Elements of integrated Care: Post-discharge Network Coordination

In most countries of the western hemisphere, psychiatric care is still undergoing a process of change. Many clinic beds are disappearing in favor of day-patient or out-patient treatments, and the length of stay is becoming increasingly shorter. However, increasingly shorter in-patient stays urgently call for a more structured and well-prepared discharge plan. The first week following psychiatric in-patient treatment is a time of great stress. Studies have shown that, particularly after shorter stays, the risk of suicide following discharge is many times higher, that there is a higher risk of re-hospitalization and that, without appropriate supporting services, many of the patients do not turn up for their first out-patient appointment.

In the meantime, throughout Switzerland there are various projects for patients with greater demands, which focus on better out-patient treatment and, by the same token, on preventing a relapse. By way of comparison, for patients with lesser demands, less research is being made into co-ordination following discharge and the continuity of treatment as an in-patient becomes an out-patient. At present, in Lausanne, a pilot project is examining "case management for transition". The intervention specializes in patients for whom, after in-patient treatment, psychiatric out-patient care is not guaranteed. The results of the randomized study have to date not yet been published. In the German-speaking region of Switzerland a comparative project has not yet been launched.

The existing ZInEP sub-project aims to close this gap. On the basis of a randomized, prospective study, the effectiveness is to be demonstrated of the social work co-ordination for patients with lesser demands on being discharged and during the transition from in-patient to out-patient care. The main outcome criterion is the number of days in care and the secondary criteria the reduction of symptoms and an improvement in the quality of life and independence.

On all 5 intensive care wards of the Integrated Psychiatric Clinic of Winterthur and Zurich Unterland, 160 patients are to be recruited over a period of 18 months. On admission to the ward, suitable participants will be informed about the project verbally and in writing. After obtaining their written permission they will be randomly allocated to the treatment group or to the control group. The control group receives the normal care of a social worker, which, as a rule, ends when the patient is discharged from the clinic. Patients in the treatment group are looked after intensively by the social worker allocated to them after being discharged to guarantee continuity of their psychiatric care in an out-patient situation.

In order to measure the effects, patients entering the study undergo an initial assessment based on an interview before the first appointment with the social worker (baseline t0) as well as a follow-up assessment on discharge (t1) und after 1(t2), 3(t3), 6(t4) and 12(t5) months. For each interview the participant receives CHF50.

Recruitment will begin in June 2011.