13. What are the characteristics of patients who are admitted to hospital despite the availability of an intensive home treatment team?

Research has shown that patient factors that are most often associated with needing hospitalization even though home treatment is available include 1. Mode of referral ( eg police, outside working hours) 2. Greater symptom severity 3. comorbid substance abuse or personality disorder 4. Previous history of hospital admission 5.Male/Living alone 6. Uncooperativeness.

Interestingly, only one paper found serious suicidal ideas to be a factor

This paper is the most recent ( 2007) , includes the most patients, and the data is analysed in a way that shows which factors were independent influences on hospitalization. The patients were from the two Islington studies previously posted, plus one as yet unpublished study using similar methodology, and in a similar area of London-the North Southwark study

It identified the following factors: 1 Patients who were uncooperative with the initial  assessment 2. Risk of unintentional harm to self ( eg through neglect or recklesness) 3. History of involuntary admissions 4. Patients assessed in the emergency room.

Factors that one might think would affect risk of hospitalization but didn’t included 1. Diagnosis ( substantial numbers of patients with manic and psychotic symptoms were managed at home )2. comorbid substance abuse/personality disorder 3. Living alone 4. Suicidal ideation

The  North Islington  team admitted much fewer patients than the other two ( 22% compared to 51 and 65%) . This raised questions about variations in practice and in admission thresholds between teams, and whether different implementations of the intensive home treatment model may result in different admission rates.

Factors that may be amenable to change are 1 avoiding initial assessment in the ER 2. A greater understanding of patients’ views and the reasons why they don’t cooperate Investigation of reasons for hospitalization despite crisis resolution and home treatment Mary-Anne Cotton Sonia Johnson 2007

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