Psychiatr Prax 2002; 29(7): 334-342
DOI: 10.1055/s-2002-34658
Übersicht
© Georg Thieme Verlag Stuttgart · New York

Heavy user psychiatrischer Versorgungsdienste

Ein Überblick über den Stand der ForschungHeavy Users of Psychiatric CareA Review of the State of ResearchChristiane  Roick1 , Anke  Gärtner1 , Dirk  Heider1 , Matthias  C.  Angermeyer1
  • 1Universität Leipzig, Klinik und Poliklinik für Psychiatrie
Further Information

Publication History

Publication Date:
14 October 2002 (online)

Zusammenfassung

Anliegen: Die Arbeit gibt einen Überblick über Erkenntnisse und Probleme der Heavy-user-Forschung. Methode: Dazu wurden deutsch- und englischsprachige Publikationen zum Thema „heavy user” und zu relevanten Grenzgebieten analysiert. Ergebnisse: Heavy user sind Patienten, die einen überdurchschnittlich hohen Anteil medizinischer Versorgung konsumieren. Die Merkmale dieser Patienten sind inhomogen. Soziale Probleme, Krankheitsverleugnung, Noncompliance und begleitende Persönlichkeitsstörungen sowie Substanzmissbrauch treten gehäuft auf. Künftige Untersuchungen müssen heavy use krankheitsspezifisch definieren und klären, ob die starke Inanspruchnahme bestimmter Dienste der Situation der Patienten angemessen ist. Schlussfolgerungen: Heavy user sollten frühzeitig identifiziert werden, um ihnen Versorgungsalternativen anbieten zu können, die ihren Problemen besser gerecht werden und die inadäquat starke Inanspruchnahme kostenintensiver Leistungen überflüssig machen.

Abstract

Objective: This paper reviews findings and problems of heavy users research. Methods: The German- and English language literature about „heavy users” and relevant border areas was analyzed. Results: Heavy users are patients who consume a disproportionate share of medical services. The characteristics of heavy users are inhomogeneous. Social problems, denial of illness, non-compliance, comorbid personality disorders and substance misuse contribute significantly to heavy use. Future studies should define heavy use illness-related. More research is needed to clarify whether heavy use of special services is adequate to the patients situation. Conclusions: Heavy users should be identified early, in order to offer them alternative services, which better fulfil the patients specific conditions and prevent an inadequate heavy use of expensive services.

