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      Effectiveness of Transitional Interventions in Improving Patient Outcomes and Service Use After Discharge From Psychiatric Inpatient Care: A Systematic Review and Meta-Analysis

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          Background: The transition from psychiatric hospital to community is often hindered by challenges that influence community adjustment and continuity of care. Transitional interventions with bridging components are provided prior to discharge and continue beyond inpatient care. They provide continuity of care and may be effective in preventing readmission. We aimed to assess the effectiveness of transitional interventions with predischarge and postdischarge components in reducing readmissions and improving health-related or social outcomes of patients discharged from psychiatric hospitals.

          Methods: We conducted a systematic review by searching electronic databases (MEDLINE, Embase, Cochrane Library, CINAHL, PsycINFO, and Psyndex) and included randomized, nonrandomized, and one-group study designs. A random effects meta-analysis was conducted with randomized controlled trials (RCTs) reporting data on readmission rates. Other study designs were synthesized qualitatively.

          Results: After screening 2,673 publications, 16 studies (10 RCTs, three quasi-experimental, and three cohort studies) were included and nine RCTs were included in the meta-analysis. The tested interventions included components from case management, psychoeducation, cognitive behavioral therapy, and peer support. All studies with significant improvements in at least one outcome provided elements of case management, most frequently in combination with cognitive behavioral therapy and psychoeducation. Readmission rates during follow-up ranged between 13% and 63% in intervention groups and 19% and 69% in control groups. Overall, we found an odds ratio of 0.76 (95% confidence interval = 0.55–1.05) for readmission due to transitional interventions. Heterogeneity was low at only 31% (p = 0.17) and the funnel plot indicated no obvious publication biases.

          Conclusions: We observed that transitional interventions with bridging components were no more effective in reducing readmission than treatment as usual; however, these results are based on limited evidence. Therefore, additional high-quality research is required to conclude the effectiveness of transitional interventions. Nevertheless, transitional interventions with bridging components are preferred by service users and could be an alternative to strategies regularly employed.

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          Most cited references 39

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          Discharge planning from hospital

          Discharge planning is a routine feature of health systems in many countries. The aim of discharge planning is to reduce hospital length of stay and unplanned readmission to hospital, and to improve the co-ordination of services following discharge from hospital.This is the third update of the original review.
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            Discharge planning in mental health care: a systematic review of the recent literature.

            To determine and estimate the efficacy of discharge planning interventions in mental health care from in-patient to out-patient treatment on improving patient outcome, ensuring community tenure, and saving costs. A systematic review and meta-analysis identified studies through an electronic search on the basis of defined inclusion and exclusion criteria and extracted data. Of eleven studies included, six were randomised controlled trials, three were controlled clinical trials, and two were cohort studies. The discharge planning strategies used varied widely, most were limited to preparation of discharge during in-patient treatment. Pooled risk ratios were 0.66 (95% CI = 0.51 to 0.84; P < 0.001) for hospital readmission rate, and 1.25 (1.07 to 1.47; P < 0.001) for adherence to out-patient treatment. Effect sizes (Hedge's g) were -0.25 (-0.45 to -0.05; P = 0.02) for mental health outcome, and 0.11(-0.05 to 0.28; NS) for quality of life. Discharge planning interventions are effective in reducing rehospitalisation and in improving adherence to aftercare among people with mental disorders.
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              Patient outcomes following discharge from secure psychiatric hospitals: systematic review and meta-analysis

              Background Secure hospitals are a high-cost, low-volume service consuming around a fifth of the overall mental health budget in England and Wales. Aims A systematic review and meta-analysis of adverse outcomes after discharge along with a comparison with rates in other clinical and forensic groups in order to inform public health and policy. Method We searched for primary studies that followed patients discharged from a secure hospital, and reported mortality, readmissions or reconvictions. We determined crude rates for all adverse outcomes. Results In total, 35 studies from 10 countries were included, involving 12 056 patients out of which 53% were violent offenders. The crude death rate for all-cause mortality was 1538 per 100 000 person-years (95% CI 1175–1901). For suicide, the crude death rate was 325 per 100 000 person-years (95% CI 235–415). The readmission rate was 7208 per 100 000 person-years (95% CI 5916–8500). Crude reoffending rates were 4484 per 100 000 person-years (95% CI 3679–5287), with lower rates in more recent studies. Conclusions There is some evidence that patients discharged from forensic psychiatric services have lower offending outcomes than many comparative groups. Services could consider improving interventions aimed at reducing premature mortality, particularly suicide, in discharged patients.

                Author and article information

                Front Psychiatry
                Front Psychiatry
                Front. Psychiatry
                Frontiers in Psychiatry
                Frontiers Media S.A.
                21 January 2020
                : 10
                1 Research Institute, Careum School of Health Ltd. , Zurich, Switzerland
                2 International Graduate Academy (InGrA), “Participation as Goal of Nursing and Therapy”, Faculty of Medicine, Institute of Health and Nursing Sciences, Martin-Luther-University Halle-Wittenberg , Halle-Wittenberg, Germany
                3 Department of Clinical Nursing Science, University Psychiatric Hospital of Bern , Bern, Switzerland
                4 Centre for Psychiatric Rehabilitation, University Psychiatric Hospital of Bern , Bern, Switzerland
                5 Department of Health Professions, Bern University of Applied Sciences , Bern, Switzerland
                6 Faculty of Medicine, Institute of Health and Nursing Sciences, Martin-Luther-University Halle-Wittenberg , Halle-Wittenberg, Germany
                7 Frankfurt Institute of Supervision, Institutional Analysis and Social Research (ISIS non profit e.V.) , Frankfurt, Germany
                Author notes

                Edited by: David Roe, University of Haifa, Israel

                Reviewed by: Sean Kidd, University of Toronto, Canada; Alan Simpson, King’s College London, United Kingdom; Charles Bonsack, Lausanne University Hospital (CHUV), Switzerland

                *Correspondence: Anna Hegedüs, anna.hegedues@ 123456careum-hochschule.ch

                This article was submitted to Social Psychiatry and Psychiatric Rehabilitation, a section of the journal Frontiers in Psychiatry

                Copyright © 2020 Hegedüs, Kozel, Richter and Behrens

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                Page count
                Figures: 3, Tables: 5, Equations: 0, References: 50, Pages: 11, Words: 4707
                Systematic Review


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