The frequency of rehospitalization and associated factors in Colombian psychiatric patients: a cohort study.

BACKGROUND: The rehospitalization of patients with mental disorders is common, with rehospitalization rates of up to 80% observed in these patients. This phenomenon negatively impacts families, patients, and the health care system. Several factors have been associated with an increased likelihood of rehospitalization. This study was aimed at determining the frequency and the factors associated with rehospitalization in a psychiatric clinic. METHODS: We performed a prospective cohort study with 361 patients who were hospitalized at the Clinic of Our Lady of Peace in Bogota, Colombia from August-December 2009. We calculated the incidence rates of rehospitalization and the risk factors using Cox regression. RESULTS: Overall, 60% of the patients in this cohort were rehospitalized during the year that followed the index event. The variables associated with rehospitalization were separated, divorced, or single status; higher socio-economic strata; a longer duration of index hospitalization; and a diagnosis of substance abuse, schizophrenia, bipolar disorder, or depression. CONCLUSIONS: The rehospitalization rate in our study was as high as reported in other studies. The associated factors with it in this group, may contribute to the design of programs that will reduce the frequency of rehospitalization among patients with mental disorders, in countries like Colombia. Additionally, these results may be useful in interventions, such as coping skills training, psycho-education, and community care strategies, which have been demonstrated to reduce the frequency of rehospitalization.

Factores asociados a rehospitalización temprana en psiquiatría / Factors associated with early psychiatric rehospitalization

Introducción. La rehospitalización temprana es la que se presenta dentro de los tres primeros meses después de un egreso hospitalario. Objetivo. Determinar los factores de riesgo para rehospitalización temprana, evaluando dos posibilidades: que hubiera ocurrido en los primeros tres meses o en el primer mes después del egreso, . Materiales y métodos. Se hizo un estudio de cohorte prospectiva que incluyó 214 pacientes que asistieron a un hospital psiquiátrico en Bogotá. El seguimiento se efectuó durante un año después del egreso. Se analizaron 311 eventos de hospitalización. Se utilizaron modelos de ecuaciones de estimación generalizada (Generalized Estimating Equation, GEE) para datos longitudinales para manejar el caso de medidas repetidas en el análisis estadístico. Resultados. El 49,5 % de los eventos hospitalarios evaluados cumplió el criterio de rehospitalización temprana dentro de los tres meses siguientes y el 31 %, dentro del mes siguiente al egreso. En el modelo de tres meses se encontró asociación significativa con las variables estado civil separadodivorciado (tienen mayor riesgo que los casados), diagnóstico relacionado con uso de sustancias, diagnóstico secundario a condición médica (tienen menor riesgo que los pacientes con enfermedad maníaco-depresiva) y salida por remisión. En el modelo de un mes se encontraron como factores protectores el sexo masculino y la unión libre. Conclusión. En esta muestra de pacientes, la rehospitalización temprana es un fenómeno frecuente. Los factores que mostraron una relación más fuerte tienen que ver con el soporte social, las enfermedades médicas concomitantes, el uso de sustancias psicoactivas y la decisión de remisión a otro centro.

Introduction: Early psychiatric rehospitalization is defined as the readmission within the first three months after discharge. Objective: To determine risk factors for early rehospitalization through the evaluation of two scenarios: readmission within three months and within one month post-discharge. Materials and methods: A prospective cohort study was conducted including 214 patients attending a psychiatric hospital in Bogotá. The follow-up included one year post discharge. A total of 311 hospitalization events were analyzed. GEE models for longitudinal data were used to deal with repeated measures in the statistical analysis. Results: Using the three-month criteria, early rehospitalization was found in 49.5% of 311 hospitalization events, while the one-month criteria was found in 31% of them. The three-month model showed that marital status (divorced-separated), diagnosis of substances use disorder, diagnosis related to medical condition and discharge produced by remission are factors associated with the outcome. The onemonth model showed that male gender and domestic partnership act as protective factors. Conclusion: In this sample, early rehospitalization is a frequent phenomenon. Factors strongly associated are related to psychosocial support, medical comorbidity, psychoactive substances use disorders and remission to a different hospital.

[Factors associated with early psychiatric rehospitalization]. / Factores asociados a rehospitalización temprana en psiquiatría.

INTRODUCTION: Early psychiatric rehospitalization is defined as the readmission within the first three months after discharge. OBJECTIVE: To determine risk factors for early rehospitalization through the evaluation of two scenarios: readmission within three months and within one month post-discharge. MATERIALS AND METHODS: A prospective cohort study was conducted including 214 patients attending a psychiatric hospital in Bogotá. The follow-up included one year post discharge. A total of 311 hospitalization events were analyzed. GEE models for longitudinal data were used to deal with repeated measures in the statistical analysis. RESULTS: Using the three-month criteria, early rehospitalization was found in 49.5% of 311 hospitalization events, while the one-month criteria was found in 31% of them. The three-month model showed that marital status (divorced-separated), diagnosis of substances use disorder, diagnosis related to medical condition and discharge produced by remission are factors associated with the outcome. The one-month model showed that male gender and domestic partnership act as protective factors. CONCLUSION: In this sample, early rehospitalization is a frequent phenomenon. Factors strongly associated are related to psychosocial support, medical comorbidity, psychoactive substances use disorders and remission to a different hospital.

Factores relacionados con el número de rehospitalizaciones en pacientes psiquiátricos / Factors Related to the Number of Readmissions in Psychiatric Patients

Objetivo: Evaluar el efecto que un grupo de variables demográficas, clínicas y de tratamiento Tienen en la re hospitalización. Método: Se efectuó un estudio de cohorte en el que se siguieron a 218 pacientes durante doce meses. El desenlace principal fue el número de hospitalizaciones durante el seguimiento. Se usó un modelo de regresión binomial negativa para evaluar el efecto que el grupo de variables tienen en el número de hospitalizaciones. Resultados: El porcentaje de re hospitalizaciones está en el límite superior del rango reportado en otros Estudios. El uso de sustancias psicoactivas está fuertemente asociado con el número de re hospitalizaciones. La duración de la estancia y el número de episodios previos también se asociaron con la re hospitalización. La salida voluntaria y la comorbilidad con enfermedades médicas actuaron como factores protectores. Conclusión: Es llamativo el elevado índice de re hospitalización, ya que influye significativamente en los pacientes, la familia y el sistema de salud; así como en la necesidad de intervenir sobre los factores de riesgo, sobre todo el consumo de sustancias psicoactivas...

Objective: The purpose of this study was to assess the effect on readmissions of a group of Clinical, therapeutic, and demographic variables. Methods: A 12-month follow-up study of A cohort of 218 patients was performed. The main outcome was the number of hospitalize tions during the follow-up. Binomial negative regression was used to assess the effect that a group of variables had on the number of hospitalizations. Results: The percentage of readmissions was at the upper limit of the range reported in other studies. The use of psychoactive substances was strongly associated with the number of readmissions. Length of stay and number of previous episodes were also associated with readmissions. Voluntary discharge and co morbidity with medical diseases were protective factors. Conclusion: The rate of readmissions was strikingly high, having significant impact on patients, families, and the health system. This highlights the need of intervening on risk factors, especially the use of psychoactive substances...