Heavy user psychiatrischer Versorgungsdienste

Christiane Roick; Anke Gärtner; Dirk Heider; Matthias C. Angermeyer

doi:10.1055/s-2002-34658

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Psychiatr Prax 2002; 29(7): 334-342
DOI: 10.1055/s-2002-34658

Übersicht

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

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Publication History

Publication Date:
14 October 2002 (online)

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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

PubMed Search in Google Scholar
2 Kent S, Fogarty M, Yellowlees P. A review of studies of heavy users of psychiatric services. Psychiatr Serv. 1995; 46 1247-1253

PubMed Search in Google Scholar
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

PubMed Search in Google Scholar
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

Crossref PubMed Search in Google Scholar
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

PubMed Search in Google Scholar
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

PubMed Search in Google Scholar
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

PubMed Search in Google Scholar
8 Casper E S. Identifying multiple recidivists in a state hospital population. Psychiatr Serv. 1995; 46 1074-1075

PubMed Search in Google Scholar
9 Geller J L. In again, out again: preliminary evaluation of state hospital's „worst” recidivists. Hosp Community Psychiatry. 1986; 39 386-390

PubMed Search in Google Scholar
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

PubMed Search in Google Scholar
11 Geller J L. A report on the „worst” state hospital recidivists in the U.S. Hosp Community Psychiatry. 1992; 43 (9) 904-908

PubMed Search in Google Scholar
12 Green J H. Frequent rehospitalization and noncompliance with treatment. Hosp Community Psychiatry. 1988; 39 963-966

PubMed Search in Google Scholar
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

Crossref PubMed Search in Google Scholar
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

PubMed Search in Google Scholar
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

PubMed Search in Google Scholar
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

Crossref PubMed Search in Google Scholar
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

PubMed Search in Google Scholar
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

PubMed Search in Google Scholar
19 Voineskos G, Denault S. Recurrent psychiatric hospitalization. Can Med Assoc J. 1978; 118 (4) 247-250

PubMed Search in Google Scholar
20 Kent S, Yellowlees P. Psychiatric and social reasons for frequent rehospitalization. Hosp Community Psychiatry. 1994; 45 347-350

PubMed Search in Google Scholar
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

PubMed Search in Google Scholar
22 Mustard C A, Derksen S, Tataryn D. Intensive use of mental health care. Can J Psychiatry. 1996; 41 93-101

PubMed Search in Google Scholar
23 Lavik N J. Utilization of mental health services over a given period. Acta Psychiatr Scand. 1983; 67 404-413

PubMed Search in Google Scholar
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

PubMed Search in Google Scholar
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

PubMed Search in Google Scholar
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

PubMed Search in Google Scholar
27 Kennedy J, Hird F. Description and evaluation of a short stay admission ward. Br J Psychiatry. 1980; 136 205-215

PubMed Search in Google Scholar
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

PubMed Search in Google Scholar
29 Maylath E, Seidel J. Analyse der psychiatrischen Krankenhausfälle in Hamburg 1988 - 1994 - Entwicklungstrends, Versorgungslücken und -perspektiven. Gesundheitswesen. 1997; 59 423-433

PubMed Search in Google Scholar
30 Woogh C M. A Cohort through the revolving door. Can J Psychiatry. 1986; 31 214-220

PubMed Search in Google Scholar
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

PubMed Search in Google Scholar
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

PubMed Search in Google Scholar
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

PubMed Search in Google Scholar
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

PubMed Search in Google Scholar
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

PubMed Search in Google Scholar
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

PubMed Search in Google Scholar
37 DiScipio W J, Sommer G. Therapeutic failures: patient who return within 30 days of hospital discharge. Psychiatr Q. 1973; 47 371-376

PubMed Search in Google Scholar
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

PubMed Search in Google Scholar
39 Rosenblatt A, Mayer J E. The recidivism of mental patients: a review of past studies. Am J Orthopsychiatry. 1974; 44 697-706

PubMed Search in Google Scholar
40 Fontana A F, Dowds B N. Assessing treatment outcome, II: the prediction of rehospitalization. J Nerv Ment Dis. 1975; 161 231-238

PubMed Search in Google Scholar
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

PubMed Search in Google Scholar
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

PubMed Search in Google Scholar
43 Lewis P A, Hugi R. Therapeutic stations and the chronically treated mentally ill. Soc Serv Rev. 1981; 55 206-220

PubMed Search in Google Scholar
44 Weimer S R, Hatcher C, Gould E. Family characteristics in high and low health care utilization. Gen Hosp Psychiatry. 1983; 5 55-61

PubMed Search in Google Scholar
45 Schanding D, Siomopoulos V, Godbole A. et al . Readmissions to an general psychiatric unit. Hosp Community Psychiatry. 1984; 35 170-171

PubMed Search in Google Scholar
46 Richart R, Millner L. Factors influencing admission to a community mental health center. Community Ment Health J. 1968; 4 27-35

Crossref PubMed Search in Google Scholar
47 Abramowitz S, Tupin J, Berger A. Multivariate prediction of hospital readmission. Compr Psychiatry. 1984; 25 71-76

Crossref PubMed Search in Google Scholar
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

PubMed Search in Google Scholar
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

Search in Google Scholar
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

PubMed Search in Google Scholar
51 Goldstein J M, Horgan C M. Inpatient and outpatient psychiatric services: Substitutes or compliments?. Hosp Community Psychiatry. 1988; 39 632-636

PubMed Search in Google Scholar
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

PubMed Search in Google Scholar
53 Dincin J, Witheridge T F. Psychiatric rehabilitation as a deterrent to recidivism. Hosp Community Psychiatry. 1982; 33 (8) 645-650

PubMed Search in Google Scholar
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

