Regardless of a patient’s level of engagement in psychiatric care prior to being hospitalized, having an appointment scheduled when discharged from the hospital may increase the likelihood that the patient receives follow-up care, according to a study published yesterday in Psychiatric Services.
“In the United States, 42%−51% of adults and 31%−45% of youths do not attend mental health visits within 30 days after discharge,” which can increase the risk of relapse, rehospitalization, and death, wrote Thomas Smith, M.D., of the New York State Psychiatric Institute and colleagues. “Patients who were not engaged in psychiatric care before admission are much more likely to fail to transition to outpatient care after inpatient psychiatric discharge.”
Smith and colleagues used data from four sources, including the New York state Medicaid claims records and the 2012-2013 New York state Managed Behavioral Healthcare Organization Discharge File, which was created to review discharge planning practices related to inpatient psychiatric admissions. The 18,793 participants were Medicaid enrollees under 65 years old who were admitted to an inpatient psychiatric unit from 2012 to 2013 with a principal diagnosis of a mental disorder and had an inpatient stay of no more than 60 days before being discharged. The study’s primary outcome was whether the patient attended an outpatient psychiatric visit within either seven or 30 days after discharge.
The researchers compared the outcomes of the patients according to their levels of engagement in psychiatric care during the six months before hospitalization: high engagement (four or more visits with a psychiatric provider, with visits in at least four of the six months), partial engagement (four or more visits but with all visits occurring in three of the six months), low engagement (one to three visits in the six-month period), and no engagement (no visits in the six-month period).
The less patients were engaged in care prior to their admission, the less likely they were to have a follow-up appointment scheduled as part of their discharge plan. Only 15% of highly engaged patients did not have an appointment scheduled, compared with 18%, 22%, and 28% of partial, low, or no engagement patients, respectively. However, regardless of the patients’ level of engagement, scheduling an outpatient appointment as part of the discharge plan was significantly associated with attending an initial outpatient psychiatric appointment within seven or 30 days after discharge. Among patients who had not received any outpatient care in the six months before hospitalization, those whose discharge plans included a scheduled outpatient appointment were about three times more likely than those who did not receive an appointment to follow up within seven days and more than twice as likely to follow up within 30 days.
“This finding has important implications; hospital providers who do not offer discharge planning to patients who are leaving against medical advice or otherwise refusing to collaborate on discharge planning should consider revising their policies to ensure that all patients receive a follow-up appointment regardless of the circumstances of their discharge,” the authors wrote.
For related information, see the Psychiatric News article “Most Patients Do Not Obtain Follow-up Care After Nonfatal Opioid Overdose.”
