Evaluating patient-controlled admissions in adolescent psychiatric care: a quantitative study

Abstract

BACKGROUND: An agreement on Patient-Controlled Admissions (PCA) is enabling patients to initiate at brief inpatient stay, on their own initiative, outside the existing referral system, at a well-known ward. PCA has mostly been studied in adult psychiatry, and the purpose of the current study is to describe the effect of PCA in a naturalistic setting in a psychiatric adolescent ward in Denmark. METHODS: Patients with several admissions and coercion were offered the possibility of a PCA and enrolled in the study when signing the contract. Information from electronic patient records was compared on outpatient contacts, admissions (both voluntary and compulsory), inpatient days, and prescribed medication from one year prior to signing the contract to a fixed date in March 2023. RESULTS: A total of 27 patients (25 females) aged 15-20 years with different main diagnoses were included in the study. They were followed for an average of 630 days. Outpatient contacts and admissions were significantly reduced, IRR 0.7 (95% CI 0.6;0.8) and 0.8 (95% CI 0.6;0.9) respectively. Also, compulsory admissions were reduced by IRR 0.3 (95% CI 0.2;0.5) and inpatient days by 0.6 (95% CI 0.5;0.7). Furthermore, the analyses showed a tendency towards a reduction in prescribed psychotropic medication both daily and as-needed. CONCLUSION: The PCA had a positive effect on the adolescents' needs for both outpatient contacts and admissions. PCA is an effective intervention for some adolescent patients, but it is crucial that it is accomplished in close collaboration with the patients, their relatives, and the outpatient services.