Literatur

  • 1 Hadley T R, Culhane D P, McGurrin M C. Identifying and tracking „heavy users” of acute psychiatric inpatient services.  Adm Policy Ment Hlth. 1992;  19 279-290
  • 2 Kent S, Fogarty M, Yellowlees P. A review of studies of heavy users of psychiatric services.  Psychiatr Serv. 1995;  46 1247-1253
  • 3 Carpenter M D, Mulligan J C, Bosler I A. et al . Multiple admissions to an urban psychiatric center: A comparative study.  Hosp Community Psychiatry. 1985;  36 1305-1308
  • 4 Casper E S, Pastva G. Admission histories, patterns, and subgroups of the heavy users of a state psychiatric hospital.  Psychiatr Q. 1990;  61 121-134
  • 5 Casper E S, Donaldson M A. Subgroups in the population of frequent users of inpatient services.  Hosp Community Psychiatry. 1990;  41 (2) 189-191
  • 6 Casper E S, Romo J M, Fasnacht R C. Readmission patterns of frequent users of inpatient psychiatric services.  Hosp Community Psychiatry. 1991;  42 (11) 1166-1167
  • 7 Casper E S, Regan J R. Reasons for admission among six profile subgroups of recidivists of inpatient services.  Can J Psychiatry. 1993;  38 657-661
  • 8 Casper E S. Identifying multiple recidivists in a state hospital population.  Psychiatr Serv. 1995;  46 1074-1075
  • 9 Geller J L. In again, out again: preliminary evaluation of state hospital's „worst” recidivists.  Hosp Community Psychiatry. 1986;  39 386-390
  • 10 Geller J L. A historical perspective on the role of state hospitals viewed from the era of the „revolving door”.  Am J Psychiatry. 1992;  149 (11) 1526-1533
  • 11 Geller J L. A report on the „worst” state hospital recidivists in the U.S.  Hosp Community Psychiatry. 1992;  43 (9) 904-908
  • 12 Green J H. Frequent rehospitalization and noncompliance with treatment.  Hosp Community Psychiatry. 1988;  39 963-966
  • 13 Hadley T R, McGurrin M C, Pulice R T. et al . Using fiscal data to identify heavy service users.  Psychiatr Q. 1990;  61 41-48
  • 14 Havassy B E, Hopkin J T. Factors predicting utilization of acute psychiatric inpatient services by frequently hospitalised patients.  Hosp Community Psychiatry. 1989;  40 (8) 820-823
  • 15 Holohean E J, Pulice R T, Donahue S A. Utilization of acute inpatient psychiatric services: „heavy users” in New York State.  Adm Policy Ment Hlth. 1991;  18 173-181
  • 16 Lucas B, Harrison-Read P, Tyrer P. et al . Costs and characteristics of heavy inpatient service users in outer London.  Int J Soc Psychiatry. 2001;  47 (1) 63-74
  • 17 Quinlivan R, Hough R, Crowell A. et al . Service utilization and costs of care for severely mentally ill clients in an intensive case management program.  Psychiatr Serv. 1995;  46 365-371
  • 18 Surber R W, Winkler E L, Monteleone M. et al . Characteristics of high users of acute psychiatric inpatient services.  Hosp Community Psychiatry. 1987;  38 1112-1114
  • 19 Voineskos G, Denault S. Recurrent psychiatric hospitalization.  Can Med Assoc J. 1978;  118 (4) 247-250
  • 20 Kent S, Yellowlees P. Psychiatric and social reasons for frequent rehospitalization.  Hosp Community Psychiatry. 1994;  45 347-350
  • 21 Taube C A, Goldman H H, Burns B J. et al . High users of outpatient mental health services, I: definition and characteristics.  Am J Psychiatry. 1988;  145 19-24
  • 22 Mustard C A, Derksen S, Tataryn D. Intensive use of mental health care.  Can J Psychiatry. 1996;  41 93-101
  • 23 Lavik N J. Utilization of mental health services over a given period.  Acta Psychiatr Scand. 1983;  67 404-413
  • 24 Kent S, Fogarty M, Yellowlees P. Heavy utilization of inpatient and outpatient services in a public mental health service.  Psychiatr Serv. 1995;  46 1254-1257
  • 25 Kent S, Yellowlees P. The relationship between social factors and frequent use of psychiatric services.  Aust NZ J Psychiatry. 1995;  29 (3) 403-408
  • 26 Junghan U. Das ungleiche Ausmaß der Nutzung psychiatrischer Akutstationen: eine wichtige Beobachtung für die gemeindepsychiatrische Versorgungsplanung.  Schizophrenie: Beiträge zu Forschung, Therapie und psychosozialem Management. 2000;  15 24-34
  • 27 Kennedy J, Hird F. Description and evaluation of a short stay admission ward.  Br J Psychiatry. 1980;  136 205-215
