Skip to main content

Advertisement

Log in

Factors associated with clinicians’ dispositions in an out-patient psychiatric department

  • ORIGINAL PAPER
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Aim

This cross-sectional study attempted to identify factors associated with clinicians’ dispositions of patients after the first visit in an out-patient psychiatric department.

Methods

Over a 33-month period, all new episodes of care with the department were included in the study. For each patient, socio-demographic, clinical information and contact characteristics were prospectively collected in relation to the first visit, as was information on case disposition. Factors associated with clinicians’ disposition were analysed.

Results

Of the 1,138 patients who met the study criteria, 848 (75%) were followed up by the department, 150 (13%) were referred to other services and 140 (12%) were discharged. Suffering from a major psychiatric disorder, being younger and not living in an institution influenced clinicians’ disposition to follow-up patients. Older age increased the chances of being referred to other services rather than discharged.

Conclusions

Examining decision-making behaviour in out-patient psychiatric departments is a worthwhile endeavour because this setting represents the main entry point of modern and accessible community-based systems of care. The findings confirmed the importance of psychiatric determinants in the dispositional process and contribute to make clinicians more aware of other factors related to their decision-making.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Mendel W, Rapport S (1969) Determinants of the decision for psychiatric hospitalization. Arch Gen Psychiat 20:321–328

    PubMed  CAS  Google Scholar 

  2. Gerson S, Bassuc E (1980) Psychiatry emergencies: an overview. Am J Psychiat 137:1–11

    PubMed  CAS  Google Scholar 

  3. Friedman S, Margolis R, David OJ, Kesselman M (1983) Predicting psychiatric admission from an emergency room: psychiatric, psychosocial, and methodological factors. J Nerv Ment Dis 171:155–158

    Article  PubMed  CAS  Google Scholar 

  4. Apsler R, Bassuk E (1983) Differences among clinicians in the decision to admit. Arch Gen Psychiat 40:1133–1137

    PubMed  CAS  Google Scholar 

  5. Marson DC, McGovern MP, Pomp NC (1988) Psychiatric decision making in the emergency room: a research overview. Am J Psychiat 145:918–925

    PubMed  CAS  Google Scholar 

  6. Rabinowitz J, Mark M, Slyuzberg M (1994) How individual clinician make admission decisions in psychiatric emergency rooms. J Psychiat Res 28:475–482

    Article  PubMed  CAS  Google Scholar 

  7. Rabinowitz J, Massad A, Fenning S (1995) Factor influencing disposition decision for patients seen in a psychiatric emergency service. Psychiat Serv 46:712–718

    CAS  Google Scholar 

  8. Viinamaki H, Tienari P, Niskanen L, Niskanen M, Leppavuori A, Hiltunen P, Rahikkala H, Herzog T, Malt UF, Lobo A, Huyse F (1998) Factors predictive of referral to psychiatric hospital among general hospital psychiatric consultations. Acta Psychiat Scand 97:47–54

    PubMed  CAS  Google Scholar 

  9. Way BB, Banks S (2001) Clinical factors related to admission and release decisions in psychiatric emergency services. Psychiat Serv 52:214–218

    Article  CAS  Google Scholar 

  10. Schaefer BA, Koeter MWJ, Wouters L, Emmelkamp PMG, Shene AH (2003) What patient characteristics make clinicians recommend brief treatment? Acta Psychiat Scand 107:188–196

    Article  PubMed  CAS  Google Scholar 

  11. Johnson JH, Klingler DE, Giannetti RA (1979) A study of mental status and anamnestic factors related to the decision for inpatient or outpatient treatment. J Clin Psychol 35:844–850

    PubMed  CAS  Google Scholar 

  12. Khuri R, Wood K (1984) The role of diagnosis in a psychiatric emergency setting. Hosp Commun Psychiat 35:715–718

    CAS  Google Scholar 

  13. Way BB, Evans ME, Banks SM (1992) Factors predicting referral to inpatient or outpatient treatment from psychiatric emergency services. Hosp Commun Psychiat 43:703–708

    CAS  Google Scholar 

  14. Khanna R, Gupta N, Verma S, Khanna N (1992) Factors related to psychiatric hospitalisation for first contact patients. Int J Soc Psychiat 38:293–303

    PubMed  CAS  Google Scholar 

  15. Slagg NB (1993) Characteristics of emergency room patients that predict hospitalization or disposition to alternative treatments. Hosp Commun Psychiat 44:252–256

    CAS  Google Scholar 

  16. Schnyder U, Klaghofer R, Leuthold A, Buddeberg C (1999) Characteristics of psychiatric emergencies and the choice of intervention strategies. Acta Psychiat Scand 99:179–187

