Psychiatric hospitalization and continuity of care in immigrants treated in Madrid (Spain)

Abstract.

Background:

The ethnic group and also the socioeconomic level of a patient are linked with the quality of the health care received that is associated, among other factors, with the continuity of care between the different services involved in treatment. The main goal of this study is to identify whether foreigners resident in Madrid run a greater risk than Spaniards of interruption in the continuity of their care after discharge from a psychiatric hospitalization. Other characteristics of the patients associated with disruption of care continuity are identified in order to be able to design specific actions with this group of subjects to foster their compliance with treatment.

Methods:

An observational, prospective, controlled study is performed to analyse the risk of not attending the first outpatient appointment after discharge from hospital in 60 foreign patients versus 115 Spaniards admitted to four short-stay psychiatric hospitalization units in Madrid.

Results:

The multivariate analysis indicates that the relevant factors associated with a break in the continuity of care are the fact of being an immigrant having a monthly income of less than 240 € [adjusted OR = 8.05 (2.59–25.05)], not having consulted with a mental health problem in the 6 months prior to admission [adjusted OR = 5.32 (1.84–15.34)], the lack of collaboration with treatment by the family [adjusted OR = 3.73 (1.33–10.42)] and suffering a personality disorder as the main diagnosis for admission [adjusted OR = 7.09 (1.26–39.98)], whereas the longer duration of the admission protects against the failure to attend the appointment after discharge [adjusted OR = 0.94 (0.90–0.99)].

Conclusions:

While it is true that the results confirm the suspicion that the fact of being an immigrant hinders continuity of care in patients admitted to psychiatric hospitalization units in our community, this would not be the variable directly influencing the interruption of treatment, but rather a series of factors that are more likely to be associated with this group than with the native population. These variables are the ones that should alert us to the need for closer follow-up in the transfer of these patients from one mental health service to another.