  • 28 Hansson L, Persson K B, Borgquist L. Patients with mental illness in primary health care. A long-term follow-up of health care utilization and contact patterns with psychiatric care.  Scand J Prim Health Care. 1997;  15 (3) 129-133
  • 29 Maylath E, Seidel J. Analyse der psychiatrischen Krankenhausfälle in Hamburg 1988 - 1994 - Entwicklungstrends, Versorgungslücken und -perspektiven.  Gesundheitswesen. 1997;  59 423-433
  • 30 Woogh C M. A Cohort through the revolving door.  Can J Psychiatry. 1986;  31 214-220
  • 31 Kapur K, Young A S, Murata D. Risk adjustment for high utilizers of public mental health care.  J Ment Health Policy Econ. 2000;  3 129-137
  • 32 Kivlahan D R, Heiman J R, Wright R C. et al . Treatment cost and rehospitalisation rate in schizophrenic outpatients with a history of substance abuse.  Hosp Community Psychiatry. 1991;  42 609-614
  • 33 Reich J H, Green A I. Effect of personality disorder on outcome of treatment.  Journal of Nervous and Mental Disease. 1991;  179 74-82
  • 34 Ellison J M, Blum N R, Barsky A J. Frequent repeaters in a psychiatric emergency service.  Hosp Community Psychiatry. 1989;  40 (9) 958-960
  • 35 Postrado L T, Lehman A F. Quality of life and clinical predictors of rehospitalization of persons with severe mental illness.  Psychiatr Serv. 1995;  46 (11) 1161-1165
  • 36 Buell G J, Anthony W A. Demographic characteristics as predictors of recidivism and post-hospital employment.  J Consult Clin Psychol. 1973;  20 361-365
  • 37 DiScipio W J, Sommer G. Therapeutic failures: patient who return within 30 days of hospital discharge.  Psychiatr Q. 1973;  47 371-376
  • 38 Weinstein A S, DiPasquale D, Winsor F. Relationship between length of stay in and out of the New York State mental hospitals.  Am J Psychiatry. 1973;  130 904-909
  • 39 Rosenblatt A, Mayer J E. The recidivism of mental patients: a review of past studies.  Am J Orthopsychiatry. 1974;  44 697-706
  • 40 Fontana A F, Dowds B N. Assessing treatment outcome, II: the prediction of rehospitalization.  J Nerv Ment Dis. 1975;  161 231-238
  • 41 Rosenblatt A, Mayer J E. Revolving-door patients at Bronx State Hospital: a preliminary report.  Journal of Bronx State Hospital. 1973;  1 5-11
  • 42 Harris M, Bergmann H, Bachrach L L. Psychiatric and nonpsychiatric indicators for rehospitalization in a chronic patient population.  Hosp Community Psychiatry. 1986;  40 958-960
  • 43 Lewis P A, Hugi R. Therapeutic stations and the chronically treated mentally ill.  Soc Serv Rev. 1981;  55 206-220
  • 44 Weimer S R, Hatcher C, Gould E. Family characteristics in high and low health care utilization.  Gen Hosp Psychiatry. 1983;  5 55-61
  • 45 Schanding D, Siomopoulos V, Godbole A. et al . Readmissions to an general psychiatric unit.  Hosp Community Psychiatry. 1984;  35 170-171
  • 46 Richart R, Millner L. Factors influencing admission to a community mental health center.  Community Ment Health J. 1968;  4 27-35
  • 47 Abramowitz S, Tupin J, Berger A. Multivariate prediction of hospital readmission.  Compr Psychiatry. 1984;  25 71-76
  • 48 Egan K J, Katon W J. Responses to illness and health in chronic pain patients and healthy adults.  Psychosom Med. 1987;  49 (5) 470-481
  • 49 Junghan U M, Tschacher W. Heavy users of acute inpatient psychiatric services: A view from different perspectives. Presented at the 4th international conference of the European Network for Mental Health Service Evaluation. Leipzig; 2000
  • 50 Mandelberg J H, Kuhn R E, Kohn M A. Epidemiologic analysis of an urban, public emergency department's frequent users.  Acad Emerg Med. 2000;  7 637-646
  • 51 Goldstein J M, Horgan C M. Inpatient and outpatient psychiatric services: Substitutes or compliments?.  Hosp Community Psychiatry. 1988;  39 632-636
  • 52 Arana J D, Hastings B, Herron E. Continuous care terms in intensive outpatient treatment of chronically mentally ill patients.  Hosp Community Psychiatry. 1991;  42 503-507
  • 53 Dincin J, Witheridge T F. Psychiatric rehabilitation as a deterrent to recidivism.  Hosp Community Psychiatry. 1982;  33 (8) 645-650
