Impact of Physician Follow-Up Care on Psychiatric Readmission Rates in a Population-Based Sample of Patients With Schizophrenia
Impact of Physician Follow-Up Care on Psychiatric Readmission Rates in a Population-Based Sample of Patients With Schizophrenia
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DOI：
10.1176/appi.ps.201600507
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发表时间：
2018-01-01
影响因子：
3.8
通讯作者：
Stukel, Therese
中科院分区：
文献类型：
--
作者：
Kurdyak, Paul;Vigod, Simone Natalie;Stukel, Therese
目的：该研究评估了出院后30天内的医生随访与随后180天内的精神病再入院之间的关系。在2007年至2012年期间出院的安大略精神分裂症住院患者中，（N= 19，132），将仅接受初级保健医生（PCP）、仅接受精神科医生或两者均接受30天随访的患者与无随访组进行比较。主要结果是在随后的180天内精神病再入院。二次分析分层的基础上，再入院的风险在discharity.Results：约65%的患者出院后30天内进行了后续护理的样本。接受任何医生随访的患者的精神病再入院率相似，显著低于未接受随访的患者（26%）：仅PCP：22%;调整后的风险比[aHR]= 0.88，95%置信区间[CI]= 0.81 - 0.96;仅精神科医生，22%; aHR= 0.84，CI= 0.77 - 0.90;两者，21%，aHR= 0.82，CI= 0.75 - 0.90）。在分层分析中，66%的患者处于精神病再入院风险最高的类别，与没有随访的高再入院风险患者相比，任何医生的随访对这些患者的影响都是显著的，高再入院风险患者的再入院率为29（仅PCP，20%再入院率，aHR=.85，CI=.77-.94;仅精神科医生，29%，aHR=.84，CI=.77-.92;两者均为17%，aHR=.81，CI=.73-.90）。及时的医生随访与降低精神病再入院风险相关，在高风险再入院患者中降低最大。由于超过三分之一的患者在出院后30天内没有医生就诊，因此改善医生随访可能有助于降低精神科再入院率。
Objective: The study evaluated the association between physician follow-up within 30 days after hospital discharge and psychiatric readmission within the subsequent 180 days.Methods: Among inpatients with schizophrenia who were discharged between 2007 and 2012 in Ontario (N=19,132), those who had a 30-day follow-up visit with a primary care physician (PCP) only, a psychiatrist only, or both were compared with a no-follow-up group. The primary outcome was psychiatric readmission in the subsequent 180 days. Secondary analyses stratified the sample on the basis of readmission risk at discharge.Results: About 65% of patients had follow-up care within 30 days postdischarge. Psychiatric readmission rates were similar among patients with any physician follow-up and significantly lower than among those with no follow-up (26%): PCP only: 22%; adjusted hazard ratio [aHR]=.88, 95% confidence interval [CI]=.81-.96; psychiatrist only, 22%; aHR=.84, CI=.77-.90; both, 21%, aHR=.82, CI=.75-.90). In stratified analyses, 66% of patients were in the category at highest risk of psychiatric readmission, and the effect of follow-up with any physician was significant for these patients, compared with high-readmission risk patients with no follow-up, who had a 29% readmission rate (PCP only, 20% readmission rate, aHR=.85, CI=.77-.94; psychiatrist only, 29%, aHR=.84, CI=.77-.92; both, 17%, aHR=.81, CI=.73-.90).Discussion: Timely physician follow-up was associated with reduced risk of psychiatric readmissions, with the greatest reduction among patients at high risk of readmission. Because more than one-third of patients had no physician visit within 30 days postdischarge, improving physician follow-up may help reduce psychiatric readmission rates.