    PubMed  CAS  Google Scholar 

  17. Bass C, Bolton J, Wilkinson P (2002) Referral to liaison psychiatry out-patient clinic in a UK general hospital: a report on 900 cases. Acta Psychiat Scand 105:117–125

    Article  PubMed  CAS  Google Scholar 

  18. Tansella M, Balestrieri M, Meneghelli G, Micciolo R (1991) Trends in provision in psychiatric care 1979–1988. Psychol Med 19:5–16

    Google Scholar 

  19. Tansella M, Williams P (1987) The italian experience and its implication. Psychol Med 17:283–289

    Article  PubMed  CAS  Google Scholar 

  20. Rossi A, Amaddeo F, Bisoffi G, Ruggeri M, Thornicroft G, Tansella M (2002) Dropping out of care: inappropriate termination of contact with community-based psychiatric services. Br J Psychiat 181:331–338

    Article  Google Scholar 

  21. Rossi A, Amaddeo F, Sandri M, Tansella M (2005) Determinant of once only contact in a community based psychiatric service. Soc Psychiat Psychiat Epidemiol 40:50–56

    Article  Google Scholar 

  22. Agresti A (1996) An introduction to categorical data analysis. Wiley, New York

    Google Scholar 

  23. Derksen S, Keselman HJ (1992) Backward, forward and stepwise automated subset selection algorithms: frequency of obtaining authentic and noise variables. Br J Math Statist Psychol 45:265–282

    Google Scholar 

  24. Austin PC, Tu JV (2004) Bootstrap methods for developing predictive models. Am Stat 58:131–137

    Article  Google Scholar 

  25. Breiman L (2001) Random forests. Mach Learn 45:5–32

    Article  Google Scholar 

  26. Hosmer DW Jr, Lemeshow S (2000) Applied logistic regression, 2nd edn. Wiley, New York

    Book  Google Scholar 

  27. StataCorp (2001) Stata statistical softwer: release 7.0. College Station. Stata Corporation, TX

    Google Scholar 

  28. Ihaka R, Gentleman R (2005) R: a language for data analysis and graphics. J Comput Graph Stat 5:299–314

    Article  Google Scholar 

  29. Liaw A, Wiener M (2002) randomForest for R. Classification and Regression with RandomForests (http://lib.stat.cmu.edu/R/CRAN/src/contrib/Descriptions/randomForest.html)

  30. Neumann M, Salganik I, Rabinowitz S, Bauer A, Kastner M (1990) The effect of diagnosis and educational level on therapists’ treatment decisions in a regional psychiatric outpatient clinic. Isr J Psychiat Relat Sci 27:199–204

    CAS  Google Scholar 

  31. Rossi A, Morgan V, Amaddeo F, Sandri M, Tansella M, Jablensky A (2005) Psychiatric out-patients seen once only in South Verona and Western Australia: a comparative case-register study. Aust N Z J Psychiat 39:414–422

    Article  Google Scholar 

  32. Lincoln CV, McGorry P (1995) Who cares? Pathways to psychiatric care for young people experiencing a first episode of psychosis. Psychiat Serv 46:1166–1171

    CAS  Google Scholar 

  33. Blenkiron P (1998) Referral to a psychiatric clinic: what do patients expect? Int J Health Care Qual Assur Inc Leadersh Health Serv 11:188–192

    PubMed  CAS  Google Scholar 

  34. Hoencamp E (1999) Yes doctor, no doctor’: what do patients want from you? Acta Psychiat Scand 100:319–320

    PubMed  CAS  Google Scholar 

  35. Noble LM, Duoglas BC, Newman SP (1999) What do patients want and want to know? A review of patients’ requests of psychiatric services. Acta Psychiat Scand 100:321–327

    Article  PubMed  CAS  Google Scholar 

  36. Chamberlin J (2005) User/consumer involvement in mental health service delivery. Epidemiol Psichiat Soc 14:10–14

    Google Scholar 

  37. Becker T, Kilian R (2006) Psychiatric services for people with severe mental illness across western Europe: what can be generalized from current knowledge about differences in provision, costs and outcomes of mental health care? Acta Psychiat Scand 113(Supplement 429):9–16

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Alberto Rossi PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rossi, A., Sandri, M., Bianco, M. et al. Factors associated with clinicians’ dispositions in an out-patient psychiatric department. Soc Psychiat Epidemiol 41, 832–840 (2006). https://doi.org/10.1007/s00127-006-0105-8

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-006-0105-8

Key words

Navigation