  • 54 Pepper B, Ryglewicz H, Kirshner M C. The uninstitutionalized generation: A new breed of psychiatric patient.  New Dir Ment Health Serv. 1987;  14 3-14
  • 55 Goldfinger S M, Hopkin J T, Surber R W. Treatment resisters or system resisters? Toward a better service system for acute care recidivists.  New Dir Ment Health Serv. 1984;  21 17-27
  • 56 Hadley T R, Schinnar A P, Rothbard A B, Kinosian M S. Capitation of mental health services for the chronically mentally ill. Wharton PMW Report No. 8801. Philadelphia; University of Pennsylvania, The Wharton School, Policy Modeling Workshop 1988
  • 57 ten Horn G H, Moschel G, Giel R. et al . Patterns of mental health care in two european areas: Mannheim, Federal Republic of Germany; and Groningen, The Netherlands.  Acta Psychiatr Scand. 1988;  77 271-279
  • 58 Saarento O, Hansson L, Sandlund M. et al . The nordic comparative study on sectorized psychiatry. Utilization of psychiatric hospital care related to amount and allocation of resources to psychiatric services.  Soc Psych Psych Epid. 1996;  31 327-335
  • 59 Blumenthal S, Bell V, Neumann N U. et al . Die Wiedereinweisung ersthospitalisierter Patienten - Verlauf und prädiktive Einflüsse nach 5 Jahren.  Psychiat Prax. 1988;  15 96-101
  • 60 Roemer M I. Social medicine. The advance of organized health services in America. New York; Springer 1978
  • 61 Hirsch S R. Psychiatric beds and resources. Factors influencing bed use and service planning. Report of a working party of the section for social and community psychiatry of the Royal College of Psychiatrists. London; Gaskell 1988
  • 62 Hansson L, Öiesvold T, Göstas G. et al . The nordic comparative study on sectorized psychiatry. I. Treated point prevalence and characteristics of the psychiatric services.  Acta Psychiatr Scand. 1995;  91 41-47
  • 63 Solomon P, Doll W. The varieties of readmission: The case against the use of recidivism rates as a measure of program effectiveness.  Am J Orthopsychiatry. 1979;  49 (2) 230-239
  • 64 Erickson R C, Paige A B. Fallacies of using length of stay and return rates as measures of success.  Hosp Community Psychiatry. 1973;  24 (8) 559-561
  • 65 Streiner D, Goodman J, Woodward C. Correlates of hospitalization decision: a replicative study.  Can J Public Health. 1975;  66 411-415
  • 66 Byers E S, Cohen S H. Predicting patient outcome: the contribution of prehospital, inhospital, and posthospital factors.  Hosp Community Psychiatry. 1979;  30 327-331
  • 67 Marks F M. The characteristics of psychiatric patients admitted within a month of discharge.  Psychol Med. 1977;  7 345-352
  • 68 DeFrancisco D, Anderson D, Pantano R. et al . The relationship between length of hospital stay and rapid readmission rates.  Hosp Community Psychiatry. 1980;  31 196-197
  • 69 Abbott S, Smith S, Clark R. et al . Who is a heavy service user? Preliminary development of a screening instrument for prospective consumers of a mobile intensive treatment team.  Aust NZ J Psychiatry. 1997;  31 744-750
  • 70 Goldman H H, Taube C A. High users of outpatient mental health services, II: implications for practice and policy.  Am J Psychiatry. 1988;  145 24-28
  • 71 Roberts S J. Psychosocial assessment of the high utilizer of occupational health services.  AAOHN Journal. 1990;  38 62-66
  • 72 Belcher J V, Alexy B. High-resource hospital users in an integrated delivery system.  J Nurs Adm. 1999;  29 (10) 30-36
  • 73 Meenan R T, O'Keeffe-Rosetti M C, Hornbrook M C. et al . The sensitivity and specificity of forecasting high-cost users of medical care.  Med Care. 1999;  37 (8) 815-823
  • 74 Caton C L, Kow S P, Fleiss J L. et al . Rehospitalization in chronic schizophrenia.  J Nerv Ment Dis. 1985;  173 139-148
  • 75 Jed J. Social support for caretakers and psychiatric rehospitalization.  Hosp Community Psychiatry. 1989;  40 1297-1299
  • 76 Woogh C M. Patients with multiple admissions in a psychiatric record linkage system.  Can J Psychiatry. 1990;  35 401-405
  • 77 Goodpastor W A, Hare B K. Factors associated with multiple admissions to an urban psychiatric hospital.  Hosp Community Psychiatry. 1991;  42 85-87
  • 78 Evans M, Rice D, Routh C. Patients repeatedly admitted to psychiatric wards.  Psychiatr Bull R Coll Psychiatr. 1992;  16 157-158
