Abstract
Aims
This study measures the impact of 90-day physician follow-up care after psychiatric hospitalization among 3,311 adults and youth, with risk of subsequent readmission within six months.
Methods
A 5-year investigation was conducted based on Quebec (Canada) medical administrative databases. Cox proportional-hazards regression was performed, with 90-day follow-up care as the main independent variable, controlling for various sociodemographic, clinical, and other service use variables.
Results
Within the 90-day follow-up period after patient discharge, or in the first 30 days, receiving at least one consultation per month as opposed to no consultation was associated with a reduced risk of psychiatric readmission. Women showed an increased readmission risk compared to men, while those living in less materially deprived areas a decreased risk as opposed to more deprived areas. Patients hospitalized for suicide attempt or schizophrenia spectrum and other psychotic disorders, and those with co-occurring mental and substance-related disorders or chronic physical illnesses, especially illnesses high on the severity index, also presented a heightened risk of hospitalization. Patients hospitalized for personality disorders or receiving a high continuity of physician care showed a reduced risk of readmission.
Conclusion
This study demonstrates that follow-up care, if provided within the first 30 days of discharge or monthly during the 90-day follow-up period, decreased the risk of readmission, as did having a high continuity of physician care prior to and within the 90-day follow-up period. However, few patients in this study had received such high-quality care, indicating that the Quebec system needs to considerably improve its discharge planning processes.
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Data Availability
In accordance with Quebec relevant ethics regulations, the principal investigator is responsible for preserving the confidentiality of the data.
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Acknowledgements
We gratefully acknowledge the support of the Canadian Institutes of Health Research (CIHR). We would also like to thank the the Fonds de la recherche en santé du Québec (FRQ-S) for awarding a postdoctoral fellowship to the second author.
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This study was funded by the Canadian Institutes of Health Research (CIHR, Grant Number 8400997).
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Study funding received by MJF. MJF, LG and ER designed the article, analysis plan. LG produced the quantitative analyses and tables. LG, GG, and MJF wrote the article. ER reviewed the article prior to submission. All authors thus contributed to this article and approved the submitted version.
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The Quebec Commission of Access to Information, and the Douglas Mental Health University Institute Ethics Committee approved the study protocol.
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Fleury, MJ., Gentil, L., Grenier, G. et al. The Impact of 90-day Physician Follow-up Care on the Risk of Readmission Following a Psychiatric Hospitalization. Adm Policy Ment Health 49, 1047–1059 (2022). https://doi.org/10.1007/s10488-022-01216-z
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DOI: https://doi.org/10.1007/s10488-022-01216-z