In most Western countries, psychiatric care continues to be in a process of change. The number of psychiatric beds has been reduced in favor of partly inpatient care or of outpatient care, and at the same time, the length of psychiatric hospitalizations has become shorter. But increasingly shorter inpatient stays urgently require structured and prepared discharge planning. The first week after discharge from inpatient psychiatric care is a very stressful time for patients. There is evidence that suicide risk is greatly increased, especially after short psychiatric hospital treatment, that there is a higher risk of re-hospitalization, and that without appropriate supporting services many of the patients do not keep their first outpatient appointments.

For patients with high utilization of mental health care services, there are now various projects all over Switzerland that are working towards improved outpatient care and thus prevention of rehospitalization. However, in comparison, for patients with lower utilization, less research is being conducted in the area of discharge coordination and continuity of care from inpatient to outpatient settings. A pilot project in Lausanne is examining specifically case management de transition. The intervention in the study is a specialized one for patients for whom outpatient psychiatric care following hospital discharge is not ensured. The results of the randomized controlled trial (RCT) have not yet been published. In German-speaking Switzerland no comparable study has been launched.

This study, "Elements of integrated care: Post-hospitalization network coordination", aims to close this gap. The aim of the randomized, prospective study is to test whether post-hospitalization network coordination by social workers can reduce the number of inpatient clinic days for patients with less utilization of psychiatric services. The primary outcome criterion is the number of days in care, and the secondary criteria are the reduction of symptoms and better quality of life and independence.

Recruitment of a total of 160 patients will take place over an 18-month period at all five acute care stations of Integrated Psychiatry Winterthur – Zuercher Unterland (ipw). Patients suited for inclusion in the study will be given written and oral information on the project when they enter inpatient care. After the patients sign a declaration of informed consent, they are assigned randomly to either the treatment group of control group. The control group receives social work Treatment as Usual, whereby the social work assistance normally ends when the patient is discharged from inpatient psychiatric care. Patients in the treatment group receive intensive support from the assigned after discharge from inpatient care, to ensure continuity of care also in the outpatient setting.

To measure the factors, there will be a baseline assessment (baseline t0) at study entry, conducted as an interview prior to the participant’s first conversation with the social worker. 5. At discharge from inpatient care (t1), there is a second assessment conducted by the study assessor. The study assessor will conduct further assessments of all participants in the study at one month (t2), three months (t3), six months (t4) and 12 months (t5) after discharge from inpatient care.

Publications

Hengartner MP, Klauser M, Heim G, Passalacqua S, Andreae A, Rössler W, von Wyl A (2015). Introduction of a psychosocial post-discharge intervention program aimed at reducing psychiatric rehospitalization rates and at improving mental health and functioning. Perspectives in Psychiatric Care, doi: 10.1111/ppc.12131.

Hengartner MP, Passalacqua S, Heim G, Andreae A, Rössler W, von Wyl A (2016). The Post-Discharge Network Coordination Programme (PDNC-P): A randomised controlled trial to evaluate the efficacy of an intervention aimed at reducing rehospitalisations and improving mental health. Frontiers in Psychiatry, 7, 27.

Von Wyl A, Heim G, Rüesch N, Rössler W, Andreae A (2013). Network coordination following discharge from psychiatric inpatient treatment: a study protocol. BMC Psychiatry, 13, 220