  • 79 Joyce P R, Khan A, Jones A V. The revolving door patient.  Compr Psychiatry. 1981;  22 (4) 397-402
  • 80 Harris M, Bergmann H C, Greenwood V. Integrating hospital and community systems for treating revolving-door patients.  Hosp Community Psychiatry. 1982;  33 (3) 225-227
  • 81 Geller M P. The „revolving door”: a trap or a life style?.  Hosp Community Psychiatry. 1982;  33 (5) 388-389
  • 82 Geller J L. Treating revolving-door patients who have „Hospitalphilia”: compassion, coercion, and common sense.  Hosp Community Psychiatry. 1993;  44 (2) 141-146
  • 83 Morin R C. A social network approach and the revolving door patient.  Schizophr Bull. 1986;  12 (2) 262-273
  • 84 Kastrup M. The use of a psychiatric register in predicting the outcome „revolving door patient”.  Acta Psychiatr Scand. 1987;  76 552-560
  • 85 Lewis T, Joyce P R. The new revolving-door patients: results from a national cohort of first admissions.  Acta Psychiatr Scand. 1990;  82 130-135
  • 86 Hiday V A, Scheid-Cook T L. Outpatient commitment for „revolving door” patients: compliance and treatment.  The J Nerv Ment Dis. 1991;  179 (2) 83-88
  • 87 Hofmann W, Gougleris G, Panzer E. et al . Mehrfachaufnahmen im psychiatrischen Krankenhaus - eine Untersuchung zur Situation so genannter „Drehtür-Patienten”.  Psychiat Prax. 1992;  19 217-224
  • 88 Haywood T W, Kravitz H M, Grossman L S. et al . Predicting the „revolving-door” phenomenon among patients with schizophrenic, schizoaffective, and affective disorders.  Am J Psychiatry. 1995;  152 (6) 856-861
  • 89 Rabinowitz J, Mark M, Popper M. et al . Predicting revolving-door patients in a 9-year national sample.  Soc Psychiatry Psychiatr Epidemiol. 1995;  30 65-72
  • 90 Weiden P, Glazer W. Assessment and treatment selection for „revolving-door” inpatients with schizophrenia.  Psychiatr Q. 1997;  68 (4) 377-393
  • 91 Pallis D J, Langley A M, Birtchnell J. Excessive use of psychiatric services by suicidal patients.  Br Med J. 1975;  3 216-218
  • 92 Surles R C, McGurrin M C. Increased use of psychiatric emergency services by young chronic mentally ill patients.  Hosp Community Psychiatry. 1987;  38 (4) 401-405
  • 93 Bassuk E, Gerson S. Chronic crisis patients: a discrete clinical group.  Am J Psychiatry. 1980;  137 1513-1517
  • 94 Schwartz S R, Goldfinger S M. The new chronic patient: Clinical characteristics of an emerging subgroup.  Hosp Community Psychiatry. 1981;  32 470-474
  • 95 Caton C LM. The new chronic patient and the system of community care.  Hosp Community Psychiatry. 1981;  32 475-478
  • 96 Pepper B, Kirshner M C, Ryglewicz H. The young adult chronic patient: overview of a population.  Hosp Community Psychiatry. 1981;  32 463-469
  • 97 Lamb H R. Young adult chronic patients: the new drifters.  Hosp Community Psychiatry. 1982;  33 468
  • 98 Zacker J, Pepper B, Kirshner M C. Neuropsychological characteristics of young adult chronic psychiatric patients: preliminary observations.  Percept Mot Skills. 1989;  68 391-399
  • 99 Coid J W. „Difficult to place” psychiatric patients.  Br Med J. 1991;  302 603-604
  • 100 Knuth P. Notarzt und Notfallarzt. Aufgabenbereiche der Notfallmedizin.  Internist. 1998;  39 (2) 120-123
  • 101 Stein L I, Test M A. Alternative to mental hospital treatment: I. Conceptual model, treatment program and clinical evaluation.  Arch of Gen Psychiatry. 1980;  37 392-397
  • 102 Brekke J S. What do we really know about community support programs? Strategies for better monitoring.  Hosp Community Psychiatry. 1988;  39 946-952
  • 103 Witheridge T F, Dincin J. The Bridge: an assertive outreach program in an urban setting.  New Dir Ment Health Serv. 1985;  26 65-76
  • 104 Bond G R, Miller L D, Krumwied M HA. et al . Assertive case management in three CMHCs: a controlled study.  Hosp Community Psychiatry. 1988;  35 411-417
  • 105 McRae J, Higgins M, Lycan C. et al . What happens to patients after five years of intensive case management stops?.  Hosp Community Psychiatry. 1990;  41 175-179

Dr. med. Christiane Roick,MPH 

Universität Leipzig · Klinik für Psychiatrie

Johannisallee 20

04317 Leipzig