and improve other clinical outcomes for psychiatric in‐patients. Methods During 2013–2016, 422 patients in the PCA group were propensity score matched 1:5 with a control group ( n = 2110) that received treatment as usual ( TAU ). Patients were followed up for at least one year using the intention to treat principle utilising nationwide registers. In a paired design, the outcomes of PCA patients during the year after signing a contract were compared with the year before. Results No reduction in coercion (risk difference = 0.001; 95% CI : −0.038; 0.040) or self‐harming behaviour (risk difference = 0.005; 95% CI : −0.008; 0.018) was observed in the PCA group compared with the TAU group. The PCA group had more in‐patient bed days (mean difference = 28.4; 95% CI : 21.3; 35.5) and more medication use ( P < 0.0001) than the TAU group. Before and after analyses showed reduction in coercion ( P = 0.0001) and in‐patient bed days ( P = 0.0003). Conclusion Implementing PCA did not reduce coercion, service use or self‐harm behaviour when compared with TAU . Beneficial effects of PCA were observed only in the before and after PCA comparisons. Further research should investigate whether PCA affects other outcomes to better establish its clinical value.