PubMed Search in Google Scholar
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

PubMed Search in Google Scholar
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

Search in Google Scholar
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

PubMed Search in Google Scholar
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

PubMed Search in Google Scholar
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

PubMed Search in Google Scholar
60 Roemer M I. Social medicine. The advance of organized health services in America. New York; Springer 1978

Search in Google Scholar
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

Search in Google Scholar
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

PubMed Search in Google Scholar
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

PubMed Search in Google Scholar
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

PubMed Search in Google Scholar
65 Streiner D, Goodman J, Woodward C. Correlates of hospitalization decision: a replicative study. Can J Public Health. 1975; 66 411-415

PubMed Search in Google Scholar
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

PubMed Search in Google Scholar
67 Marks F M. The characteristics of psychiatric patients admitted within a month of discharge. Psychol Med. 1977; 7 345-352

PubMed Search in Google Scholar
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

PubMed Search in Google Scholar
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

PubMed Search in Google Scholar
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

PubMed Search in Google Scholar
71 Roberts S J. Psychosocial assessment of the high utilizer of occupational health services. AAOHN Journal. 1990; 38 62-66

PubMed Search in Google Scholar
72 Belcher J V, Alexy B. High-resource hospital users in an integrated delivery system. J Nurs Adm. 1999; 29 (10) 30-36

PubMed Search in Google Scholar
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

Crossref PubMed Search in Google Scholar
74 Caton C L, Kow S P, Fleiss J L. et al . Rehospitalization in chronic schizophrenia. J Nerv Ment Dis. 1985; 173 139-148

PubMed Search in Google Scholar
75 Jed J. Social support for caretakers and psychiatric rehospitalization. Hosp Community Psychiatry. 1989; 40 1297-1299

PubMed Search in Google Scholar
76 Woogh C M. Patients with multiple admissions in a psychiatric record linkage system. Can J Psychiatry. 1990; 35 401-405

PubMed Search in Google Scholar
77 Goodpastor W A, Hare B K. Factors associated with multiple admissions to an urban psychiatric hospital. Hosp Community Psychiatry. 1991; 42 85-87

PubMed Search in Google Scholar
78 Evans M, Rice D, Routh C. Patients repeatedly admitted to psychiatric wards. Psychiatr Bull R Coll Psychiatr. 1992; 16 157-158

PubMed Search in Google Scholar
79 Joyce P R, Khan A, Jones A V. The revolving door patient. Compr Psychiatry. 1981; 22 (4) 397-402

Crossref PubMed Search in Google Scholar
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

PubMed Search in Google Scholar
81 Geller M P. The „revolving door”: a trap or a life style?. Hosp Community Psychiatry. 1982; 33 (5) 388-389

PubMed Search in Google Scholar
82 Geller J L. Treating revolving-door patients who have „Hospitalphilia”: compassion, coercion, and common sense. Hosp Community Psychiatry. 1993; 44 (2) 141-146

PubMed Search in Google Scholar
83 Morin R C. A social network approach and the revolving door patient. Schizophr Bull. 1986; 12 (2) 262-273

PubMed Search in Google Scholar
84 Kastrup M. The use of a psychiatric register in predicting the outcome „revolving door patient”. Acta Psychiatr Scand. 1987; 76 552-560

Crossref PubMed Search in Google Scholar
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

PubMed Search in Google Scholar
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

PubMed Search in Google Scholar
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

PubMed Search in Google Scholar
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

Crossref PubMed Search in Google Scholar
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

Crossref PubMed Search in Google Scholar
90 Weiden P, Glazer W. Assessment and treatment selection for „revolving-door” inpatients with schizophrenia. Psychiatr Q. 1997; 68 (4) 377-393

Crossref PubMed Search in Google Scholar
91 Pallis D J, Langley A M, Birtchnell J. Excessive use of psychiatric services by suicidal patients. Br Med J. 1975; 3 216-218

PubMed Search in Google Scholar
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

PubMed Search in Google Scholar
93 Bassuk E, Gerson S. Chronic crisis patients: a discrete clinical group. Am J Psychiatry. 1980; 137 1513-1517

PubMed Search in Google Scholar
94 Schwartz S R, Goldfinger S M. The new chronic patient: Clinical characteristics of an emerging subgroup. Hosp Community Psychiatry. 1981; 32 470-474

PubMed Search in Google Scholar
95 Caton C LM. The new chronic patient and the system of community care. Hosp Community Psychiatry. 1981; 32 475-478

PubMed Search in Google Scholar
96 Pepper B, Kirshner M C, Ryglewicz H. The young adult chronic patient: overview of a population. Hosp Community Psychiatry. 1981; 32 463-469

PubMed Search in Google Scholar
97 Lamb H R. Young adult chronic patients: the new drifters. Hosp Community Psychiatry. 1982; 33 468

PubMed Search in Google Scholar
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

PubMed Search in Google Scholar
99 Coid J W. „Difficult to place” psychiatric patients. Br Med J. 1991; 302 603-604

PubMed Search in Google Scholar
100 Knuth P. Notarzt und Notfallarzt. Aufgabenbereiche der Notfallmedizin. Internist. 1998; 39 (2) 120-123

Crossref PubMed Search in Google Scholar
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

PubMed Search in Google Scholar
102 Brekke J S. What do we really know about community support programs? Strategies for better monitoring. Hosp Community Psychiatry. 1988; 39 946-952

PubMed Search in Google Scholar
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

PubMed Search in Google Scholar
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

PubMed Search in Google Scholar
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

PubMed Search in Google Scholar

Dr. med. Christiane Roick,MPH

Universität Leipzig · Klinik für Psychiatrie

Johannisallee 20

04317 Leipzig